The specter of the specialty pharmaceutical industry looms large over events in the health economy over the past few weeks, paradoxically both by its relative absence in one aspect and its prominence in another. On one hand, several health insurance companies briefly mentioned the impact of specialty pharmaceutical costs on their Q2 earnings in comparison to other challenges. On the other hand, much was written about the resignation of Vinay Prasad, MD, MPH as director of the Food and Drug Administration’s Center for Biologics and Evaluation Research. For an industry that IQVIA projects will represent about 46% of global spending on medicines in 2029 and 54% of total spending in leading developed markets, information is surprisingly difficult to find.1
What follows are views informed by extensive research into mostly publicly available information as well as my 35 years in the healthcare industry. Those views are also forged by what I have learned about the specialty pharmacy sector, specifically gene therapy, from my son’s death from Duchenne muscular dystrophy at the age of 19.
Because eulogizing a child is not in the natural course of events, it changes your perspective in many ways.
I began my career in the health economy as a securities and M&A attorney, during which time I drafted countless documents that were ultimately filed with the U.S. Securities and Exchange Commission (SEC). Under Rule 10b-5(b) of the Securities Exchange Act of 1934, it is unlawful “to make any untrue statement of a material fact or to omit to state a material fact necessary in order to make the statements made, in the light of the circumstances under which they were made, not misleading.”2 The practical effect of Rule 10b-5 is to make SEC filings the truth serum of publicly traded companies, prompting the disclosure of truths that “you don’t talk about at parties” – and don’t have to include in advertisements – like this from page 106 of Moderna’s 10-K filing for the year ended December 31, 2020 within the 60-page section titled “Risk Factors”:
“Currently, mRNA is considered a gene therapy product by the FDA. Unlike certain gene therapies that irreversibly alter cell DNA and could act as a source of side effects, mRNA-based medicines are designed to not irreversibly change cell DNA; however, side effects observed in gene therapy could negatively impact the perception of mRNA medicines despite the differences in mechanism.”3
Based on my training, I focus both on what public companies report to the SEC and reveal to Wall Street research analysts and also on what is left unsaid.
Last month, I wrote of the potential emergence of a death spiral resulting from adverse selection based on the language used by several health insurers to describe their Q2 results. In that article, I also questioned whether healthcare services utilization was to blame. The next day, HCA’s earnings release provided additional evidence that the utilization of the most resource-intensive healthcare services is an incomplete explanation of the health insurers’ Q2 results. HCA, the largest U.S. hospital operator, reported the following volume metrics:
“Same facility admissions increased 1.8 percent and same facility equivalent admissions increased 1.7 percent in the second quarter of 2025, compared to the prior year period. Same facility emergency room visits increased 1.3 percent in the second quarter of 2025, compared to the prior year period. Same facility inpatient surgeries declined 0.3 percent, and same facility outpatient surgeries declined 0.6 percent in the second quarter of 2025, compared to the same period of 2024.”4
In addition to our research and HCA’s results, other public data confirm that utilization of healthcare services is flat to declining. Moreover, with respect to the impact of Medicaid provisions in the One Big Beautiful Bill Act, HCA stated that “the adverse impacts over the next few years are manageable.”5
To analyze the results of the health insurers, we tallied how frequently the insurers used certain words or phrases in their earnings call remarks.
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way - ”6
For the insurers that, as I wrote about the potential death spiral, “messed around and got addicted” to Medicaid and ACA Marketplace Exchange lines of business, it was the worst of times. Centene’s earnings call transcript provides a good example of the tenor of the disclosures:
“Analysis of the full data confirmed a significant shift in the marketplace risk pool in 2025, which we now believe is primarily being driven by three things. First, a higher than expected percentage of healthy and or low utilizing members left the marketplace during open enrollment, which was likely the result of program integrity measures that were introduced after 2024 pricing was finalized and implemented for the 2025 open enrollment cycle. Second, new sign-ups to the market had higher morbidity, likely reflecting changes in the underlying member mix from redeterminations and those same program integrity guardrails deterring new healthy sign-ups in 2025. And third, a step up in marketplace utilization more broadly, combined with more aggressive provider coding, is likely driving higher in year documented morbidity…
Turning to Medicaid. Our Medicaid portfolio also fell short of expectations in the second quarter, producing an unanticipated and unacceptable health benefits ratio of 94.9%. Driving this underperformance was a step up in medical cost trend in three areas: behavioral health, home health and high-cost drugs. Behavioral health was the most significant driver of the quarter over quarter increase with ABA or Applied Behavioral Analysis as an accelerating pressure point across a number of our markets. In response, we have formed enterprise-wide behavioral health and ABA task forces to further support our markets in aggressively managing this trend.”7
For those with limited exposure to Medicaid or ACA Marketplace Exchange plans, the results were very different. Cigna’s earnings call transcript provides the best example of that limited exposure:
“Joshua Richard Raskin: Could you provide an update related to the exchange business on your risk adjustment accruals?... And then could you provide maybe broader commentary on expectations for that book in 2026 and how you’re pricing — how you’re approaching the pricing environment?
Brian C. Evanko: …I think it’s important to step back and rewind the clock a couple of years to 2023. At that point in time, we served nearly 1 million customers in the individual exchanges, albeit with mixed financial performance. Based upon our performance as well as our forward view of the market, we made the strategic choice to prioritize margin over growth, which included adjustments to product and network strategies, refinements to our geographic footprint and increased prices where necessary. And this decision to prioritize margin over growth in the individual exchanges has helped us to navigate some of the industry-wide pressures that have emerged here in 2025.
And we now serve fewer than 400,000 customers in this business, down materially from the nearly 1 million we served in 2023. Additionally, across both the 2024 and 2025 pricing cycles, our nationwide price increases were roughly double the industry average in each of those years. So as a result of those actions, some of our competitors showed meaningful growth in their individual exchange businesses while we chose to reposition our portfolio, which resulted in fewer individual exchange customers for Cigna Healthcare…
Meanwhile, across the industry, individual exchange enrollment is up nearly 50% over that same time period. As it relates to 2026, we expect to take further price increases. We’re in the process of working through the refiling of that as we speak. And again, we’ll prioritize margin over growth for the 2026 year in the individual exchanges.”8
As to the fact that five insurers – and Wakely – implied or asserted that coding was a significant cost driver, it is interesting to consider the extent to which AI-driven coding of essentially flat services volumes could move medical loss ratio (MLR). Also left unsaid by the insurers is that the very purpose of AI-driven coding is to eliminate the voluminous mistakes that humans make individually and in aggregate in healthcare billing, meaning that AI-driven coding is as likely to be more accurate as it is “aggressive.”
It is perhaps more instructive to consider the extent to which MLR was impacted by this trend:
Centene mentioned it in passing:
“Driving this underperformance was a step up in medical cost trend in three areas: behavioral health, home health and high-cost drugs.”9
United took a “just the facts” approach:
“Optum Rx second quarter revenues grew $6 billion, or 19%, over last year to $38.5 billion, driven by new customer adds as well as continued contribution from specialty products. Total adjusted scripts were 414 million compared to 399 million in the year ago quarter.”10
Humana was more explicit and candid about the impact of specialty pharmacy, citing the "higher volumes and more favorable drug mix than expected.”11
“Specialty drug trend is high. I mean, let’s just say that it is because it is. And — but that’s as expected…”12
In my view, Cigna’s earnings call provides the broadest context for the current environment. According to Cigna's most recent Form 10-K, 14.1M of Cigna’s 19.1M “medical customers” are “administrative services only,” which is why Cigna’s CEO referred to its business as a “service-based model” that is “capital light.”13,14 Specialty pharmacy has been a material part of Cigna’s “service-based model” since its 2018 acquisition of ExpressScripts, including Accredo, which are now part of Cigna’s Evernorth division. For that reason, it is unsurprising that Cigna was an outlier in discussing the impact of specialty pharmacy.
To my ear, Evernorth’s Q2 performance sounds like the “best of times.”
“Turning to Evernorth…
As a reminder, the specialty space is more than a $400 billion market today and is growing at high single digits annually. In 2024, approximately 70% of new drugs approved by the U.S. Food and Drug Administration were specialty medications. These medicines flow through both the pharmacy and medical benefit with the medical benefits segment representing about 40% of the specialty space. Specialty represents one of the highest growth areas in health care and within The Cigna Group, and we continue to expect long-term average annual income growth of 8% to 11% across our specialty portfolio…
Our specialty distribution serves more than 12,000 providers today, distributing some of the most complex and critical medications to physician offices, health systems and infusion centers. We do this through CuraScript SD, which has seen double-digit average revenue growth over the past 3 years and is now a $25 billion business…
We offer specialty pharmacy and infusion services on behalf of more than 700 hospitals, health systems and physician groups across the country, helping them expand their ability to offer coordinated access and continuity of care…
I will start by commenting on Evernorth, our services chassis, which now contributes over 60% of our enterprise earnings. Evernorth’s results reflect sustained strength across our Pharmacy Benefit Services business and Specialty and Care Services business. Second quarter 2025 revenues grew to $57.8 billion, while pretax adjusted earnings grew to $1.7 billion, slightly ahead of expectations. Specialty and Care Services demonstrated strong growth with revenue up 13% to $25.9 billion…This performance showcases the power of our robust and unique specialty capabilities as we delivered broad-based growth across both Accredo and CuraScript…
Turning to Cigna Healthcare… the medical care ratio was 83.2%...Cost trends for our commercial business, including stop-loss, remained elevated in the quarter, consistent with expectations.
For our individual business, utilization was higher than expected, reflecting an increase in medical costs across the ACA marketplace. However, this pressure was manageable due to the smaller relative size of our ACA book, aided by our disciplined pricing actions over the past 2 years…
Albert J. William Rice: I appreciate the comments about the innovative products that Evernorth brought to the market, particularly around GLP-1s. It makes me think even a little more broadly about your positioning in the commercial market, ASO insurance and how you use potentially Evernorth’s PBM and pharmacy services business...
David Michael Cordani: A.J., it’s David. Maybe just a couple of macro comments and I’ll hand it over to Brian. First, I appreciate your broad framing. Two, contextually, as we step back, you go back a decade or so ago, aggregate pharmacy services was low double-digit percentage of the total medical cost equation. Fast-forward to today, the pie is both larger and aggregate pharmacy services, including specialty, is mid-20s growing, starting at potentially a 30% slice of the pie in short order. So one, to reinforce your point, it’s a more significant part of the overall care equation. Two is the interdependency between medical pharmacy, both traditional pharmacy and specialty pharmacy. And I would simply add mental health further consolidates in terms of a lot of our capabilities to be able to look at the whole person, both the predictive nature of more complex medical issues based on pharmaceutical consumption as well as the interdependency between the mental health aspect, which includes pharmacy as well as medical…
Secondly, the size of the overall health care equation of what pharmacy is today, 25-plus percent of the overall pie, on its way to 30% on a larger pie versus 10%, 12% just a decade ago or so. Brian?
Brian C. Evanko: …And to your point, specialty pharmacy continues to be one of the highest trend categories across the health care system. That and mental health services, in particular, were large contributors to the overall cost trend environment that we’ve seen year-to-date…
Affordability continues to be the #1 area of focus for employers, particularly with the persistently high cost trend environment that the industry has been experiencing. And part of that’s driven by the question that A.J. asked around specialty injectables as well as GLP-1s and the continued growth we’re seeing in mental health spending…”
Mispricing Medicaid and ACA Marketplace products in 2025 is a relatively short-term problem with an obvious fix, and the insurers are determined to correct that mistake in 2026. KFF reports that ACA Marketplace insurers are requesting the highest premium increases for 2026 since 2018.15
A larger and more intractable problem is the “hockey stick” growth of specialty pharmaceutical spend: “25-plus percent of the overall pie, on its way to 30% on a larger pie versus 10%, 12% just a decade ago or so.” It is curious to consider whether Cigna’s broad reach, helping “more than 700 hospitals, health systems and physician groups across the country…expand their ability to offer coordinated access and continuity of care,” might partially explain the “utilization trends” that almost every health insurer mentioned in their earnings calls.
While there is no single factor to explain the widely varying Q2 results of the health insurers and healthcare providers, there is a unitary theme encapsulated in the Cigna earning call:
"As David was just making reference to, 20% of an average employer’s total cost of care is specialty drugs today. Now that’s not all in the drug benefit. A portion of that’s in the medical benefit…"
For employers and CMS, specialty pharmaceuticals are the elephant in the room.
The specialty pharmaceutical industry can also be a bull in a china shop. Initially, I intended to document that in part based on the controversy surrounding Dr. Prasad’s resignation on July 29 related to his view on a therapy to treat Duchenne muscular dystrophy (DMD). In the past week, that angle has been extensively covered by STAT, The Free Press, MedPage Today, Alex Berenson and Anish Koka, MD, among others. As a result, my observations address issues that others have not, most of which are informed by my son’s battle with that dreadful disease.
DMD is a disease that affects only boys and results from an abnormal mutation in the dystrophin gene. One result of the dystrophin deficiency is that the body fails to regulate calcium, which leads to muscle damage and cell death. Since the heart and the lung are muscles, most boys with DMD die from cardiac or pulmonary failure.
The Editorial Board of The Wall Street Journal has, by their own account, been actively involved in the controversy about Dr. Prasad and a DMD therapy, publishing two articles in the online edition on July 27. One was an editorial and the other as much ad hominem attack as opinion piece titled "Vinay Prasad Is a Bernie Sanders Acolyte in MAHA Drag," which included a rather blithe dismissal of the cost of a cancer therapy whose efficacy Dr. Prasad, a practicing hematologist-oncologist, had previously questioned:
“But Dr. Prasad complained that the treatment was pricey (then $419,500 for a course) and may ‘only delay inevitable progression’ in some patients. In other words, sick patients should just give up and die. Got that?”
Curiously, the opinion piece also omits the name or the price of the DMD “gene therapy that can slow the degenerative loss of muscular function in young boys with certain genetic mutations” and overlooks the many questions raised by the manufacturer’s own press releases about the therapy.
On July 30, the WSJ published an editorial titled “On Sarepta, A Welcome FDA Reversal,” taking a victory lap with this subheader: “After our editorial, the agency relents to allow a Duchenne treatment.” The editorial included this:
“The FDA said Monday that the agency recommended partially lifting a hold on shipments of the gene therapy Elevidys, which treats Duchenne muscular dystrophy. Our editorial that went online Sunday reported that the agency had used rare deaths in patients with advanced disease as a pretext to relitigate the drug’s approval and force it from the market.
The agency now says boys who still walk independently can receive the gene therapy. This was always the right answer based on the available evidence of the treatment’s risks and benefits. In June the company suspended the drug for boys who could no longer walk, while digging into the emerging safety concerns.
The FDA press release nods that ‘the patient community is an important voice,’ and thank heavens. The Trump Administration was hearing from Duchenne parents who want this important clinical option for their sons and think they and their doctors are capable of making an informed choice.
Such patients are portrayed by the paternalistic left and the anti-pharma right as desperate and preyed on by villainous drug companies. But patients are better suited to choosing treatments than Washington’s regulatory afflatus, and the alternative with Duchenne is inexorable decline and death.”
As the father of a son who died of DMD, the phrase “the agency had used rare deaths in patients with advanced disease as a pretext” is shockingly callous and grossly offensive. More subtle is the implication that there is a long-term alternative to DMD other than “inexorable decline and death.” And, yet again, the WSJ Editorial Board omitted a material fact: the price of the drug, which is $3.2M for a one-time, single dose. Unlike an earnings report for a publicly traded company, Rule 10b-5 does not apply to the WSJ Editorial Board. Further bayonetting the dead, the WSJ published yet another editorial on July 31 titled “Why Vinay Prasad Had to Go at FDA.”
Dr. Prasad is well-known for his apparently old-fashioned notion that a clinical trial should be judged by whether it meets its primary endpoint. Sarepta reported that the primary endpoint for ELEVIDYS was not met for the EMBARK trial.16 According to multiple media reports, many FDA staffers agree with Dr. Prasad’s view, but in 2024 Dr. Peter Marks approved widespread use of ELEVIDYS over their objections anyway.
My oldest son was diagnosed with DMD in May 2004. The only thing worse than learning that your son has a terrible and terminal disease is waiting in anguish for lab results to find out whether your other two sons also have that same disease. My wife and I were obviously relieved and grateful to learn that our two younger sons had not inherited a mutated dystrophin gene, but it is a strange feeling to be ecstatic that only one of your children has been handed a death sentence.
Like every DMD parent receiving that news, we began to read and research in the hope of a miracle. Sooner than most DMD families, we realized the futility of that effort. The TL;DR summary of years of research for DMD therapies is this:
Having lived through the false hope that a therapy can cure DMD, my heart breaks for my fellow DMD parents, especially those who are only now beginning to learn what I now know, which is that there is no hope in this world for a different outcome for their boys. If their experience is like mine, the care and treatment and desperate search for a cure will be financially devastating, with out-of-pocket costs well in excess of $100,000 for drugs and physical therapy and ramps and motorized wheelchairs and vans customized to load those wheelchairs.
None of the many DMD families that I have met over the years have $3.2M to pay for even a life-saving drug, much less one that failed its primary endpoint.17 If, God forbid, all three of my sons had been afflicted with DMD – as was the case for one DMD family we met – I might be faced with the question of whether I would pay almost $10M for my sons to be ambulatory for a little longer.
For me, the hopelessness of my son’s DMD diagnosis fed the resentment that can occur in the heart and mind of even the most dutiful caregiver, a frightening insight into a man’s heart of darkness. I spent many days and nights contemplating that suffering a cardiac event, as my son did, would be more merciful than a slower chronic pulmonary decline. And, when my son had a heart attack the day before Father’s Day in 2014, I was reminded of America’s infatuation with heroic – and often wasteful – medicine, as well-meaning cardiologists at Vanderbilt University Medical Center tried to convince me to keep a boy whose heart was literally broken in the cardiac ICU instead of transferring him to palliative care.
Being a caregiver is hard, and caring for a dying child is physically and emotionally exhausting, Watching your son waste away, little by little, over the course of a decade that for other boys represents the transition to manhood, knowing that there is nothing you can do to save them, is even harder. When my son died in 2014, I lost some part of me that I don’t even know how to describe; I have yet to recover it and have begun to doubt that I ever will.
As the kids say, IYKYK. But most people don’t, which is why most people are too scared to face the inconvenient truth that America cannot afford its healthcare system.
Since there is no evidence that any drug can prevent a boy with DMD from dying of that dreadful disease, society – which frequently helps to underwrite the cost of specialty drugs – must address several difficult and uncomfortable questions.
In the inevitable emotion of a devastating diagnosis, it is easy to let hope overcome reason or logic or actual science or societal good. America’s healthcare system consistently over-indexes to self-interest and under-indexes to a critically important societal good, the existence of a sustainable health system.
Regular readers will know that I think that government-implemented price controls are both un-American and doomed to fail. Ironically, the Declaration of Independence seems to inform the American approach to healthcare as much as anything, particularly the supporters of “healthcare for all,” by which is meant “all healthcare for all.”
The European Union has the European Medicines Agency (EMA), whose purpose is “ensuring that all medicines available on the EU market are safe, effective and of high quality.”18 Similarly, the British have the National Institute for Health and Care Excellence (NICE), which evaluates “new technologies for NHS use, considering clinical effectiveness and value for money” based on more than 200 published quality standards.19 Both the EMA and NICE effectively remove personal emotions – which inevitably cloud judgment – from the decision of whether to pay for a therapy or device. Perhaps unsurprisingly, Roche announced on July 25 that the EMA “issued a negative opinion on the conditional marketing authorisation (CMA) for Elevidys™ (delandistrogene moxeparvovec) for ambulatory individuals aged three to seven years with Duchenne muscular dystrophy.”
What permeates the WSJ articles is a sense that Dr. Prasad was not politically correct. But death doesn’t care about political ideology, and no political ideology changes the biology that governs the reality that the parents of a boy with DMD inevitably face…which is that their boy will die too young after living an extraordinarily difficult life.
Cigna’s earnings demonstrate the increasing influence of specialty pharmacy in the health economy. What makes the specialty pharmacy industry so powerful?
First, and importantly, some specialty therapeutics are superior to other clinical pathways. Every health economy stakeholder that is not a specialty pharmaceutical manufacturer – providers, device manufacturers, employers, health insurers and CMS – ignores at their own peril the intensifying and existential battle for the hearts and minds and bodies and wallets of the American consumer.
Cigna describes the battle this way:
“Increasingly, health systems and other providers are seeking to manage their in-house pharmacy capabilities and inventory, most specifically within specialty drugs as this provides an important source of revenue that can help to counterbalance pressures in other aspects of their business.”20
We have summarized it this way in our last two editions of the Trends Shaping the Health Economy Report:
On the other hand, the replacement of healthcare services by specialty therapeutics is limited only by science. Had my son wanted to become a physician, I would have advised him to be an orthopedic surgeon, as specialty therapeutics increasingly offer non-surgical treatments for organ, muscle and auto-immune diseases.
Second, one must consider the outside influence to which any regulatory agency can be subjected when the industry it regulates is a source of its funding. A significant – and increasing – portion of the Food and Drug Administration’s budget comes from user fees.
The First Amendment, of course, is about speech, not truth. Lobbying is always about influence and power, which means that facts or truth or justice are sometimes sacrificed at the altar of greed. The influence of the pharmaceutical industry is immense and, at least in healthcare, unrivaled. Sometimes that interest is aligned with the interest of everyday Americans, and sometimes it is not.
As such, a conservative news outlet’s editorials about an industry with a long history of product recalls might be expected to be more “caveat emptor” than “ride or die,” particularly for a gene therapy. The fact that the WSJ has scarcely mentioned cost or risk in their op/eds doesn’t change the fact that the specialty pharmaceutical industry is, like Eric B and Rakim, focused on getting paid in full.
The combination of these factors manifests this way:
“Today, President Donald J. Trump sent letters to leading pharmaceutical manufacturers outlining the steps they must take to bring down the prices of prescription drugs in the United States to match the lowest price offered in other developed nations (known as the most-favored-nation, or MFN, price).”21
Regular readers will also know that I am a fierce, if lonely, advocate for value for money as the only way to bend America’s healthcare cost curve. Value for money, otherwise known as “you get what you pay for,” is the governing principle of capital markets and free market economies, and it permeates every part of the U.S. economy except for higher education and healthcare.
In healthcare, value for money exists at the intersection of cost and quality. Mortality is the ultimate quality measure because as William Farr, the British epidemiologist, noted in 1838, “death is a fact; all else is inference.” Channeling my inner Marshawn Lynch, I have written about it over and over and over and over, and over and over and over. As we have repeatedly demonstrated, there is no observable correlation between cost and quality in healthcare services in the United States. For the individual American, that means that whether you get what you pay for healthcare is highly random.
Importantly, the health economy is the most socialized part of the U.S. economy, both in size and in scope. Federal and state funding of healthcare is more than twice the amount of government funding of any other industry, underwriting 32% of the $4.9T health economy. What differentiates the life sciences sector from other health economy stakeholders is the existence of patent monopolies, a regulatory moat about which a healthcare provider can only dream.
As a general principle, the extent to which any regulatory body must evaluate whether consumers are receiving value for money is correlated with the extent of the government’s subsidy of that industry, whether directly or indirectly. Warren Buffett famously noted that is “only when the tide goes out do you discover who’s been swimming naked,” which is as good a way as any to evaluate the earnings reports of the health insurers who are – currently – “long” in the heavily subsidized Medicaid and ACA Marketplace Exchange plans.
In a free market economy in which the consumer pays the bill, whether they get what they paid for is for them to decide. In a socialized or heavily subsidized economy in which the taxpayer is paying some of – or all – the bill, the question is whether the consumer gets what society paid for, which explains the existence of NICE and the EMA. For Federal and state policymakers to have that discussion is as important as it is uncomfortable. As P.J. O’Rourke said, “if you think healthcare is expensive now, just wait till you see what it costs when it’s free.”22
The “brand promise” of a specialty pharmaceutical is that it will change, or even save, your life, recalling the mythology of the fountain of youth. What betrays the brand promise is that “time waits for no one,” as the Rolling Stones are somehow still singing. Specialty pharmaceuticals merely delay the inevitable fact that Death is undefeated for mere mortals, no matter what Ray Kurzweil or Bryan Johnson or The Liver King say. It is certain that time has “no favors” for boys with DMD.
The Rolling Stones also imply what most of us fear: Judgment Day, when the Book of Revelation says that the dead will be “judged by what was written in the books, according to what they had done.”23
I know that I am only given today, and I know that my days are numbered, even if I don’t know how many I have left. As a result, I think about Judgment Day almost every day. As a husband and father, I am hopeful about how my motives will be judged, even if my execution is frequently flawed.
Likewise, I am hopeful about how my motives as a health economy stakeholder will be judged, with this newsletter and our Field Guide for healthcare strategy and our public research as evidence of living our noble purpose:
“Trilliant Health’s ‘noble purpose’ recognizes that every American is impacted by the health economy, and we are committed to making it exponentially better.”
But my real confidence is that, as my buddy Rivers Rutherford sang at my son’s funeral, “when I get where I’m going, there’ll be only happy tears.” I will walk with my son,
“And he'll match me step for step
And I'll tell him how I've missed him
Every minute since he left
And then I'll hug his neck”
I can’t wait.