Blue Cross Blue Shield of Massachusetts just posted a $400 million loss—the worst in their history. The culprit? GLP-1 medications that could eventually save insurers billions. The costs hit today, the savings arrive years later, and health systems are caught in the middle.

GLP-1 medications may do far more than treat diabetes or reduce weight. If they substantially cut obesity and metabolic disease, they could trigger the first large-scale decline in healthcare demand seen in the modern era. This piece explores how earlier demand shocks reshaped medicine, why GLP-1s pose a similar challenge for chronic-disease–based service lines, and what hospitals must do now to prepare for a world with fewer cardiometabolic patients.