iiinova — where your digital self keeps evolving

Reposted by Mason Roberts

Bradley @bradleyross.bsky.social · 08/07/2026

Public stadium financing is a scam. youtube.com/shorts/ACL-4...

youtube.com

Are sports stadium subsidies a scam?

YouTube video by Alex Falcone

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Mason Roberts @masonroberts.bsky.social · 29/04/2026

Housing is a human right, and it is a win-win in terms of costs to society. I see this in study after study (check Health Affairs articles on housing) and I see it on the ground in my work as an appointed Boulder official.

Pinwheel graphic titled "The Economic Benefits of Affordable Housing" with six segments: Reduced Healthcare Costs (lower expenses for individuals and society), Decreased Hospital Readmissions (fewer patients returning to the hospital), Lower Emergency Department Visits (reduced reliance on emergency services), Durable Impact (long-term positive effects on health and well-being), Addressing Mental Health (support for individuals with depression and anxiety), and Community Planning (integration of housing into health policies). The Reduced Healthcare Costs and Decreased Hospital Readmissions segments are highlighted in blue.

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Mason Roberts @masonroberts.bsky.social · 28/04/2026

REACH was wildly successful and there’s even higher hopes for LEAD. Here’s what was achieved:

A pros and cons graphic titled "LEAD Model" on a dark background. Pros listed on the left in blue: shared savings, prospective assignment, sensible pricing. Cons listed on the right in purple: equity concerns, infrastructure uncertainty, political risk. A central icon shows two figures with checkmark and X symbols above them.

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Mason Roberts @masonroberts.bsky.social · 07/04/2026

Your payer partners' financial pressure is your contract pressure. CMS is proposing some major shake-ups in MA for risk adjustment and Stars. Here’s a quick summary for both. For providers in VBC deals, this is going to directly impact the terms of your contracts.

Dual-arrow diagram titled "Navigating MA Changes for Contract Success." Left arrow (blue, risk adjustment): Training Data Update — shift in coefficients; Unlinked Chart Reviews — removed from calculation. Right arrow (gray, Star Ratings): Measure Removal — administrative measures dropped; Health Equity Index — reward eliminated; Historical Reward Factor — favors incumbents.

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

LEAD vs. REACH: What's actually new. No pussyfooting around - let’s get right to it. Benchmarking - This one is pretty huge. No more rebasing. Specialists - LEAD has built-in infrastructure for downstream episode-based risk between ACOs and Preferred Provider specialists (CARA)

Podium-style infographic titled "LEAD Program Innovations" showing three medal placements. First place: Benchmarking — durable shared savings corridor with stable floor and incentive to stay. Second place: Specialists — built-in infrastructure for downstream episode-based risk between ACOs and specialists. Third place: Duals — planning phase for Medicare-Medicaid partnership arrangements with select states.

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

Patient reported surveys just don’t cut it. -- Response rates are low -- They’re biased towards more privileged patients -- And they’re often gamed (see my last post) So what to do about it?

A balanced scale diagram titled "Balancing Outcomes and Surveys in Value-Based Care," showing Outcomes Measures on the left pan weighted down by Attribution Lag and Risk Adjustment Inadequacy, and Survey-Based Measures on the right pan weighted down by Attribution Ambiguity and Adverse Selection Incentives.

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

One of the major challenges i see repeatedly in my world is it’s extremely difficult to align incentives with outcomes. Here’s an example from the Medicare Advantage space, the Star ratings.

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

“AI won’t take your job. Someone using AI will.” I’m sure you’ve heard this before, but it’s not completely true. What we’re seeing in health care is that reliance on human connection insulates many from mass AI-driven job loss. What’s really happening is a role shift.

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Mason Roberts @masonroberts.bsky.social · 25/03/2026

New mandatory model from CMS, Ambulatory Specialty Model, targets Specialists in 25% of CBSAs. I was reading up on this and it’s really MIPS with some tweaks for specialists (a broad list) who treat heart failure or low back pain. Here’s the tweaks and how to know if you’re impacted:

Chart titled "Ambulatory Specialty Model (ASM) Impact." A donut chart shows that 25% of CBSAs (Core-Based Statistical Areas) are targeted by ASM, meaning specialists in those markets face new financial risk and peer benchmarking requirements. A caption reads: "ASM introduces financial risk and peer benchmarking for specialists, potentially driving performance improvements."

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Mason Roberts @masonroberts.bsky.social · 24/03/2026

Senate Democrats are signaling their priorities for healthcare reform. They’re largely focusing on the ACA marketplace given the large disenrollment and doubling in premiums, but for providers in the value-based contracts there are some important points to watch out for.

Infographic titled "Senate Democrats' Healthcare Reform Agenda" showing a target/bullseye graphic with four labeled arrows pointing toward the center. The four targets are: (1) ACA Marketplace — core focus due to disenrollment and premium increases; (2) Junk Insurance Plans — elimination of short-term and fixed indemnity products; (3) UM Management — increased scrutiny and potential regulations; (4) Big Insurance — potential breakup of large insurance companies.

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Mason Roberts @masonroberts.bsky.social · 19/03/2026

Hospitals drive healthcare costs more than insurance and physician billing and AI is likely to make it worse (or at the very least further bifurcate the market). A thread:

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Mason Roberts @masonroberts.bsky.social · 18/03/2026

Continuing on the Vivian Ho fest from yesterday, let's talk about her paper "Nonprofit Hospitals: Profits and Cash Reserves Grow, Charity Care Does Not," Health Affairs, June 2023. Between 2012 and 2019, mean nonprofit hospital operating profits grew from $43M to $58.6M, but

Bar chart titled "Allocation of Hospital Profits to Charity Care and Cash Reserves (2012–2019)" showing the estimated association between a $1 increase in hospital profit and changes in charity care spending versus cash reserves, broken out by hospital type. For charity care, all three groups show near-zero allocation: nonprofit hospitals $0, for-profit hospitals $0.04, and combined $0. For cash reserves, all three groups show allocations well above $1: nonprofit hospitals $1.73, for-profit hospitals $1.92, and combined $1.74. Source: Jenkins & Ho, Health Affairs, June 2023.

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Mason Roberts @masonroberts.bsky.social · 17/03/2026

What gives me hope is how many are working to improve our health system. Economist Vivian Ho has spent her career studying the factors leading to rising costs. I've been reading through her studies after listing to her interview on @AnArmandaLeg. I found

Line chart titled "Hospital prices outpace insurance and physician costs" showing the Consumer Price Index for three healthcare components from 2006 to 2023, indexed to 100. Hospital services (orange solid line) rises steadily throughout the period, reaching 184 by 2023, an 84% increase. Professional services (gray line) rises modestly to 138, a 38% increase. Health insurance (blue dashed line) tracks near the bottom until 2018, spikes sharply to a peak of 170 in 2022 due to BLS methodology changes, then drops back to 128 by 2023. Source: Kanimian & Ho, Health Affairs Scholar, 2024.

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Mason Roberts @masonroberts.bsky.social · 11/03/2026

As of January 2025, over 53% of traditional Medicare beneficiaries, more than 14.8 million people, are now in accountable care relationships, the largest annual increase since CMS began tracking this metric.

Infographic titled "Medicare Beneficiaries in Accountable Care" showing two statistics on a dark background: 53% of traditional Medicare beneficiaries — over 14.8 million people — are in accountable care, and 75% of ACOs earned performance payments totaling $4.1 billion. Caption reads: "Medicare beneficiaries are increasingly participating in accountable care, indicating strong progress towards value-based care goals."

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Mason Roberts @masonroberts.bsky.social · 10/03/2026

741 hospitals are now mandated to participate in CMS TEAM as of January 1, 2026. This means that bundles are no longer optional. By definition, all costs must be managed within a single fixed episode payment. This means you really only have two levers to pull:

Infographic titled 'Achieving Bundled Payment Success' showing three interconnected steps in a circular flow: (1) Precise Implant Management — categorize, benchmark, ensure compliance; (2) Surgeon Engagement — align goals with cost reduction; (3) Early Action — build governance framework now.

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Mason Roberts @masonroberts.bsky.social · 04/03/2026

VBC contracts are creating a new reinsurance frontier that existing actuarial tools weren't built for. What we see everyday is that pricing reinsurance to match the risk of a VBC contract is a gift that just keeps giving in terms of challenges. Let me give you a sense of the complications:

Mathematical formula showing the Delta Method approximation for the variance of a ratio R = X/Y. The formula expresses Var(R) in two equivalent forms: first using means and variances of X and Y with a covariance term, then equivalently using coefficients of variation (CV) and the correlation ρ between claims X and premium Y. Used to illustrate how MLR variance exceeds claims variance alone when pricing VBC reinsurance.

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Mason Roberts @masonroberts.bsky.social · 26/02/2026

This week seems to be revolving around hospital systems. My sense is that with the additional CMMI programs and the increases to our uninsured populations, hospital systems are feeling attacked from every angle (and thus the increase in news and posts).

Graphic titled “Hospital Systems Under Pressure” showing multiple interlocking gears around a large cracked central gear. Surrounding labels include: Incentive Misalignment (lack of motivation for VBC adoption), Reimbursement Changes (need to adapt to new payment models), Uninsured Populations (higher costs and reduced revenue), CMMI Programs (increased regulatory burden), Financial Architecture (inaccurate cost modeling and forecasting), and Data Infrastructure (inadequate data for informed decision-making). The cracked central gear symbolizes systemic strain within hospital systems.

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Mason Roberts @masonroberts.bsky.social · 25/02/2026

CMS has been doubling down on pushing hospital systems into risk with programs like TEAM and AHEAD. Readmissions, SNF quality issues, and poor handoffs and post-acute care costs now directly hit hospital margins.

Dark-background infographic titled “Strategies for Post-Acute Care Risk Sharing.” On the left is a series of concentric circles forming a target graphic, representing layered strategy. On the right, dotted arrows point to five labeled strategies with icons: Preferred Post-Acute Networks (globe icon), Shared Metrics and Reviews (handshake icon), Actionable Predictive Analytics (chart icon), Real-Time Data Visibility (document icon), and Share Post-Acute Care Risk (clock/medical cross icon).

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Mason Roberts @masonroberts.bsky.social · 19/02/2026

We all know there’s waste in the health system (~$750B annually), and many in my circles are working to reduce it. A recent Becker’s webinar featuring Dr. Mogul Mira (Illumicare/Premier) and Susan Hughes from Ardent Health shared their experience tackling this problem.

Slide titled “Reducing Healthcare Waste.” On the left, text reads “High Healthcare Waste – $750 billion annually” with a cost icon. In the center, a large circle labeled “Stewardship Program.” On the right, text reads “Reduced Healthcare Waste – $97 savings per admission” with a checkmark icon. Along the bottom, four components are listed: provide rules for medications and labs; integrate institution-specific cost data; provide references to peer-reviewed literature; implement context-based alerts.

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Mason Roberts @masonroberts.bsky.social · 18/02/2026

People don't want AI to replace human touch. They want it to make their life's easier, to remove barriers of access / cost and their work easier. From a business perspective, people want the same thing, but they want it in terms of bottom line and quality of experience / output.

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Mason Roberts @masonroberts.bsky.social · 17/02/2026

Knowing your BATNA is a VBC skill. Scripps didn’t exit Medicare Advantage emotionally. They exited it analytically. They understood their margins, their admin burden, their alternative revenue path, and negotiated accordingly. buff.ly/1Bl9Eew

Dark background graphic titled “How to approach Medicare Advantage contracts?” On the left is a large question mark. A horizontal line runs across the bottom with two labeled options above it. On the left, in blue, “Negotiate Analytically” with subtext: “Understand margins, admin costs, and alternative revenue to negotiate effectively.” On the right, in purple, “Treat as Fixed” with subtext: “Accept contracts as is, losing leverage and potential benefits.” The visual contrasts an analytical negotiation approach versus passively accepting contracts.

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Mason Roberts @masonroberts.bsky.social · 12/02/2026

We don’t have a data problem. We have a decision problem. This MIT Press / Harvard Data Science Review article makes a point that quietly explains a lot of frustration in healthcare analytics: Better models don’t automatically lead to better decisions.

Illustration titled “Ineffective Healthcare Analytics due to Decision Disconnect.” A stylized tree represents analytics, with branches above ground and roots below. Four labeled disconnects are shown with dotted lines: Operational Timing (models ignore real-world decision timelines), Decision Context (evidence not tailored to decision-makers), Actionable Insights (analytics explain risk, not impact of action), and Audience Disconnect (analytics built for analysts, not decision-makers). The visual emphasizes misalignment between analytics and real-world decisions.

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Mason Roberts @masonroberts.bsky.social · 11/02/2026

A new study confirms a familiar pattern (but with commercial data): Primary care intensity matters most for medium- and high-risk patients, and the relationship is nonlinear. There’s a clear inflection point where additional primary care stops producing savings and can even increase total cost.

Illustrated process flow titled “From Risk Identification to Cost Alignment.” Four purple plant pots appear left to right, connected by dashed arcs. The first pot, labeled “Untargeted Primary Care,” shows a hand scattering seeds with the caption “Over-investment dilutes ROI.” The second pot, “Risk Stratification,” shows a watering can pouring water, labeled “Necessary front door for care.” The third pot, “Downstream Decisions,” shows small leaves growing, labeled “Referrals, site of care, procedures.” The final pot, “Aligned Care Delivery,” shows a healthy flowering plant, labeled “Next cost frontier for ROI.” The visual conveys progression from unfocused primary care investment to aligned, cost-effective care delivery.

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Mason Roberts @masonroberts.bsky.social · 10/02/2026

One of the most common challenges we see in healthcare analytics: “We don’t have enough historical data to run a clean study. What do we do?” Recently, we ran into this in a pricing engagement. The client’s internal experience wasn’t deep enough to support a traditional trend analysis.

Graphic with dark background showing a bridge connecting “Data Scarcity” on the left to “Credible Analytics” on the right. The left side includes a dotted data icon and the text “Insufficient historical data hinders analysis.” The right side shows a bar chart icon and the text “Transparent, reproducible, and defensible models inform decisions.” Above the bridge is the headline “Healthcare analytics overcomes data limitations through defensible assumptions,” with a dashed arc illustrating the connection between limited data and credible analytics.

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Mason Roberts @masonroberts.bsky.social · 05/02/2026

I enjoyed this paper from JAMA Health Forum that looks at how physician payment incentives are playing out globally. A few fun (and unsurprising) facts from across countries: 1) Pay-for-performance programs are now common in Europe, the UK, Australia, and parts of Asia, not just the U.S.

World map highlighting countries with physician pay-for-performance or incentive initiatives. The United States is darkest (about 30 initiatives). Several European countries and the United Kingdom show multiple initiatives, while China, Brazil, and a few other countries show one initiative each. Most countries are shaded gray, indicating no identified initiatives.

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Mason Roberts @masonroberts.bsky.social · 04/02/2026

Happy Advanced Notice week to those that celebrate (a week late)! This year’s gift was… subtle. From a policy perspective, the 2027 Medicare Advantage Advance Notice signals stability. From a value-based care perspective, it signals opportunity.

Dark background slide titled ‘Unveiling MA Plans’ Needs from VBC Providers.’ On the left, an icon labeled ‘MA Plans’ Needs’ points toward a central gray triangular prism. From the prism, four arrows extend to the right, each pointing to an icon and label: ‘Predictable Medical Cost,’ ‘Early Risk Identification,’ ‘Operational Control,’ and ‘Fewer Surprises.’ The graphic illustrates how MA plans’ core needs translate into specific capabilities expected from value-based care providers.

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Mason Roberts @masonroberts.bsky.social · 03/02/2026

Over the past few months, our team has been formalizing how we use AI in actuarial and analytics work and one thing it painfully clear: AI absolutely boosts productivity, but only when it’s actively managed and governed.

Dark-themed infographic titled ‘AI Governance for Actuarial Success.’ A circular framework surrounds the center text ‘Implement AI Governance.’ Four sections are labeled: ‘Respect AI Limits – Dangerous outside capability frontier,’ ‘Prioritize Verification – First drafts are cheap,’ ‘Define AI Use Cases – Brainstorming ≠ reserving,’ and ‘Invest in Talent – Talent development matters more.’ At the bottom, a horizontal arrow shows a progression from ‘Unmanaged AI Use – Degraded judgment, poor quality’ on the left to ‘Managed AI Use – Boosted productivity, improved quality’ on the right. Icons represent each section, emphasizing the transition from risky to well-governed AI use.

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Reposted by Mason Roberts

KFF @kff.org · 30/01/2026

Highlights from this week’s edition of The Monitor: 💊 Have FDA decisions about the abortion pill consistently followed scientific evidence? 🤖 Google’s removal of some AI-generated summaries for search results about health topics. Read and subscribe: on.kff.org/4a6fn2W

on.kff.org

Abortion Pill Safety Decisions by FDA Were Science-Based, New JAMA Study Finds — The Monitor | KFF

A new study found the FDA’s abortion pill decisions followed scientific evidence, as misleading claims about the drug’s safety continue to shape public understanding. And Google removed some health AI...

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Reposted by Mason Roberts

KFF Health News @kffhealthnews.org · 30/01/2026

When hospitalized detainees can’t be found by family members or attorneys, advocates say, it leaves patients vulnerable to abuse and isolation and deprives them of their constitutional right to counsel. Read the full story ⤵️

kffhealthnews.org

‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees - KFF Health News

Some hospitals are registering patients detained by federal immigration officers under pseudonyms and prohibiting staff from contacting family members. Attorneys and health care workers say the practi...

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Mason Roberts @masonroberts.bsky.social · 29/01/2026

Reengineering ACOs is necessary, but it’s not sufficient. A recent Health Affairs Forefront article argues that Medicare needs to reengineer ACOs to stay competitive with Medicare Advantage. I agree with the premise and I think the hard part starts after the policy changes.

A dark-themed infographic titled “Reengineering ACOs for Medicare Competitiveness.” Four curved pillars progress left to right across a bridge-like shape. Pillar 1 reads “Predictable Benchmarks — Stable benchmarks for planning.” Pillar 2 reads “Credible Risk Adjustment — Explainable risk adjustment for trust.” Pillar 3 reads “Financial Tooling — Tools for managing financial variance.” Pillar 4 reads “ROI-Driven Care Coordination — Measurable ROI for care coordination.” Beneath the pillars, centered text reads “Focus on Execution.” On the lower left, a gray box reads “Uncompetitive ACOs — Medicare ACOs lag behind MA.” On the lower right, a gray box reads “Competitive ACOs — Medicare ACOs compete effectively.”

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Kathryn Anne Edwards @kedseconomist.com · 28/01/2026

The AI bubble is well trod territory. In my latest for Bloomberg, I write about the economy's dependency on an industry that has poor outcomes, inefficiently high costs, and is completely dependent on government support: health care. www.bloomberg.com/opinion/arti...

bloomberg.com

Health Care Is Just as Dangerous for the Economy as AI

Forget the AI 'Bubble' – Health Care Poses a Bigger Risk to the US Economy

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Reposted by Mason Roberts

Dr. DaShanne Stokes @dashannestokes.com · 27/01/2026

Minneapolis Police Chief Brian O’Hara told his officers that they have a duty to intervene if they see ICE committing crimes and will be fired if they don't. We need a lot more of this. www.ms.now/news/minneap...

ms.now

Minneapolis police chief warns officers: Stop unlawful force by ICE or lose your job

Chief Brian O’Hara says he’ll fire city police officers if they don’t intervene when immigration agents use unlawful force.

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Reposted by Mason Roberts

KFF Health News @kffhealthnews.org · 27/01/2026

New studies show unexpected, long-term health issues from covid, including increased risk of autism in children, cancer relapses, and brain damage. Meanwhile, Trump officials have narrowed covid vaccine recommendations and cut research. @stephaniearmour.bsky.social reports ⤵️

kffhealthnews.org

Trump Policies at Odds With Emerging Understanding of Covid’s Long-Term Harm - KFF Health News

Studies increasingly offer insights into the health risks and burdens faced by people who have had covid infections. Meanwhile, the Trump administration has narrowed covid vaccine recommendations and ...

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Mason Roberts @masonroberts.bsky.social · 28/01/2026

A recent JAMA Network Open paper on the Hospital Readmissions Reduction Program (HRRP) is a good reminder of something many of us run into in value-based care. The paper shows how HRRP penalties can shift simply because Medicare Advantage (MA) penetration changes.

Dark-themed infographic titled “HRRP Penalties: A Value-Based Care Challenge.” The graphic shows clusters of blue and purple squares representing shifting patient populations. Four labeled callouts highlight key issues: “Peer Grouping Ineffectiveness” (doesn’t solve all measurement issues), “Population Mix Sensitivity” (metrics shift with patient enrollment), “Risk Adjustment Limitations” (doesn’t fully capture patient health), and “Mix-Shift Incentives” (affects provider financial performance). The overall visual emphasizes how changes in population mix and risk adjustment can influence readmissions penalties in value-based care.

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Rep. Joe Neguse @neguse.house.gov · 27/01/2026

Last week marked 16 years since the Supreme Court’s disastrous decision in Citizens United. I’ve authored a proposed constitutional amendment — H.J.Res. 122 — to overturn it & over 70 of my colleagues have joined our effort. I’ll keep fighting to get it across the finish line.

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KFF @kff.org · 27/01/2026

Per enrollee spending by private insurers almost doubled from 2008 to 2024 — much faster than both Medicare and Medicaid spending growth per enrollee (59.5% and 51.6%, respectively.) More in our chart collection: on.kff.org/4r7rQKA

Line graph titled "Per Enrollee Spending by Private Insurance Has Generally Grown Faster Than Medicare and Medicaid Spending" showing the cumulative percent growth in per enrollee spending from 2008 to 2024 for private insurance, Medicare, and Medicaid. The data indicate that spending growth on private insurance is higher compared to Medicare and Medicaid over the period. The source of the data is KFF analysis of National Health Expenditure data, and the graph is from the Peterson-KFF Health System Tracker.

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Mason Roberts @masonroberts.bsky.social · 27/01/2026

It’s been a while since an AI/ML paper inspired me to post on LinkedIn, but if you’re looking for a method that would help with care intervention design, here’s a great option.

Diagram titled ‘Reeb Graphs for Care Intervention Design.’ On the left, ‘Unexplained System Dynamics’ with icons indicating uncertainty and the subtitle ‘Missing explanatory layer in healthcare.’ In the center, a circle labeled ‘Implement Reeb Graphs,’ with lines pointing downward to two outcomes: ‘Surface natural splits and bottlenecks’ and ‘Reason about intervention timing and impact.’ On the right, ‘Explained System Dynamics’ with icons indicating clarity and the subtitle ‘Understanding why the system behaves.

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David Roberts @volts.wtf · 26/01/2026

If only there were some sort of institution that could look into it and figure out who's got it right.

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KFF @kff.org · 24/01/2026

The flu is brutal this season. What we’re watching: Misleading narratives about flu vaccines and shifting federal guidance as flu vaccination rates decline from pre-pandemic levels to around 43% for both adults and children. on.kff.org/4jYjEdp

on.kff.org

AI Health Tools Raise Safety Concerns. Plus, Flu Vaccine Myths Spread During Record Season — The Monitor | KFF

A new features from AI companies, like ChatGPT Health and Claude for Healthcare, aim to provide personalized health guidance, but may still provide wrong or dangerous health advice. And, as the U.S. e...

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Eric Budd @ericmbudd.com · 23/01/2026

going to work to make sure a pro-ICE ballot measure goes down in flames. thanks for your reporting, Alex

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Mason Roberts @masonroberts.bsky.social · 21/01/2026

The HHS Office of Inspector General’s FY 2025 priority report has fairly direct implications for provider groups operating under value-based care contracts. At a high level, the report reinforces that federal oversight is tightening around the fee-for-service mechanics...

Dark graphic titled “Increased HHS Oversight Challenges Value-Based Care.” A stylized cave carved into rock represents value-based care, emphasizing that it sits within underlying fee-for-service structures. The hollow cave opening suggests exposure to oversight and scrutiny. Surrounding callouts highlight key impacts: “Fee-for-Service Mechanics” (underlying FFS mechanics are under scrutiny), “Shared Savings Scrutiny” (substantiating savings requires more documentation), “Medicare Advantage Risk” (RAF-driven upside is less predictable), “Operational Controls” (fraud, vendor oversight, and cybersecurity are financial risks), and “Claims-Level Scrutiny” (claims-level oversight still applies to VBC).

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David Roberts @volts.wtf · 18/01/2026

For some reason, very few people these days will stand up and say it, but: the US federal bureaucracy is one of the great wonders of the world, staffed with incredibly diligent people who do their jobs well and care deeply. Trump's destruction of the federal apparaus was a historic crime.

theatlantic.com

The Purged

Donald Trump’s destruction of the civil service is a tragedy not just for the roughly 300,000 workers who have been discarded, but for an entire nation.

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Mason Roberts @masonroberts.bsky.social · 16/01/2026

A Friday thought from music: Consistency matters more than intensity. Music taught me this. You can’t brute-force meaning. You show up, practice, share your work often without feedback, and trust that showing up will do its job.

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Mason Roberts @masonroberts.bsky.social · 15/01/2026

I just finished reading Integrating Environmental Health in the AI Era: An Urgent Imperative in Harvard Data Science Review, a must-read for anyone thinking seriously about the responsible scaling of AI infrastructure.

Illustration showing the progression of AI development as a butterfly lifecycle on a branch. From left to right: a caterpillar labeled “Unchecked AI Expansion” with text noting rapid growth and environmental costs; several chrysalises labeled “Transparent Reporting” (public data on energy, water, emissions), “Health-Informed Siting” (consider local burdens and equity), and “Open Data & Tools” (enable assessment and accountability); ending with a butterfly labeled “Sustainable AI,” described as innovation that benefits society.

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Mason Roberts @masonroberts.bsky.social · 14/01/2026

There’s a lot of hand-waving about what’s “wrong” with U.S. healthcare. This piece by Nikhil Krishnan at Out-Of-Pocket is one of the clearest attempts I’ve seen to actually lay the problems out—cleanly, structurally, and without pretending there’s a single villain or silver bullet.

Illustration titled “U.S. Healthcare System Challenges” showing a leaking bucket filled with water. Arrows represent problems causing leaks: volume-driven models with weak price discipline, fragmentation that destroys continuity and accountability, different stakeholders where buyers, users, and decision-makers differ, consolidation that creates leverage without transparency, and invisible costs hidden from stakeholders. The image conveys how multiple systemic issues collectively drain value from the U.S. healthcare system.

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Brian C. Keegan, Ph.D. @brianckeegan.com · 13/01/2026

No one should be particularly interested voting for candidates who promise to return to some imaginary fairy tale where Republicans and Democrats collaborated. This hasn't existed in at least 30 years and led to the current constitutional crisis.

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Mason Roberts @masonroberts.bsky.social · 13/01/2026

I went down a rabbit hole reading about the surge in Independent Dispute Resolution (IDR) under the No Surprises Act. At first glance, it looked like another commercial insurance story with no real relevance to provider value-based care. #ValueBasedCare #HealthcareFinance

Graphic titled “Should I enter a commercial VBC deal with a self-funded employer?” showing a central decision funnel with four considerations. On the left: “Evaluate Benchmark Inclusion” (determine whether out-of-network claims are included in the benchmark) and “Exclude Payer Savings” (ensure payer-generated savings are excluded to avoid artificial inflation). On the right: “Understand Pricing Basis” (clarify whether benchmarks use allowed, paid, or standardized prices) and “Address Pricing Changes” (establish audit rights to monitor mid-contract pricing behavior). The visual emphasizes due diligence in commercial value-based care contracts.

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Hank Green @hankgreen.bsky.social · 12/01/2026

This picture was taken in 2000 by an Associated Press photographer who was allowed to be present as an observer. ICE now keeps press blocks away from the areas where they are operating. One of the first actions ICE takes during a raid is to confiscate phones.

A famous photograph taken in April 2000 during a federal raid in Miami connected to the custody and immigration case of a six-year-old Cuban boy whose situation had become an international political dispute between the United States and Cuba. The image shows armed federal agents entering a private home to seize the child, who is being held by a relative inside a closet.

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