Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

One hundred sixty four dollars. That is what North Carolina Medicaid saved every month, on every person enrolled in the Healthy Opportunities Pilots, after paying for the groceries, the rent assistance, the bus fare, and the staff who ran the whole thing. For close to two decades, healthcare executives have stood on stages and promised to treat the whole patient. Then they killed the budget line the second a finance leader asked what it returned. I have watched that slide deck get archived more times than I care to count. A state legislature just answered the return question in public, in a purple state, with a peer-reviewed evaluation and a line item, and the industry keeps asking for a business case that already exists.

The Cecil G. Sheps Center for Health Services Research at UNC ran the summative evaluation. More than 31,000 enrollees. Services ran from March 15, 2022 through November 30, 2024. Across a 32-month follow-up, the pilots produced $164.49 less spending per member per month, with a 95 percent confidence interval of negative $311.67 to negative $17.32. That interval clears zero, which means the finding holds up statistically. It also counts everything, not just the easy part: medical care spending, the cost of every pilot service delivered, and the administrative overhead to run the program. An earlier UNC estimate put annual savings closer to $1,000 per person. The final number lands near $1,968. The savings grew as the program matured. Participants logged fewer emergency department visits and fewer hospital stays, and they spent more time with primary care and other outpatient providers. Read that utilization pattern for what it is: care moved from crisis to management.

Patients told the same story from the other direction. The evaluation found that pilot services cut the total number of social risks a participant carried, and specifically reduced the probability of reporting food needs, housing needs, and transportation needs. Nearly 90 percent of participants said the program improved their health or the health of their children, a figure former North Carolina health secretaries Mandy Cohen and Kody Kinsley cited in STAT this month. Pair the self-report with the claims data and the piece stands on both feet. Sentiment alone convinces nobody who controls a budget. Sentiment plus utilization convinces almost everybody.

Now the political record, which matters more than any single clinical outcome. CMS approved the waiver in 2018 under a Democratic governor, a Republican state legislature, and the first Trump administration. The General Assembly let the funding lapse in July 2025 and the program went dark for roughly a year. Then, in the budget that passed at the start of July 2026, legislators appropriated $25 million in nonrecurring funds to restart it. Regional organizations had asked for $80 million, so nobody should call this a victory lap. Call it what it is: eight years, multiple election cycles, one full defunding, and a bipartisan vote to bring it back anyway. Almost nothing in the evidence base survives that kind of pressure test.

Here is where the advocacy community fits. Archo’s ELAVAY research has fielded annually since 2015 across more than 20 disease states, asking patient advocacy organizations, professional societies, and community groups to rate how biopharmaceutical companies actually behave as partners. The consistent pattern across those cycles separates two things the industry treats as one: how responsive a company feels in the moment, and how committed the advocacy community believes that company is to patient outcomes. Fast email replies do not buy you the second rating. Removing barriers does.

Start with the industry side, because the failure there is structural rather than moral. Companies fund patient services organizations that report enrollments, not barriers removed. Real-world evidence teams code a missed infusion as nonadherence, route the finding to medical affairs, and medical affairs owns exactly zero transportation budget. Look at where the money sits. Patient services reports to commercial. Social needs screening reports nowhere. Those two lines never reconcile inside a single planning cycle, so the insight dies of organizational homelessness rather than disagreement.

Now the advocacy side, and this one deserves to sting. CMS closed the comment period on August 17 for the proposed rule that makes the Medicare Drug Price Negotiation Program permanent, the rule that governs drug selection, maximum fair price methodology, and renegotiation from 2029 forward. The docket drew 11,408 comments. Brian Reid read that docket for Cost Curve on August 19 and found the shape of it familiar: biopharma trade groups filed on coercive structure and eligibility definitions, oncology groups filed on combination products, hospital systems filed on 340B duplicate discounts, right-leaning think tanks filed for narrow implementation, and patient organizations showed up thin. A handful filed and filed well. Most did not file at all. A comment letter costs staff time and a deadline. Advocacy organizations skip the cheapest leverage in health policy, then act surprised when the final rule treats patients as a rounding error.

Skip the values statement. Watch the behaviors. Top-performing organizations screen for transportation, food, and housing barriers inside the patient services intake, before the first missed dose, not in the retrospective analysis six months later. They assign a named human being to every patient insight the moment the meeting ends, and that person carries it or answers for it. They write the insight into the planning cycle as required input at a specific decision gate, with a documented record of what changed because of it. The companies the advocacy community rates highest in ELAVAY route community input into decisions. The median company routes it into a deck, presents the deck, and archives the deck. Same input. Completely different organization.

Three moves.

Walk into that meeting carrying the $164 figure, the utilization shift, and the bipartisan record. Every one of those three sits in the public record right now.

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If you want to know how the advocacy community actually rates your organization before you walk into that conversation, the 2025/2026 ELAVAY report is available now, and fielding for 2026/2027 opens in October. Email [email protected]. Or take the Advocacy Influence Diagnostic. Free, anonymous, five minutes.