As we near the end of the administration’s first year, continued state and federal shifts are forming the future of the healthcare landscape. These changes highlight a growing urgency around public health protections, health data interoperability and financial pressures in care delivery.

• CMS Rural Health Transformation Program (RHTP) Spurs State Action: The Centers for Medicare & Medicaid Services (CMS) recently launched the RHTP, offering states new funding opportunities to strengthen rural care delivery. With a focus on integrating behavioral and physical health, closing equity gaps and improving data sharing, RHTP is designed to help states reduce costs and expand access for high-need populations. For state Medicaid leaders, health systems and community partners, this initiative presents a unique chance to align infrastructure investments with sustainable federal support.
• Florida Moves to Restrict 7-OH Opioid Products: In August, the Food and Drug Administration (FDA) endorsed Florida’s decisive step to restrict concentrated forms of 7-hydroxymitragynine (7-OH), a potent opioid. Florida Attorney General James Uthmeier filed an emergency rule, effective immediately, classifying concentrated 7-OH products as Schedule I controlled substances. FDA Commissioner Marty Makary, M.D., M.P.H., applauded the move, citing growing concern over youth-targeted products, such as gummies, candies and even ice cream cones, containing concentrated 7-OH. The FDA has already recommended a federal scheduling action, and the Drug Enforcement Administration (DEA) is currently reviewing the proposal. While the federal process requires a public comment period before finalization, Florida’s swift action underscores the momentum states can take to protect communities from emerging drug threats. For providers, health plans and community health partners, this development reinforces the importance of monitoring evolving state-level drug classifications, which may precede federal action.
• Federal Reorganization and New Interoperability Standards With a New CTO: At the federal level, the Trump Administration recently announced a reorganization of the Advanced Strategic Technology Program (ASTP) under the new Office of the Chief Technology Officer (CTO) at the Department of Health and Human Services (HHS). The office, reporting to Deputy Secretary Jim O’Neill under Secretary Kennedy, will be pivotal in advancing nationwide health IT interoperability. The CTO’s focus includes promoting secure, efficient electronic health information exchange across the care continuum and continuing the implementation of the Trusted Exchange Framework and Common Agreement (TEFCA) to build a more connected national infrastructure. This realignment signals a renewed federal emphasis on health IT modernization, with direct implications for providers, health systems, and technology partners navigating data exchange, compliance, and care coordination.
• Medicaid Cost Pressures and ABA Services in Focus: At the health plan level, mounting financial pressures are reshaping the conversation around Medicaid. Centene recently flagged surging costs for applied behavior analysis (ABA) services, raising concerns about sustainability as demand continues to climb. With Medicaid already under strain in multiple states, these rising costs underscore the challenges payers face in balancing member access to essential therapies with the economic realities of reimbursement and program design. For health systems and provider organizations, these payer pressures may influence coverage policies, reimbursement rates, and network participation strategies, particularly in areas like behavioral health where service demand is rapidly expanding.

As state and federal priorities continue to evolve, organizations must remain agile to track regulatory shifts, assess compliance impacts and ensure strategies align with evolving public health and financial realities. At Bamboo Health, we’re committed to helping organizations navigate these changes with actionable insights and strategies. Contact us today to learn more about empowering life-improving actions for everyone experiencing physical and behavioral health disorders.

As the opioid crisis continues to claim more than 3,000 lives in Illinois each year, healthcare organizations and state agencies must critically evaluate whether current controlled substance strategies are doing enough. The promise of Prescription Drug Monitoring Programs (PDMPs) lies not simply in collecting and surfacing data, but in delivering timely, actionable insights to clinical decision-makers at the point of care.  

Across the country, many states have embraced this opportunity, integrating advanced PDMP insights into electronic health records and pharmacy systems to support earlier intervention, more coordinated care and better outcomes. Illinois’ existing infrastructure and approach falls short of meeting today’s clinical and public health needs, especially concerning interstate data sharing. 

It’s time to shift the conversation. PDMPs are not just compliance tools. When leveraged effectively, they are a critical public health infrastructure that saves lives.  

• Prioritize Continuity of Medication for Opioid Use Disorder (MOUD) Treatment: Providers need easily accessible tools and insights to monitor treatment consistency.  For example, buprenorphine and other MOUD therapies are proven to reduce overdose risk, but only when treatment is consistent.  Fragmented systems and siloed data too often obscure when patients fall off their treatment plan. 
  Advanced PDMP integrations can surface this information directly within the EHR workflow, helping providers identify gaps in care and intervene early, before lapses lead to  overdose.  It’s not just about tracking prescriptions; it’s about enabling proactive recovery support.  

• Embed Overdose History at the Point of Care: When prescribers gain timely visibility into a patient’s prior overdose events within clinical workflows, they can more easily tailor treatment plans and initiate appropriate interventions for at-risk individuals. Research shows that nearly one in five individuals with a prior overdose will experience another one — yet this information is not always surfaced to prescribing clinicians when it matters most. Modern PDMP solutions are already delivering this level of insight in other states.  Embedding overdose history directly into clinical workflows allows providers to tailor care and initiate or adjust treatment plans accordingly.  

• Leverage Data for System-Wide Improvements: Using dispensation trends and overdose reporting can support individual care and offer tools to identify at-risk populations, optimize resource allocation and improve behavioral health outcomes. With streamlined insights, organizations can lower healthcare costs and enhance system efficiency. Beyond individual care decisions, these strategies hold promise for systemic improvements. By leveraging dispensation trends and overdose reporting, PDMPs can become powerful instruments for tracking at-risk populations, streamlining resource allocation and identifying broader behavioral health needs. These insights also contribute to financial sustainability: patients with behavioral health conditions, including substance use disorder, can cost 2.8 to 6.2 times more to treat when their care lacks coordination. Reducing redundancy, avoiding re-admissions and improving outcomes translate into measurable cost savings for states and healthcare systems. 

State agencies responsible for PDMPs have an opportunity and a responsibility to ensure programs are delivering value where it matters most: to the clinicians and patients at the center of the opioid crisis.  

But the path forward requires more than compliance; it demands reimagining how data is used, who it reaches and when. It means embracing modern, integrated solutions that embed clinical insights directly into care workflows.  It means making overdose risk visible, supporting treatment continuity, and empowering providers with the information they need while maintaining patient privacy and clinical relevance. By taking a holistic, proactive approach, state PDMP programs can be instrumental in preventing avoidable deaths and advancing more compassionate, effective care across communities. 

To learn more about improving your controlled substance strategy, read more here or contact Bamboo Health. 

A Fierce Healthcare Podnosis Interview With Jeff Smith, CEO of Bamboo Health

Fast Facts:

• Adults with five or more chronic conditions see an average of 14 physicians and have 37 annual appointments (CDC)
• Individuals with behavioral and physical health conditions cost up to 3.5 times more than those without (Milliman)
• The top 5% of high-cost patients account for nearly 50% of all U.S. healthcare expenditures (Kaiser Family Foundation)
• One in five adults in the U.S. live with a behavioral health condition (National Institute of Mental Health)

In today’s fragmented healthcare system, high-need, high-cost patients, especially those with behavioral health challenges, too often fall through the cracks. On a recent episode of Podnosis, Jeff Smith, Chief Executive Officer of Bamboo Health, joined Fierce Healthcare to discuss how real-time care navigation, interoperability and artificial intelligence (AI) are reshaping the future of complex care.

Q: Why are high-need, high-cost patients such a priority for health systems?

A: Roughly 20% of patients drive 60% of healthcare costs. What’s striking is how frequently behavioral health is a factor. One in 20 U.S. adults are diagnosed with serious mental illness each year, and even more, one in six U.S. youth aged 6 to 17 are diagnosed. Proactive, coordinated care addressing physical and behavioral health is essential to improve outcomes and reduce costs.

Key takeaway: Addressing behavioral and physical health is essential to improving care and controlling costs.

Q: What happens when behavioral and physical health are not integrated?

A: I recently visited a behavioral health clinic, and the director told me her biggest challenge is coordinating care for patients’ physical health needs. Without integration, patients face fragmented care, missed follow-ups and unnecessary emergency department (ED) visits. Integrated care models reduce ED visits and hospitalizations, improving outcomes during pivotal care moments.

Key takeaway: Integrated care improves quality of life and reduces overutilization of the ED and hospital.

Q: What role does care navigation play in closing these gaps?

A: A patient with five or more chronic conditions sees an average of 14 physicians in one year and uses a larger number of medications, lab tests and imaging studies than other Medicare patients while suffering more adverse events. For this group, real-time care navigation is essential. It bridges communication across providers, guides patients to the appropriate level of care and prevents unnecessary readmissions. The ability to respond during pivotal care moments, such as post-discharge or following a new diagnosis, is vital to improving adherence and outcomes.

Key takeaway: Real-time care navigation reduces redundancy, improves continuity and supports adherence.

Q: How can health plans, providers and community organizations collaborate more effectively?

A: First, we need shared data and insights. When everyone aligns around the same patient information, decision-making becomes streamlined. Second, we must build high-performing networks across all care sites, including community organizations, to support social determinants of health. These networks allow us to match individuals with the right provider or providers for their needs.

Key takeaway: Collaboration requires shared data, integrated care networks and attention to social factors.

Q: How does real-time data support value-based care?

A: Real-time data drives early identification of risks and enables timely interventions. It supports the closure of quality care gaps and accurate documentation for risk adjustment, especially under models like Medicare Advantage v28. The new model improves the accuracy of how Medicare Advantage plans are paid, particularly for managing complex patients with chronic conditions. Giving physicians prospective insights helps them manage conditions proactively and sustain the care infrastructure required under value-based care.

Key takeaway: Real-time data underpins better quality, risk management and reimbursement alignment.

Q: What innovations are you most excited about?

A: Two key innovations are transforming care delivery. Real-time, interoperable data empowers care teams to coordinate and respond more effectively. In parallel, AI unlocks predictive analytics, early warning signals and personalized support, available 24/7 and enhanced by human oversight.

Key takeaway: AI and real-time data unlock proactive, personalized and scalable care delivery.

Listen to the full episode on Fierce Healthcare’s Podnosis: Tech-Driven Care Navigation: Transforming Outcomes for Complex Patients

The second quarter of 2025 brings continued transformation to the healthcare policy landscape, especially with the release of the proposed Fiscal Year 2026 budget. As federal agencies reorganize policy priorities, significant structural and budgetary changes are beginning to take shape. Below are highlights of changes that will impact behavioral health:

• Creation of the Administration for a Healthy America (AHA): Central to the budget proposal is a sweeping reorganization that would consolidate mental health and substance use functions under a new agency: the Administration for a Healthy America (AHA). The agency would absorb functions from multiple offices, including the Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA) and others. The intent is to reduce redundancy and create greater efficiency.
• Impact of New Block Grant Structure and Funding Shifts: The AHA’s proposed $19 billion budget includes the creation of the Behavioral Health Innovation Block Grant. This $4 billion program consolidates the Community Mental Health Services Block Grant, Substance Use Prevention, Treatment and Recovery Support Services Block Grant and State Opioid Response. This shift to a block grant structure is designed to give states greater flexibility, but it also introduces the risk that funding may not keep pace with inflation or evolving public health needs. Similarly, the CDC’s former programs in violence prevention, suicide prevention and opioid overdose response would now fall under a new $550 million consolidated grant managed by the National Center for Injury Prevention and Control, leaving states to decide how to prioritize use of these block grant resources.
• Maintenance of Funding for 988 Lifeline and Other Programs: The 988 Suicide and Crisis Lifeline is proposed to receive $520 million in FY26, down slightly from the FY25 appropriation of $601.6 million. This funding is expected to maintain a 45-second average response time and support over nine million contacts. Additional investments in youth suicide prevention and behavioral health services, including Project AWARE, the Child Traumatic Stress Network and Certified Community Behavioral Health Clinics (CCBHCs), remain in the budget. However, states and localities must assess how these changes in federal structure and oversight impact the continuity of services and funding streams.

While policy priorities for the second term of the Trump administration continue to emerge and broad restructuring is pursued, the path forward for many public health and behavioral health programs is not fully known. With the potential for states to gain more discretion over how funds are used, greater variety in program implementation and prioritization across states is likely.

At Bamboo Health, we’re committed to helping organizations navigate these changes with actionable insights and strategies. Contact us today to learn more about empowering life-improving actions for everyone experiencing physical and behavioral health disorders.

Recent headlines have brought a painful truth to the forefront: nearly one in four children in the United States lives with a parent who has a substance use disorder (SUD), according to a 2025 NPR report. Behind the statistic are millions of families grappling with instability — children growing up too quickly, navigating emotional strain and often doing so in silence.

SUDs don’t happen in isolation, and they don’t heal in a vacuum. Without support, they fracture families and leave children managing instability and trauma long before they’re ready. Addressing these challenges demands systemic changes that recognize the full scope of family-centered care and prioritize early intervention.

A Call to See the Bigger Picture

The data derived from the National Survey on Drug Use and Health conducted by SAMHSA underscores the systemic nature of overdose and mental health crises. It’s not just a public health issue — it’s a family and child welfare crisis, too. According to Medscape, children growing up with parental SUD face greater risks for mental health issues, SUD later in life, academic challenges and interaction with the juvenile justice system.

Moving Toward Family-Centered Solutions

While there’s no single solution to addressing the intergenerational effects of substance use disorder, there is a better path forward — one rooted in whole-person, collaborative care. That means:

• Cross-sector coordination between behavioral health, social services and education
• Data-driven insights to identify at-risk families early for proactive intervention
• Trauma-informed approaches that prioritize the safety and stability of children
• Equitable access to behavioral health services and treatment across communities

Bringing these elements together breaks down silos and builds systems that respond to individuals in crisis and the family members and communities that surround them.

We Can and Must Connect the Dots

To connect the dots, healthcare providers need timely insights into pivotal care moments, specifically during transitions like hospital discharges when patients may require follow-up care and coordination. Effective systems must surface these insights quickly and support timely interventions. Equally important is having streamlined referral pathways and real-time visibility into behavioral health treatment availability so parents are connected to care without delay. When care extends beyond the individual and considers the entire family context, outcomes improve and gaps in coordination begin to close.

A more connected approach to behavioral health is emerging, supported by partnerships across state agencies, health systems and community organizations. It’s built on the understanding that when a parent struggles, the entire household experiences the impact.

Connection to care, community and hope is essential to breaking the cycle of behavioral health challenges. Real change becomes possible as systems become more integrated and families feel confident in response strategies.

Want to build a more connected behavioral health system?

Contact us or follow us on LinkedIn to explore how real-time insights and integrated strategies can better support families and communities.