Farewell to the Wood Snake: A 2025 Retrospective
Moving from the Loop to the Stoop
Anyone can make predictions, but it’s more fun to subject those predictions to retrospective review. As we end the year, this week’s edition of The Surgeon’s Record takes one last look back at 2025 — the Year of the Wood Snake.
To be sure, 2025 was a busy year in health tech/innovation: a couple of notable digital health IPOs, a government shut down largely over healthcare (ACA subsidies), and CMS/CMMI firing on all cylinders with a slew of new models. As always, healthcare costs remained in the spotlight; employers are bracing for another jump in premiums and physicians lamenting another round of Medicare cuts.
Wood Snakes symbolize transformation, wisdom, and calculated risk, all attributes I thought we’d see more of last year. Healthcare transformation is slow — much slower than most of us would like — and requires the right balance of experience, expertise, and bravado. Despite the glacial pace of change, I predicted we’d see “a ground level change in how we view healthcare innovation.”
Was I right?
Prediction #1: Physician unionization proves itself to be more sound than fury.
Despite high levels of employment, burnout, and dissatisfaction, I didn’t think physician unions would gain much traction. And I was wrong. Interns and residents across the country continued to lead the way on unionization, but attending physicians increasingly joined in.
You could argue that unionizing is mostly “sound” while going on strike is where the “fury” starts. I’ve been skeptical that physicians would actually take such a drastic step given the implications that come with it. While the answer to the question “Will physicians strike?” has still largely been “no,” a handful of physicians did join a nurses’ strike at Providence hospitals in Oregon last year.
So, maybe I wasn’t completely wrong. More docs are joining unions, and it may only be a matter of time before physician strikes become more common.
Prediction #2: Care delivery innovation pivots from primary care to specialty care.
Entering the year, advanced primary care was experiencing significant turbulence — most notably CVS’ struggles with Oak Street Health and Walgreen’s failed VillageMD bet. My thesis was that 2025 would be the year that specialty care overtook primary care as the focal point care model innovation.
Did that happen? More or less.
Perhaps the biggest specialty care deal was Strive Health. The kidney care company, raised a $300M Series D along with securing $250M in debt financing. Strive has an eye toward becoming a multispecialty VBC provider and, of course, is building out its AI stack.
Late in the year, VBC cancer care startup Thyme Care closed a $97M Series D round, pushing the company’s valuation past $1B. Women’s Health, Obesity Medicine, and Behavioral Health also drew investor interest.
2025 stayed challenging for traditional primary care. Much of the hype (and money) centered around longevity and functional medicine. One bright spot was CMS/CMMI’s announcement of a slew of new care delivery models and, many of which are explicitly designed to support advanced primary care. The 2026 Medicare Final Rules also provide a significant boost.
Investors may be wary, but there is still strong sentiment for revamping how primary care is delivered and paid for.
Prediction #3: Instead of sowing distrust and hyping AI, smart innovators will highlight physicians and elevate the doctor-patient relationship.
Heading into 2025, there was much talk of AI outperforming and eventually replacing doctors. Silicon Valley technophiles have long dreamed of a healthcare future where expensive, mercurial physicians are no longer gatekeepers limiting the rate of innovation. To me, this sentiment is misplaced.
As we close out the year, AI hype is in an interesting place. As with all hype cycles, a predictable backlash is forming — or, at least tried to form. There’s broader skepticism about AI in general from frothy valuations of foundational companies like OpenAI and Anthropic, to unclear ROI (an MIT paper claiming that 95% of companies got zero return on their AI investment), to eye-brow raising circular financial deals. Still, every time AI bears gather at the gates, AI bulls stampede them back.
Healthcare AI has been particularly resilient. Has it elevated the doctor-patient relationship? Possibly. Two of the biggest health tech funding deals of 2025 involved Ambience and Abridge. OpenEvidence was a breakout star. These companies offer technology meant to reduce provider burnout and allow physicians to spend more time with patients. Some of the most interesting, practical, and promising applications of AI in healthcare similarly involve clinical workflow improvements.
Though it’s not quite as loud, talk of AI-native care delivery remains. Some still envision a healthcare future that moves from “doctor-in-the-loop” to “doctor-on-the-stoop.” Whether that’s a a good thing or a bad thing remains highly POV-dependent.
Prediction #4: Brian Thompson’s murder will not lead to the hoped for referendum on our care delivery system.
It’s hard to believe it’s only been a year since the United Healthcare CEO was fatally shot outside of a Midtown Manhattan hotel. Shock over the brazen nature of the attack quickly transformed into a complex and controversial public reaction. The episode laid bare society’s deep frustration with the American healthcare system.
Luigi Mangione, the alleged perpetrator, became something of a perverse anti-hero. The victim, Brian Thompson (a husband and father) became a symbol of commercial insurance company greed. The episode sparked many forms of outrage. Did that outrage galvanize into productive change?
A year later, the answer is unclear. Employers are facing another year of rising healthcare costs. We endured the longest government shutdown in history over a disagreement on healthcare subsidies. Legislators first kicked the can down the road and then kicked the can into a storm drain. No fixes appear imminent — to the public or the private system.
Brian Thompson’s murder may not have sparked the revolution some hoped, but there are signs of progress. More people are turning outrage into action, frustration into momentum. Rather than one single episode, the events of 2025 collectively began a referendum on healthcare that will almost certainly continue in 2026.
Prediction #5: Healthcare discourse enters a new phase that’s more raw, earnest, and focused on real problems and solutions.
Yeah…kind of a vague prediction. I name checked Mark Cuban here — that part turned out to be spot on. Cuban doubled down on healthcare last year, expanding beyond Cost Plus Drugs and his anti-PBM crusade to launch Cost Plus Wellness and turn his attention to large payers. CPW aims to drive down costs by standardizing contracts, removing middlemen, and making things more transparent. In short, CPW is an attempt to create a functioning healthcare marketplace.
It’s a work in process, but, to his credit, Cuban continues to push the conversation forward in provocative ways. He regularly engages in earnest discourse on social media, podcasts, interviews, and national meetings. Other outsiders with a platform tend to offer high level criticism or half-formed platitudes in favor of socialized medicine. Whatever you think of Cuban’s views, motives, or approach, he deserves credit for entering the fray.
Cuban’s not the only one advancing healthcare discourse. Though it has yet to produce much, we’re at least seeing more political pressure to take meaningful action. Healthcare is a consistent topic of conversation across all forms of mainstream media. It remains very top-of-mind for many. It’s subtle, but it does feel as though we’ve entered a new phase of healthcare discourse.
Predicition #6: Shifting musculoskeletal care economics will force hospitals, health systems, and surgeons to re-evaluate their approaches.
It’s an interesting time for MSK care delivery economics. Site-of-service arbitrage is reaching maturity with increasingly complex cases (safely) migrating to low cost outpatient settings. CMS is phasing out the inpatient only list in 2026, paving the way for any MSK procedure to be performed in an HOPD or ASC.
Hospitals and health systems, long resistant to the lower reimbursements that come with the outpatient procedures, seem to be acknowledging its inevitability — to whit, Ascension’s acquisition of AmSurg.
For their part, Orthopedic Surgeons face another year of cuts: a -2.5% “efficiency” adjustment, a reduction in practice expense RVUs, and a 7.3-7.8% cut in joint replacement reimbursement. For surgeons who want to remain independent, ASC ownership has gone from “nice to have” to “must have.” There’s increased talk of Medicare opt outs. Overhead keeps going up. Re-evaluation continues.
Meanwhile, CMS/CMMI continue to move forward with alternative, VBC payment models. TEAM is nearly upon us, ready or (for many) not. As discussed earlier CMMI unleashed a slew of new programs over the course of 2025 — ACCESS, ELEVATE, LEAD, WISeR — many of which touch on MSK care in some way.
As we enter 2026, MSK remains a significant driver of employer healthcare costs. Direct contracting is gaining traction with steerage to centers of excellence becoming mandatory. Hospitals, health systems, and surgeons should adjust accordingly.
This is my lane, and I was pretty spot on with this prediction.
Prediction #7: Anticipated health tech IPOs provide an uneven glimpse into the business model and unit economics of virtual chronic care delivery.
The long health tech IPO winter thawed a little in 2025, led by Hinge Health and Omada Health. A lot was riding on these two companies — public and private investors waited to see if digital health could overcome the underwhelming results of its forebears. Personally, I was curious to see if either company’s business model could withstand scrutiny and justify lofty valuations.
The answer for Hinge Health has been a resounding “yes.” The company IPO’ed in May at a share price of $32; as I write this, the share price sits at $48.60, a 66% appreciation. With a current market cap of $3.8B, Hinge didn’t quite live up to its lofty $6.2B private valuation. Still, the company has posted impressive financial results since going public and recently increased its 2025 revenue guidance. As we close 2025, Hinge’s business model has resoundingly passed muster.
Omada’s results aren’t quite as robust. After going public at a share price of $23, Omada hit a peak of $28.40 in late October before quickly crashing after release of Q3 results. The company’s first positive Adjusted EBIDTA quarter wasn’t enough to impress public investors and sustain momentum. Omada stock currently sits at a little over $15 per share with some now questioning the business model.
Waiting in the wings to break the digital health IPO tie is Sword Health, another virtual MSK unicorn. Or, it used to be. Sword has aggressively expanded its scope and is leaning hard into AI, shifting from a “human-first” to “AI-first” model. The company raised $40M at a $4B valuation in June with the intent of pushing any potential IPO as far out as 2028. (Some think Hinge’s performance could accelerate that timeline).
While this prediction is incomplete, it’s interesting to note that both Hinge and Sword now look more like SaaS companies with a healthcare flavor than virtual care delivery companies (like Omada). Hinge Health is an 81% margin tech company while Omada Health is a 60% margin clinic.
That distinction may confirm something about health tech many have long suspected — when it comes to business model, it’s more about “tech” and less about “health.”
Prediction: 2025 will be a seminal year of growth and evolution for The Surgeon’s Record and for me as EIC and Senior Clinical Fellow.
Any time you see the word “seminal,” you know it’s serious. This one came true in many ways. Over the course of 2025, our total subscribers grew by 43% and total views went up 63.5%. Thanks to all who supported us by recommending The Surgeon’s Record, commenting on posts, appearing on the podcast, or sharing words of encouragement. It’s greatly appreciated.
Wrapping Up & 2026 Predictions
Out goes the Year of the Wood Snake, symbolizing transformation, wisdom, and calculated risk, and in comes the Year of the Horse — a time for energy, freedom, independence, and ambition. Here, here.
Without further ado, here are my 2026 Predictions: AI.
Wishing everyone a safe and restful holiday season. See you in January.
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
