Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

Twelve utilization review nurses at Montefiore Medical Center went on strike earlier this year. Their new contract included language requiring nurse input when management introduced new technology such as artificial intelligence. Then came the part every patient advocate should pay attention to.

In May, Montefiore announced plans to eliminate 12 utilization review nursing positions. The New York State Nurses Association says software from Datavant took over work those nurses performed. Montefiore disputes the union’s characterization of the layoffs as AI replacing nurses. Reporting from August confirms that the nurses had started using Datavant after returning from the strike and that the layoffs followed a few months later.

Argue about the technology all you want.

The bigger question sits right in front of us.

Who owns the judgment?

Utilization review involves far more than moving information from one box to another. Nurses bring clinical experience to decisions involving medical necessity, insurance coverage and complex patient circumstances. NYSNA argues that those nurses used years of clinical judgment to advocate for coverage of hospital stays, surgeries, medications and other care.

Paperwork was never the job. Judgment was the job.

And healthcare keeps finding new ways to separate judgment from the people closest to patients.

AI did not create that problem. Healthcare has spent years consolidating decision making.

A 2025 analysis of 276 hospital acquisitions of physician practices found that hospital ownership of physician practices increased 71.5% between 2008 and 2016. Two years after hospitals acquired OB-GYN practices, physician prices for labor and delivery increased 15.1%, or $502 on average. Hospital prices increased 3.3%, or $475. Researchers attributed those increases to reduced competition.

Different issue. Same question.

Where does the decision sit, and who can challenge it?

I keep coming back to that question because patient advocacy teams inside pharma and biotech face their own version of it.

Companies collect patient insight everywhere: advisory councils, advocacy partnerships, patient support programs, market research, listening sessions, journey mapping, social listening.

The industry has gotten very good at listening.

What happens next gets a lot murkier.

A patient organization identifies an access barrier. Someone documents it. The insight enters a deck. A team discusses it. People agree that it matters.

Then what?

Who has to answer? Who owns the decision? Who records what changed?

That accountability gap matters because patient engagement only creates value when somebody connects learning to action.

A 2024 patient engagement impact measurement framework co-created by industry stakeholders and patient expert advisors calls for organizations to track patient engagement activities, insights gathered, resulting decisions and actions, and downstream value.

The authors get even more specific. Companies should capture what they learned from patients and what they did with those learnings. When they cannot act, they should document the reasons and barriers.

Read that again.

What did you learn? What did you do?

Those two questions expose a lot.

I have spent enough years around patient advocacy teams to know how uncomfortable the second question can get.

Teams can usually show me the listening. They can show me the advisory board, the research, the patient journey, and 64 slides explaining what patients said.

Then I ask:

Which business decision changed?

The room gets quieter.

That silence tells you more about the influence of patient advocacy than another engagement metric ever will.

What the Best Companies Do Differently

Start with something painfully simple.

Give the insight an owner.

When an advocacy partner identifies an access problem, assign someone with actual decision authority to respond.

Yes.

No.

Not yet.

Then document why.

That creates a trail from patient insight to business decision.

The Klein framework makes the same underlying point through measurement. Its authors define actions as the decisions made and work performed because of patient learnings. They also call the recording of those decisions and actions critical to demonstrating the value of patient engagement.

That changes the conversation.

Patient advocacy stops measuring influence through activity alone.

How many meetings did we hold? How many advocates participated? How many insights did we collect?

Useful questions. Incomplete questions.

Add one more.

What changed because patients spoke?

Now you have accountability.

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You can test your organization this week.

Pull the last three meaningful patient insights your team escalated. For each one, ask:

Do not run another listening session until you can answer those questions.

Because collecting another hundred patient insights will never fix a system that cannot account for the first hundred.

That lesson reaches far beyond Montefiore.

Technology will keep moving faster. Healthcare organizations will keep consolidating. Commercial pressure will keep growing. Every one of those forces will make efficiency easier to measure than human judgment.

Patient advocacy has a different job.

Make sure patient context reaches the decision. Then make somebody accountable for what happens next.

Paperwork was never the job.

The decision was.

And it still is.

The Advocacy Influence Diagnostic helps you see where that connection breaks inside your organization. It takes about five minutes and responses remain anonymous

For a direct conversation, email [email protected].