TrumpRx, Cost Plus Drugs, and the Patients Nobody Counted

Sarah Matt • February 9, 2026

On February 5, the White House launched TrumpRx.gov, a direct-to-consumer platform connecting Americans to discounted prices on 43 brand-name prescription drugs. The site runs on GoodRx-style coupon technology and allows cash-paying patients to access manufacturer discount programs through most favored nation pricing agreements with 13 pharmaceutical companies, including Eli Lilly, Novo Nordisk, Pfizer, and Amgen.

The next day, Mark Cuban sat on stage at the Silicon Slopes Summit with U.S. Medicare Director Chris Klomp and said the quiet part out loud: "Of the drugs we both carry, we are cheaper on 90%."

Two platforms. Two approaches. Same promise: lower drug prices for Americans. But which patients actually benefit? And which ones are, once again, invisible?

I wrote The Borderless Healthcare Revolution to make a simple argument: access is not a widget. It is a system. And any system that ignores the infrastructure underneath it will fail. This week, I want to apply that framework to both platforms and expose what the headlines are missing.

TrumpRx: The Headlines vs. The Reality

The headline numbers are real. Eli Lilly's Zepbound starts at $299 per month (down from roughly $1,060). Novo Nordisk's Wegovy pill drops to $149 per month. AstraZeneca's Bevespi inhaler falls to $51. For uninsured patients paying cash for GLP-1 medications or fertility drugs, these discounts are meaningful.

But headlines do not treat patients. Systems do. So let me run TrumpRx through the Five-Pillar Access Audit from my book and see where the roof caves in.

Pillar 1: Physical Access

TrumpRx is a website. It requires an internet connection, a device, and the ability to navigate a government platform. According to the FCC, roughly 24 million Americans lack broadband access. Many are rural patients who also happen to live in communities where independent pharmacies are closing at record rates.

Some of the listed drugs ship direct-to-consumer from manufacturer fulfillment centers. That assumes the patient has a reliable mailing address and someone available to receive temperature-sensitive medications like injectable GLP-1 drugs. For the tech executive in Manhattan, this is seamless. For the patient in rural Kentucky whose nearest pharmacy just closed and whose mail comes to a PO box, this is a wall.

Pillar 2: Financial Access

This is where it gets uncomfortable. TrumpRx.gov is designed strictly for cash-paying patients—a group that includes roughly 27 million uninsured Americans. However, for the 85% of Americans with health insurance, the math rarely works. Most insured patients will likely find that their existing pharmacy benefit offers a lower price than the "discounted" rates on the government portal.

The "Cash Only" Barrier for Medicare & Medicaid

A major point of confusion surrounds Medicare and Medicaid patients. While they are not technically "banned," they can only use the platform if they bypass their government benefits entirely and pay 100% out-of-pocket. See the Cultural Pillar below.

The HHS Office of Inspector General (OIG) recently issued a Special Advisory Bulletin attempting to create a "low-risk" roadmap for manufacturers to sell directly to these patients. This guidance is a workaround for the federal Anti-Kickback Statute, which criminalizes offering incentives for items reimbursable by federal programs. For now, this pathway remains narrow and untested; many manufacturers may still avoid it to mitigate legal risk.

The Deductible "Invisible Man"

There is a hidden cost to using this portal: TrumpRx payments do not count toward your insurance deductible.. If an insured patient uses the platform for even one medication, every dollar they spend remains invisible to their insurance plan. For those with high-deductible plans, this means they aren't making any progress toward their annual out-of-pocket maximum.

The Generic Problem

Finally, there is the issue of brand-name bias. TrumpRx lists the brand-name drug Protonix for approximately $200. Meanwhile, the generic version, pantoprazole, is widely available for as little as $6 through services like GoodRx or Mark Cuban’s Cost Plus Drugs.

Analysis shows that about half of the drugs currently on TrumpRx have significantly cheaper generics available elsewhere. Without a pharmacist to guide them, a patient could easily pay six times more for a brand-name "deal" on the government site than they would for the generic at their local pharmacy.

Pillar 3: Cultural Access

The TrumpRx website launched in English. For the roughly 25 million Americans with limited English proficiency, this is not a minor inconvenience. It is a barrier. The coupon redemption process requires a level of pharmacy literacy that many patients do not have.

The "Shadow Exclusion" of Federal Beneficiaries

Perhaps the most confusing cultural signal comes from the HHS Office of Inspector General’s (OIG) January 27, 2026, Special Advisory Bulletin. In a move designed to "clear the path" for the platform's launch, the OIG provided a low-risk roadmap for manufacturers to sell directly to Medicare and Medicaid patients who choose to pay cash.

However, a cultural disconnect remains at the point of entry: the TrumpRx.gov attestation form. To access these "deals," users must still check a box confirming they are not enrolled in any government-funded program. This creates a "shadow exclusion"; where the legal theory says yes, but the government’s own digital interface says no. For a clinician, this is the ultimate red flag: we are asking the most vulnerable, high-utilization patients to either misrepresent their status or forfeit their hard-earned federal benefits just to participate in a "revolution" that wasn't actually built for them.The attestation form asks users to confirm they are not enrolled in government health coverage. For immigrant patients, entering personal information on a .gov website carries real fear, real risk, and real consequences that the platform designers clearly did not consider.

Pillar 4: Digital Access

This pillar is where TrumpRx collapses most visibly. The platform creates what pharmacists call a "dangerous information vacuum." A patient buying blood pressure medication through TrumpRx, a cholesterol medication at a retail pharmacy, and a diabetes medication through a different direct-to-consumer program has effectively fragmented their own medication record. No single pharmacist sees the full picture. The risk of drug interactions, duplicate therapies, and dosing errors multiplies.

There is no integration with electronic health records. No pharmacy claims data flows back to the care team. We spent two decades and billions of dollars building EHR infrastructure specifically so clinicians could see the whole patient. TrumpRx routes around that infrastructure entirely.

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Pillar 5: Trust and Knowledge

Trust is the currency of healthcare. TrumpRx has a trust problem on multiple fronts. First, sustainability. What happens to these prices when the current administration ends? Patients who restructure their medication access around TrumpRx have no guarantee these deals survive a change in government. Starting a patient on a medication they can afford today but not tomorrow is not access. It is a setup for medication abandonment.

Second, data. When patients bypass their insurance plan to buy through TrumpRx, the plan loses utilization and adherence data. This sounds bureaucratic until you realize that data drives formulary decisions, drug coverage, and cost forecasting. We are trading short-term savings for long-term blindness.

Third, the pharmacist relationship. If direct-to-consumer platforms pull even modest volume away from pharmacies, we lose the most accessible healthcare professional most Americans have. The pharmacist is often the last line of defense against a prescribing error. Removing them from the equation to save a few dollars is a clinical risk disguised as a consumer benefit.

Now Enter Mark Cuban

Cuban's Cost Plus Drug Company launched in 2022 with a radically different model: sell generic medications at acquisition cost plus a flat 15% markup and a $5 pharmacist fee. No coupons. No middlemen. No opaque pricing. Just transparent math.

The contrast with TrumpRx is stark.

Drug selection: TrumpRx offers 43 brand-name drugs. Cost Plus Drugs offers over 6,000 medications, overwhelmingly generics. Cuban pointed out that TrumpRx added many brands that have generic equivalents, and Cost Plus beats them on price "usually by a lot."

Pricing model: TrumpRx uses manufacturer coupons and discount cards, meaning the underlying list price stays high and the "discount" is a marketing decision. Cost Plus Drugs publishes the actual cost of the drug and adds a transparent markup. One model obscures the economics. The other exposes them.

Insurance compatibility: Cost Plus Drugs accepts coverage from more than two dozen insurance providers. TrumpRx is cash-only and explicitly excludes government insurance.

The partnership twist: Cuban confirmed that Cost Plus Drugs is sharing its API with TrumpRx so the government platform can pull pricing data. Cuban's bet is that displaying Cost Plus prices alongside brand-name TrumpRx prices will drive patients toward the cheaper generic option. It is a shrewd move: use the government's marketing budget to grow your own customer base.

The Medicare and Medicaid Problem Nobody Wants to Talk About

Here is the uncomfortable reality that both platforms share: neither one adequately serves the patients who need the most help.

TrumpRx explicitly excludes Medicare and Medicaid patients from using its coupons. That is over 150 million Americans on government-funded health coverage. The anti-kickback statute creates a legal wall that TrumpRx has not figured out how to climb, despite HHS guidance attempting to create a narrow pathway.

Cost Plus Drugs does not accept Medicare. Its transparent cost-plus model does not fit cleanly into the Medicare Part D rebate structure. Research from the Journal of Urology estimated Medicare could save $1.29 billion annually if generic drug prices matched Cost Plus levels. A separate PharmacoEconomics study put potential Part D savings at $8.6 billion. The savings are there. The regulatory framework to capture them is not.

The government is making moves on the margins. Medicare recently negotiated lower prices on key GLP-1 medications: $245 per month for Ozempic, Wegovy, Mounjaro, and Zepbound, with a $50 monthly copay for beneficiaries. State Medicaid programs can access the same rates. For the first time, Medicare will cover Wegovy and Zepbound for patients with obesity. (This starts in 2027)

But these are individual drug deals, not systemic reform. They do not address the structural problem: the pharmacy benefit manager (PBM) layer that sits between manufacturers and patients, extracting value at every turn. Cuban said it clearly at the Silicon Slopes Summit: "Those big insurance companies are too big to care." His prescription? Break them up.

The Five-Pillar Scorecard

If I run both platforms through my Five-Pillar Access Audit, neither one passes:

Physical: Both are online-only platforms. Neither solves the broadband gap or pharmacy desert problem. TrumpRx adds a direct-to-consumer shipping layer that assumes stable housing. Cost Plus ships to homes but also partners with a mail-order pharmacy. Neither has a walk-in option for patients without internet.

Financial: TrumpRx helps a narrow slice of uninsured, cash-paying patients and excludes government insurance. Cost Plus Drugs is cheaper on most overlapping medications and accepts some insurance, but does not accept Medicare. Both leave the 150+ million Americans on government coverage largely untouched.

Cultural: TrumpRx launched English-only with an attestation form that deters immigrant populations. Cost Plus Drugs has a cleaner interface but still assumes English literacy and digital fluency. Neither platform has invested meaningfully in multilingual access or community health worker integration.

Digital: TrumpRx creates a fragmented medication record with no EHR integration. Cost Plus Drugs shares prescription data with its partner pharmacy (Truepill/pharmacy network), but does not integrate with a patient's primary care EHR either. Neither platform solves the information vacuum problem.

Trust: TrumpRx's sustainability depends on who occupies the White House. Cost Plus Drugs is a private company with a transparent model, which is more durable but still subject to market forces. Neither platform has built the community-level trust infrastructure (local champions, clinic partnerships, navigator programs) that my book identifies as the foundation of lasting access.

The Bottom Line

TrumpRx is not a bad idea. Neither is Cost Plus Drugs. Lowering drug prices for Americans is a legitimate goal, and both platforms deliver real savings for specific populations.

But both are 'Castle' solutions. They were designed for people with broadband, health literacy, and English fluency.

TrumpRx does not account for the grandmother in Appalachia without broadband. Cost Plus Drugs does not account for the Medicare patient in a food desert who cannot afford the bus fare to a pharmacy, let alone a monthly subscription. Neither accounts for the immigrant mother who is afraid to enter her name on any website, government or otherwise.

If you are a health system leader reading this, run your own Five-Pillar Audit before recommending either platform to patients. Ask: which of my patients does this actually reach? And which does it leave behind?

The answer will tell you everything about where the real work still needs to be done.

What to Do Next

Audit Your Medicine Cabinet: Before your next refill, cross-check your brand-name prescriptions against TrumpRx.gov and Mark Cuban’s Cost Plus Drugs. If you find a massive price gap that doesn't make sense, let’s talk about it.
Subscribe to The Clinical Realist: If you want more "no-filter" breakdowns of how policy actually hits the pavement in your clinic or boardroom, join the community on Buzzsprout so you never miss an episode.
Drop Me a Note: I want to hear from the front lines. Are your patients actually asking about TrumpRx, or is this just more "health tech theater"? Reply to this email or DM me, I read every single message.

-Dr. Matt

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TrumpRx, Cost Plus Drugs, and the Patients Nobody Counted

The $28 Billion AI Tax: Is Oracle Trading the Hospital for the GPU?

By Sarah Matt • February 1, 2026

In 2022, I was part of the team at Oracle, helping lead the post-close diligence and integration of the Cerner acquisition. I worked alongside brilliant clinical and technical minds dedicated to a singular mission: proving that a cloud giant could fix the fragmented heart of healthcare. But in 2026, the "hospital of the future" is facing a $156 billion competitor: The GPU. This week, the industry was rocked by reports from TD Cowen stating that Oracle is evaluating a sale of Cerner and potentially cutting 30,000 jobs. The reason? A staggering financial pivot to fund its $300 billion OpenAI infrastructure deal. As a surgeon who has lived in the EHR and a strategist who saw the integration roadmap from the inside, I see this not as a failure of the team, but as a "Regulatory Darwinism" event. Oracle isn’t just selling a business unit; they are paying an "AI Tax" to stay in the hyperscale race. The $156 Billion Gravity Well Oracle is currently building the "Stargate" of AI infrastructure. To meet its commitments to Sam Altman and OpenAI, the company needs to deploy roughly 3 million high-end GPUs . The math is brutal: Oracle’s capital expenditure for 2026 has jumped to $50 billion. Total debt has climbed past $100 billion, and to keep the lights on, Oracle is reportedly requiring some customers to pay 40% deposits upfront. In a world where a giant has to choose between a service-heavy EHR and a high-margin GPU cluster, the clinical record becomes "Slow Money." And in 2026, the market only wants "Fast Money." The New Map: Winners & Losers of the Great Divestiture If these reports lead to a sale or spin-off, the healthcare landscape doesn't just shift—it shatters. Here is how the pieces land: The Big Winner: Epic Systems Epic is the last titan standing. With over 42% of the U.S. acute-care market, they are now the default "safe" choice. While Oracle fought integration friction, Epic focused on embedding ambient AI natively. Their win is a victory for stability, but it’s a warning for competition. We are entering a "Monopoly Era" for the clinical record. The Ultimate Loser: Healthcare Providers & Innovation This is where the real damage happens. When Oracle (the only credible threat to Epic’s dominance) retreats, providers lose their only "Plan B." The Leverage Crisis: Without a viable alternative, health systems have zero leverage during contract renewals. We’ve already seen lawsuits, like the Texas AG’s case against Epic, alleging that this market power is already raising costs and stifling competition. The Innovation Winter: Monopolies don't have to innovate; they only have to maintain. If the "EHR War" is over, the pressure to improve clinician UI or lower implementation costs evaporates. The "Service-Heavy" Trap: If Cerner is sold to a private equity firm (a common fate for "legacy" assets), the focus will shift to cost-cutting, not clinical excellence. The doctors at the bedside will be the ones who pay that price in the form of stagnant software and reduced support. Get the "Clinical Reality Check" Before Everyone Else. I send these briefings to my private list 24 hours before they hit social media. Join other healthcare leaders who get the raw, uncensored analysis first. [Join the Clinical Realist List] The Global Implications: A "Single Point of Failure" This isn't just a U.S. problem. Globally, the EHR market is becoming a massive cybersecurity "tail risk." Cybersecurity Concentration: As noted in recent clinical research, having 90% of U.S. patient records in the hands of essentially two vendors creates a catastrophic single point of failure. One breach could paralyze the global healthcare infrastructure. The Sovereign Data Conflict: Many nations (especially in the Middle East and UK) were betting on Oracle’s sovereign cloud to host national health records. If Oracle sells the "clinical" layer, those national security agreements could be thrown into legal chaos. The Clinical Realist Take I loved my time at Oracle because the vision was grand. But a vision without a sustainable financial tether is just a dream. We are seeing the decoupling of the Clinical Application from the Data Infrastructure . Oracle might sell the "tank" (the software), but they will fight to keep the "fuel" (the data) on their cloud. As leaders, we have to stop asking which EHR is better and start asking: Who actually owns the ground your data sits on? Call to Action Audit your "Distraction Risk." If your primary vendor is under $100B+ in debt and pivoting to AI infrastructure, your implementation roadmap is at risk. Demand Data Portability. Ensure your clinical data isn't trapped in a "legacy silo" that could be sold to the highest bidder. Bet on the "Middle Layer." Stop waiting for the EHR monolith to innovate. Look for agile startups that can sit on top of any EHR, ensuring you aren't held hostage by a monopoly. Are you doubling down on a monolith, or are you preparing for the deconstructed future? Send me a note! I’d love to hear how your system is protecting its leverage.

Elon Musk says Medical School is "Pointless": (Here is why he's wrong)

By Sarah Matt • January 26, 2026

If you listened to the keynote speakers at CES earlier this month, or if you have been following the latest soundbites from Silicon Valley, you have likely heard the term "Agentic AI." The promise is seductive. We are told that by the end of 2026, autonomous AI agents will handle 90% of your clinical documentation, schedule your patients, and battle insurance denials while you sleep. The "Digital Doctor," they say, is finally here to save us from administrative purgatory. It sounds like nirvana. But then, there is Elon Musk. You might have seen the clip circulating on X this week. During a conversation with Peter Diamandis, Musk made a prediction that stopped my scroll. When asked if young people should still pursue a medical degree, he didn't hesitate. "No. Pointless," he said. He went on to predict that within three years, AI-driven humanoids (like Optimus) will be better surgeons than humans, and that everyone will have access to medical care better than what the President receives right now. (You can watch the full clip here). It is a beautiful vision. It is also missing some key info...... Musk is making the classic futurist mistake because he is confusing Capability with Implementation. Sure, in a sterile lab with perfect 6G connectivity, a robot might be able to suture a grape better than a resident. But healthcare doesn't happen in a lab. It happens in a rural ER with spotty Wi-Fi, a patient screaming in a language the intake nurse doesn't speak, and a legacy EMR system that crashes if you look at it wrong. So yeah the tech will be ready, but the hospitals won't be! While Elon is dreaming of "Robo-Surgeons," I am looking at the actual AI crisis happening in our hospitals today. It isn't about robots taking jobs. It is about "Shadow AI" breaking the system. A recent report from Wolters Kluwer has confirmed what many of us have whispered in the breakroom for months: Clinicians are cheating on their IT departments. While Health Systems spend millions vetting "Enterprise Grade" AI tools (platforms that often take 14 clicks just to open and require a dual-factor authentication that fails in the basement), exhausted doctors and nurses are bypassing protocols. They are quietly pulling out their personal phones. They are opening consumer-grade apps like ChatGPT-6 to summarize charts, draft appeals, and write discharge notes. They aren't doing this because they are rebellious or because they don't care about security. They are doing it because they are drowning. When the "official" hospital tech stack fails to save time on a Tuesday night in the ER, clinicians don't wait for a Governance Committee meeting. They find a workaround. As a Clinical Realist, I see this not as an innovation problem, but as an infrastructure failure. And it carries three massive risks for 2026 that no robot can solve. First is the Liability Trap. This is the one that keeps me up at night. If a physician uses an enterprise-approved tool and that tool hallucinates a diagnosis, the liability is shared. The vendor, the hospital, and the indemnifiers are all at the table. But if a doctor uses a "Shadow" tool on their personal iPhone and it hallucinates? The physician is on an island. Courts are already sanctioning professionals for citing non-existent cases generated by AI. Do you think they will be lenient on a doctor who uses a hallucinated summary to treat a patient? The "Digital Doctor" doesn't lose its license. You do. Second is the Data Leak. "Shadow AI" means PHI (Protected Health Information) is leaving your secure firewall. When a clinician pastes a complex case study into a public Large Language Model to get a second opinion, that data often becomes training data for the model. We aren't just leaking patient privacy. We are feeding the competition. Third is the "Digital Twin" Delusion. Hospital executives are currently making multi-million dollar strategic decisions based on workflow data from their official EMRs. But if 30% of the actual cognitive work is happening on shadow apps that the CIO can't see, the C-Suite is flying blind. We are building "Digital Twins" of a hospital that doesn't exist. You cannot optimize a workflow you cannot see. Get the "Clinical Reality Check" Before Everyone Else. I send these briefings to my private list 24 hours before they hit social media. Join other healthcare leaders who get the raw, uncensored analysis first. [Join the Clinical Realist List] So, Mr. Musk, with all due respect: We don't need you to tell us medical school is pointless. The tech is hear, we get that loud and clear. We need you to build tools that actually work in the chaos of the real world. Until then, we need a defense protocol. We can't ban AI because the genie is out of the bottle. And we can't ignore the burnout that drives it. We need "Implementation over Innovation." If you are a hospital leader, stop punishing clinicians for using Shadow AI. Instead, declare a 30-day "Amnesty Period" to find out what tools they are actually using. You will be shocked, but you will finally have the truth. If your enterprise tool isn't as easy to use as the app on your doctor's iPhone, do not buy it. In 2026, User Experience is a safety metric. If a tool is hard to use, it induces fatigue, and fatigue causes errors. Ultimately, we don't need Digital Doctors (yet!). We need Digital Scribes. The data is clear: Ambient AI tools are reducing burnout by over 13% in just 30 days. Refocus your AI budget entirely on reducing the "Pajama Time" (the documentation done at home). If the tech doesn't give the clinician 60 minutes of their life back, it is not an asset. It is a liability. The future of healthcare isn't about the algorithm. It is about the access. If we burn out the human workforce waiting for Elon's robots to arrive, there won't be anyone left to turn on the computers. It is time to stop buying "Future Tech" and start building "Now Infrastructure." Dr. Sarah Matt P.S. Navigating the 2026 Healthcare Landscape If your leadership team is struggling to balance the new $50B CMS Rural Funding with the reality of workforce burnout, you don't need another futurist predicting 2040. You need a guide who speaks fluent "C-Suite" and fluent "Frontline." I am currently booking Keynotes & Advisory for Q3/Q4 2026. My signature keynote, The Clinical Realist: Innovation that Survives the Bedside, offers a brutal, honest, and hopeful look at how to scale access without scaling burnout. [Inquire About Speaking Availability Here]

Fire Your Chief Innovation Officer!

By Sarah Matt • January 20, 2026

Yesterday I stood on stage at the SUNY UPSTATE UNIVERSITY HOSPITAL Health Justice Conference and looked out at a room full of brilliant and well-meaning professionals. These are people who have dedicated their lives to fixing the broken machinery of American healthcare. The energy was palpable. The slides were slick. The buzzwords were flying. Everyone was talking about "additive" solutions. We need new pathways, apps, AI, engagement. In between talks I was speaking to a group and asked a question that sucked the air out of the room. "How many of you have a Chief Innovation Officer?" About half the hands went up. "How many of you have a Chief Friction Officer ?" Silence. Not a single hand. We have a fundamental problem in how we approach health technology. We are obsessed with addition. We treat healthcare strategy like a hoarding situation where we keep piling new solutions on top of old problems without ever clearing the clutter. But as a surgeon, I can tell you that addition is rarely what saves a life. Extraction does. Removing the infection. Removing the tumor. Removing the blockage. It became the backbone of my talk yesterday. It is the only narrative that matters for 2026. We do not 'need' more innovation. We need a Friction Audit. The "Addition Bias" Trap Psychologists call this "addition bias." When humans are asked to improve an object or a situation, they overwhelmingly prefer to add something rather than subtract something. In healthcare, this bias is fatal. We add a digital check-in tool to "streamline" the front desk. But we forget to remove the clipboard of paper forms. Now the patient has to do both. That is not innovation. That is friction. We add an AI scribe to the exam room to capture the conversation. But we do not remove the requirement for the physician to click through forty-seven tabs to bill for the visit. That is not progress. That is administrative burden. Innovation without subtraction is just suffocation. The Friction Audit: A New Standard Yesterday in my talk I proposed a radical shift in strategy. I challenged every health system leader, startup founder, and trainee in the room to pause their product roadmap and conduct a Friction Audit . This is not a bug hunt. This is a strategic review of the "invisible walls" we build around care. A true Friction Audit looks at three specific layers. 1. Digital Friction This is the most obvious and the most ignored. I am not talking about a clunky user interface. I am talking about the "Login Wall." If a patient needs three different passwords to view their labs, message their doctor, and pay their bill, you have failed. The most advanced algorithm in the world is useless if the patient cannot remember their username. Read: The Cost of Fragmented Patient Portals 2. Physical Friction We often design digital tools for a world that does not exist. I shared the story of the "unplowed driveway" in rural New York. You can have the most advanced "Hospital at Home" monitoring kit in the world. It can be powered by the most sophisticated AI. But if that patient lives up a steep hill in a snowstorm and their driveway is unplowed, the ambulance cannot get to them when the AI detects a crisis. Friction is not just in the code. It is in the infrastructure. Data: The Broadband Gap in Rural America 3. Cognitive Friction This is the silent killer. We are asking sick, scared, and stressed patients to act as their own project managers. We ask them to coordinate between the specialist and the primary care doctor. We ask them to chase down prior authorizations. Every time we force a patient to understand the complexity of our org chart, we are introducing cognitive friction that leads to burnout and dropout. The Job Description: Chief Friction Officer If I were running a major health system today, I would hire a CFO . But not the financial kind. I would hire a Chief Friction Officer . Their job description would be simple. They would have zero budget for buying new technology. Their only power would be the power of the veto and the power of the delete key. Their primary Key Performance Indicator (KPI) would be Time to Care . Their job is to ruthlessly hunt down every policy, every click, every form, and every redundant question that slows the patient down or burns the clinician out. They are the guardian of flow. If we had this role in place five years ago, we would not be facing the crisis staring us down next week. The Ultimate Friction: The January 30 Telehealth Cliff We have a real-time example of "Government-Mandated Friction" happening right now. In just 10 days, on January 30, 2026 , the Medicare telehealth flexibilities regarding the "originating site" are set to expire. We are about to revert to a rule (unless Congress acts) that says a Medicare patient cannot receive telehealth services from their home. They must travel to a designated "originating site" (usually a clinic or hospital) to get on a video call with a specialist. Think about the absurdity of this friction. We are legally forcing an eighty-year-old woman with mobility issues to drive forty minutes on icy roads just to sit in a room and look at a screen. We have the technology to treat her in her living room. We have the connection. But we have a policy wall that says "No." This is the "Telehealth Cliff." It puts over a third of rural Medicare beneficiaries at risk of losing access to virtual care overnight. A Chief Innovation Officer would try to solve this by building a better scheduling app for the clinic, or a new patient engagement tool. A Chief Friction Officer would recognize that the drive is the barrier and fight to remove the rule. Or better yet develop a community strategy to bring transportation into the care plan, and make it a 'clinical necessity'. Read: January 30th Cliff The Bottom Line Stop looking for the next "Agentic AI" to add to your tech stack. Stop looking for the next shiny object at CES. Look for the friction you can subtract. If your algorithm can diagnose a rare disease with 99% accuracy, but your patient cannot log in to see the result, you have not innovated anything. You have just built a very expensive wall. -Dr. Matt\ Dr. Matt believes technology can erase the borders that limit access to care. This vision is the heart of her National Best Seller, The Borderless Healthcare Revolution . If your organization is drowning in "solutions" but starving for results, you do not need another consultant to tell you what to buy. You need someone to tell you what to delete. I am opening two spots next month to serve as a Fractional Chief Friction Officer for growth-stage health tech companies or progressive health systems. We will identify your three biggest barriers to care and dismantle them. And if you are new here, join thousands of others who get this newsletter every Tuesday. Subscribe to The Borderless Healthcare Revolution.