A cadre of elite techies, financiers, and high-level Trump administration officials have spent a year quietly charting an extraordinary and rapid campaign to persuade Americans to use apps and other artificial intelligence-powered tools to manage their healthcare and medical records.<\/p>\n
As that campaign has unfolded, administration officials have granted tech companies an unusual opportunity to nudge the nation\u2019s health department toward a loosely regulated future for AI health apps in which the government reimburses them for services as it does medical professionals.<\/p>\n
In February, federal health officials invited those businesses \u2014 including tech giants Microsoft, Anthropic, OpenAI, Apple, and Google \u2014 to a listening session on conversational AI products for patients, such as chatbots. Representatives from at least 35 industry organizations attended the meeting held by the Food and Drug Administration, which is responsible for regulating health apps as medical devices. Companies were prompted in advance to explain their AI products and how they access patients\u2019 sensitive medical information.<\/p>\n
But the meeting did not appear on the FDA\u2019s public calendar or regulatory notices, nor was the public invited. Rather, the invitation for a select group to help shape federal policy governing AI in healthcare was extended in a chat room on the messaging service Slack.<\/p>\n
\u201cThis is a great opportunity to support HHS\u2019 goals and share your state-of-the-art understanding of safe Conversational AI development and monitoring to help FDA shape future guidance,\u201d CMS senior policy adviser Morgan Taylor wrote in the Slack workspace.<\/p>\n
The Centers for Medicare & Medicaid Services has not formally announced the chat room through federal regulatory channels, though CMS officials have talked about it at industry conferences. Legal experts said the chat room resembles a federal advisory panel, which would be required to operate in public view.<\/p>\n
KFF Health News reviewed thousands of Slack messages, meeting transcripts, and video recordings that reveal how the Trump administration has granted the industry a direct line to top government officials \u2014 including former head of the Department of Government Efficiency Amy Gleason<\/a>.<\/p>\n The conversation took place behind the scenes as federal health officials publicly worked to integrate AI and other technology into nearly every aspect of healthcare, a plan they\u2019ve branded the \u201cHealth Technology Ecosystem<\/a>.\u201d<\/p>\n \u201cWe wanted to give industry a chance to play in the sandbox of government-supported healthcare,\u201d CMS Administrator Mehmet Oz said in September<\/a> at the public launch of an initiative that allows health apps to bill Medicare for AI services such as wearable device tracking. Last week, Health and Human Services Secretary Robert F. Kennedy Jr. delivered an enthusiastic endorsement of AI in healthcare, claiming it is \u201cmuch better informed than any doctor in the country.\u201d<\/p>\n Meanwhile, HHS staff even promised that a recently launched Medicare App Library<\/a> would serve as a lucrative pipeline for those businesses to get new users. The library\u2019s webpage currently promotes only two dozen commercial apps to millions<\/a> of American seniors and those with disabilities.<\/p>\n As Trump officials sell it<\/a>, Americans will get easier access to their medical records so apps can swiftly provide health or wellness advice. In practice, however, so will the tech companies.<\/p>\n Doctors, meanwhile, are increasingly worried about how patients use and share their medical records with the nascent technology.<\/p>\n \u201cSome of these tools just aren\u2019t ready for primetime,\u201d said John Whyte, CEO of the American Medical Association. \u201cWe don\u2019t have enough data about them. We don\u2019t understand how they work, how they\u2019re using the information. There\u2019s no liability if these tools get things wrong.\u201d<\/p>\n CMS officials declined to answer several questions about the Slack workspace, including about its legality.<\/p>\n \u201cCMS is focused on giving Medicare beneficiaries greater access to their health information and useful digital tools while promoting an open, interoperable healthcare system,\u201d Gleason, now chief product officer for the newly created Office of Health Technology and Products at CMS, wrote in an emailed statement. \u201cThe Health Technology Ecosystem is an open, voluntary technical collaboration. CMS will continue working with patients, providers, payers, technology organizations, and other stakeholders to make health information more accessible and useful to the Americans it serves.\u201d<\/p>\n The FDA did not respond to a request for comment.<\/p>\n The Conversation Begins<\/strong><\/p>\n The behind-the-scenes effort to funnel more Americans to AI-powered health apps began in August 2025 in the Slack workspace.<\/p>\n \u201cWelcome all!\u201d Gleason wrote. \u201cPlease be sure to read the Code of Conduct and see the Channel list as well to help you find channels that are relevant to you.\u201d<\/p>\n Gleason is best known for serving<\/a> as the acting administrator of Elon Musk\u2019s Department of Government Efficiency, as it gained access<\/a> to millions of Americans\u2019 sensitive personal and financial data, including at the Social Security Administration.<\/p>\n As her work with DOGE wound down last year, Gleason welcomed a variety of tech leaders, investors, and entrepreneurs to the chat room.<\/p>\n The Slack workspace\u2019s participants include representatives from major digital wellness companies like Oura Health, AI companies like Palantir, and investment outfits like 8VC, a venture capital firm<\/a> associated with Kennedy\u2019s son Finn<\/a>. While the Slack\u2019s member count has ballooned to 1,700 over the past year, only a handful of patient advocates, doctors, and hospital representatives are in it.<\/p>\n The code of conduct Gleason shared on Slack in August 2025 documented that CMS had quietly established a technology working group.<\/p>\n Documents have been reproduced from the CMS Health Tech Ecosystem Slack and highlighted by KFF Health News. <\/p>\n The document also set ground rules for the Slack workspace, noting that the group does not constitute an \u201cadvisory committee,\u201d nor would it be used \u201cto obtain advice or recommendations for HHS, CMS, or any HHS\/CMS officials.\u201d The code also advises that federal employees \u201care prohibited from endorsing any product, service, or enterprise.\u201d<\/p>\n Joseph Daval, a former FDA lawyer who is now a research specialist at Harvard Medical School, reviewed messages from the Slack workspace at the request of KFF Health News. He said the chat room in some ways resembles a federal advisory committee \u2014 an independent panel that can be formally stood up by an agency head, Congress, or the president to ensure agencies act in the best interest of the public rather than industry.<\/p>\n The law on advisory committees \u201cwas passed in part out of a concern about interest group capture, about anticompetitive capture of agency policymaking, about corruption,\u201d he said.<\/p>\n Daval said the chat group looks like a committee, with members interacting with one another and building consensus on preferred courses of action.<\/p>\n If it were a formal advisory committee, though, Daval said, it would be subject to certain \u201cmembership requirements having to do with independence and fair balance.\u201d<\/p>\n A \u2018Sales Engine\u2019<\/strong><\/p>\n Over a series of video calls, CMS officials promised tech leaders participating in the Slack workspace that the agency would promote their health apps.<\/p>\n Jacob Shiff, the chief AI and technology officer at CMS\u2019 Innovation Center, told industry representatives in a Zoom meeting in February that he hoped the agency\u2019s work would be a \u201csales engine\u201d for the health apps.<\/p>\n \u201cWe\u2019re going to have a directory of all the organizations,\u201d Shiff said in a video recording reviewed by KFF Health News. \u201cThe people on this call who hopefully will have amazing solutions that work will be the winners, and you have every incentive to obviously drive down your costs so you can be extremely profitable and scale. So hopefully we\u2019re selling \u2014 or enabling you guys to thrive.\u201d<\/p>\n A recording of the call had been publicly available through a Google Drive link but was made private the day after KFF Health News asked about comments made during the meeting.<\/p>\n CMS did not respond to queries about how the agency has decided which AI-powered health apps appear in the Medicare App Library or why federal employees have promised to promote the products.<\/p>\n Days before publicly launching the Medicare App Library, CMS officials promised AI tech leaders during an informal meeting that the new webpage would become an important distribution channel for health apps because Medicare enrollees would place trust in products listed on the CMS website.<\/p>\n \u201cIf medicare.gov is promoting it, for lack of a better word, then yeah, it would be an app that I would trust and explore,\u201d CMS\u2019 Taylor said during the April 7 meeting, channeling enrollees, according to a transcript of the call.<\/p>\n The Medicare App Library\u2019s webpage encourages older and disabled Americans to manage health conditions such as obesity, cancer, or diabetes using two dozen AI-driven apps developed by some of the world\u2019s largest corporations, including Microsoft and Google. Many of the apps promise in their product descriptions to give insight, perform analyses, or develop plans that will help patients lose weight or manage diabetes.<\/p>\n CMS officials have suggested to tech representatives during at least two meetings this year that those apps will be prioritized for a new agency program that reimburses companies for AI chatbot advice or wearable device tracking, according to video recordings.<\/p>\n CMS has not publicly divulged all the criteria it uses to decide which apps are listed in its library, but the webpage promotes apps still in their infancy.<\/p>\n Among them is Slothwise, a health app launched this year from a San Francisco apartment by a young, self-described<\/a> biotech entrepreneur and triple citizen of Russia, Israel, and the U.S. The app<\/a> says it \u201cknows your whole health\u201d by analyzing medical records and tracking health data for $9.99 a month. It has been reviewed on the Apple and Google app stores only a handful of times.<\/p>\n \u201cI trusted slothwise with my health info because it was endorsed by medicare,\u201d one reviewer wrote in a Google review<\/a> in August. \u201cConnecting info was smooth and I learned a lot about my health.\u201d<\/p>\n In a statement, Slothwise CEO Sofia Sigal-Passeck did not answer questions about the size and medical expertise of her current team, nor about the availability of a doctor to consult with patients who use the app. The app, she said, is only \u201cinformational\u201d at this time.<\/p>\n \u201cI\u2019ve spent years building at the intersection of AI and complex biological data,\u201d Sigal-Passeck wrote in an email. \u201cA small team is not the same thing as an inexperienced team. Slothwise is built by physicians, PhD researchers and engineers.\u201d<\/p>\n \u2018No Regulation, No Rulemaking\u2019<\/strong><\/p>\n What\u2019s often less clear \u2014 and buried deep in lengthy privacy policies \u2014 is that these apps are tapping into the intimate details of patients\u2019 medical records to fuel their AI-driven analyses.<\/p>\n Tech vendors have lobbied the government<\/a> to treat these apps, once they are vetted and authorized by a third-party organization, like a patient requesting records. That position gives apps sweeping access to pull sensitive health data from the national network through which providers electronically exchange medical records, called the Trusted Exchange Framework and Common Agreement<\/a>, or TEFCA.<\/p>\n A small but influential group of those tech company executives directly made the case to federal health officials during a formal meeting<\/a> in May, arguing that when health apps request medical records they should be treated as if they are standing \u201cin the shoes\u201d of a patient.<\/p>\n On Slack, tech vendors have lobbied for a \u201cfrictionless pathway\u201d for verified users, after they\u2019ve consented once, that allows the app to gain limitless access to patients\u2019 medical records from the TEFCA network.<\/p>\n Ryan Howells, a healthcare management consultant who lobbies for a Washington, D.C.-based digital health tech organization called the CARIN Alliance, has spearheaded an effort for patients \u2014 vis-\u00e0-vis apps \u2014 to more easily access medical records. He has regularly noted in Slack that health apps accessing TEFCA must be vetted by a third-party organization \u2014 one of which he sits on the board of \u2014 and agree to a code of conduct, developed by the alliance he lobbies for.<\/p>\n \u201cWhat more can you do to have trust in these apps?\u201d he wrote in a March Slack message, responding to concerns about how much patient consent is needed for apps to access medical records on the network.<\/p>\n Kristen Valdes, the CEO of b.well, a company that also connects apps to the TEFCA network, made a similar argument.<\/p>\n \u201cMy opinion is that we need to stop protecting patients from themselves,\u201d she wrote in the same message thread. \u201cFull stop.\u201d<\/p>\n Howells did not respond to an emailed list of questions from KFF Health News. In an interview, Valdes told KFF Health News that her comment reflected her frustration at the \u201cpaternalism\u201d of the healthcare system, which she said has historically made it difficult for patients to access their records. Although, she said, \u201cthere are going to be good and bad apps.\u201d<\/p>\n Other tech leaders worried in Slack about the approach.<\/p>\n One startup founder cautioned the group to think about the pitfalls of giving health apps broad leeway to pull medical records.<\/p>\n \u201cWe might all be good, honest actors here but security & privacy systems have to be designed around the presence of malicious actors \u2013 especially if we want this system to scale up to thousands of apps,\u201d wrote Jason Kulatunga, who runs Fasten Health, a medical records management platform.<\/p>\n Gleason, the CMS official, has publicly championed the vision shared by Howells and Valdes. In her speeches, she frequently urges doctors to accept patient medical records directly from apps and calls on them to \u201cKill the Clipboard<\/a>,\u201d also the title of a 2025 white paper<\/a> co-authored by Howells that urges doctors\u2019 offices to abandon paper records.<\/p>\n Last month, Gleason spoke to a crowd gathered at a swanky hotel in Washington for an event hosted by the MAHA Institute, a think tank that supports Secretary Kennedy\u2019s agenda. She laid out her work with tech companies over the past year as she discussed the Trump administration\u2019s efforts to make medical records more digitally accessible.<\/p>\n As she told it, more Americans can now download an app and access their medical records.<\/p>\n \u201cOnce you\u2019ve verified your identity you can just click a simple button and say, I\u2019d like my medical records into whatever app I choose,\u201d Gleason said.<\/p>\n She continued: \u201cThat was all done just \u2014 no regulation, no rulemaking \u2014 just by challenging industry to work together.\u201d<\/p>\n<\/div>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" A cadre of elite techies, financiers, and high-level Trump administration officials have spent a year quietly charting an extraordinary and rapid campaign to persuade Americans to use apps and other artificial intelligence-powered tools to manage their healthcare and medical records. 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