The Ideas We Brought Home from Texas Covered 2026

On the spot observations from the CureIS Healthcare team.

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In the opening keynote at Texas Covered, we heard a story about a New York textile mill in the late 1800s. The mill replaced its giant steam engine with a shiny new electric generator. Everyone expected a breakthrough. But productivity barely changed.

The problem wasn’t the new-fangled power source; it was the layout. The factory was built around the old steam behemoth, with the same ropes, pulleys and floor plan. The real gains would come later, when people started redesigning factories around the idea that electric power could be distributed anywhere.

That story stayed with us all week in Austin.

Texas Covered took place during the final days of the midterm campaign and moved right into Election Day. You could feel the tension in the hallways. People weren’t talking about the future of health care in the abstract. We were watching it unfold in real time.

The mill came up in conversations about health care’s equivalent: How do you get value from new tools, when too many old systems operate on the old “floor plan” beneath them.

What the sickest patients did. A surprising copay question.

Keynote speaker Ziad Obermeyer, an emergency physician turned AI researcher, talked about a study on Medicare patients who hit the Part D coverage gap and suddenly faced a jump in drug costs. The assumption might be that the sickest people would be the last to stop taking their heart and stroke medications. The data showed the opposite. The highest-risk patients cut back the most.

That led to one of the more interesting questions of the conference: If a medication is worth far more to one member than another, why are they paying the same copay? For some members, he suggested, the right copay might be less than zero. His idea wasn’t a vision requiring some distant future-state system. Much of the information needed already exists in claims data. The challenge for plans is how to connect and use that data in a “floor plan” that enables better decisions for members.

Five-minute provider responses. Curative’s contracting numbers.

Fred Turner, CEO of Curative, shared a number people talked about over lunch. His contracting team of about 45 people signed roughly 2,100 provider agreements last year. Curative’s AI agent signed ~2,400 in one week. But the detail that stood out most to us was about response time. Providers now hear back within five minutes. That means a rural chiropractor can get attention as quickly as a big health system.

Not everyone at the conference described AI in sweeping terms. One policy panelist called AI “iterative, not transformative, but accelerating.” He described an arms race, with providers using AI to bill more, and plans using it to push back. Either way, the edge goes to whoever’s data, workflows, and teams can keep up.

If Avik Roy couldn’t comparison-shop for an MRI, where does that leave most members?

Avik Roy of FREOPP has spent much of his career arguing that markets can work in health care. Then he tore his Achilles and tried to price-shop for an MRI. His experience mirrored that of numerous members struggling with pages of forms and a week’s wait for every quote. Since surgery would blow through his deductible anyway, all that effort and frustration saved him almost nothing.

The CEO panel explained why. Members may switch providers over a $50 to $100 price gap, but an hour of hassle makes them give up. When Community Health Choice launched its price-transparency portal, demand crashed the tool. People want to shop. They just don’t want to fight the system to get the information they need.

Roy pointed to a policy fix from Indiana, proposing that claims list the actual address where care was delivered. Hospitals opposed it, because an address can reveal when an off-campus clinic is billing hospital rates. Sometimes the most radical transparency you can ask for is a street address.

The $8,000 premium increase voters notice.

Roy also borrowed a line from the late economist Uwe Reinhardt: “It’s the prices, stupid.” He put it in household terms. From 2015 to 2025, he said, the average family’s property taxes rose by some $1,200 a year. Their health insurance premiums rose by about $8,000. Guess which one politicians campaign on?

Employers have stopped waiting for Washington to notice. The CEO panel described double-digit cost trends and said January 1 renewal submissions at Blue Cross Blue Shield of Texas were up roughly 50%. For years, employers worried that changing benefits would upset employees more than the rising costs. That has flipped.

Washington may be stuck. The states are not.

The election-eve keynote came from a Blue Cross Blue Shield Association veteran who has worked in Washington since the late 1990s. He described the current environment as the most “poisonous” gridlock he has seen and predicted that big federal reform is unlikely. Other sessions echoed this theme, with panelists saying the real action is moving to agencies and state capitols.

Texas is a major part of that story. The state has been called “ground zero” for No Surprises Act dispute resolution, with about $22 billion flowing through that process last year. One panelist predicted that states will push Medicare Advantage and Medicaid plans toward reviewing claims before payment rather than trying to recover money afterward. He said prospective review recovers about nine times more than chasing payments after the fact.

For health plans, change may not arrive as one sweeping federal law. It’s more likely to come as a steady drip of new rules, new reporting requirements, and new data feeds.

The hard part is still the data.

Leaving Austin, we kept thinking about that textile mill; new power dropped into an old layout doesn’t change productivity automatically.

Health plans have plenty of new power coming at them: AI that works in days instead of years, members ready to shop, states writing their own rules. When and if those forces deliver value will depend on the floor plan.

In health care, that floor plan is the data environment. The next wave of change has the potential to improve efficiency and outcomes. Successful transformation will depend on getting claims, provider, eligibility and member data clean, connected, and ready to move.

That work is not as glamorous as building an AI prototype over a weekend. But it’s the work we love doing at CureIS, and Texas Covered reminded us why it matters.

New tools only deliver on expectations if the data is ready.