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Rush University Medical Center in Chicago is adding a new twist to its curriculum for medical students and residents, using AI tools and learning modules to teach how to more quickly identify measles rashes on different skin tones.

Why it matters: It's another reminder that diseases once thought to have been eradicated are showing up in clinics and ERs and posing challenges for younger physicians and health workers.

• Lingering vaccine hesitancy and distrust of the medical establishment stoked by Health Secretary Robert F. Kennedy Jr. are leading some health systems to add training on old scourges that were practically wiped out by immunization campaigns and increased surveillance.

"You're taught these things in medical school, and you're taught from a very academic perspective with the sense of measles was eradicated in 2000," said Nicholas Cozzi, EMS medical director at Rush.

• "Now we're having a resurgence, the highest in 25 years, and you might have not reviewed that since the first year of medical school," he added. "It's a new paradigm and a new normal that we have to adapt to."

The big picture: The focus is particularly acute on childhood illnesses such as measles, chickenpox, invasive strep pneumoniae and pertussis, experts told Axios.

• Polio and diphtheria, covered by the DTap vaccine, are also a concern. An unvaccinated 10-year-old boy died in Germany after contracting diphtheria, once the leading cause of premature death of children.

Between the lines: Incidents such as the measles outbreak in Texas and Kennedy's recent changes to federal vaccine policy are forcing updates to physician training.

• Medical professionals are being advised to stay current on public health advisories, ask patients about travel histories and be on guard for less likely conditions that may present as more common ailments.
• They may also have to brush up on best practices for old diagnostic procedures including spinal taps in young children, experts warn.

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The Senate is moving forward with the massive reconciliation bill after ekeing out a late-night win on Saturday to set up a fierce debate over Medicaid and other health provisions in the tax and spending cut package.

The big picture: GOP leaders want to get the bill to Trump's desk by a July 4 deadline. But it's continuing to expose divisions between moderates and conservative hard-liners and could still undergo significant changes.

• Amid the drama, Sen. Thom Tillis (R-N.C.) said Sunday he wouldn't seek re-election next year after voting against starting debate on the bill and telling lawmakers he'd oppose the final version over its cuts to Medicaid.
• Trump, in response, said he'd meet with Tillis' prospective GOP challengers and accused the North Carolinian of grandstanding.

By the numbers: The bill would result in 11.8 million more uninsured people by 2034, congressional scorekeepers said in a new analysis released over the weekend.

• That highlighted the stakes if Republican Medicaid cuts and other health policies take effect, and is nearly 1 million higher than the 10.9 million more uninsured that CBO estimated for the House bill.
• Past estimates have found that proposed Medicaid work requirements are a source of much of the coverage losses.

The Senate parliamentarian on Sunday ruled that modified Medicaid provider tax cuts and provisions that would limit Medicare coverage and Affordable Care Act premium tax credits for non-citizens can stay in the bill.

Traditional Medicare is requiring more pre-treatment approvals in a bid to root out unnecessary care.

The big picture: Medicare's fee-for-service program hasn't required prior authorizations to access most drugs or services, a major perk for enrollees.

• Prior authorization in privately run Medicare Advantage plans has become a hot-button issue for Congress and federal regulators working to rein in the practice. Federal inspectors found in 2022 that prior authorization in MA prevented some seniors from getting medically necessary care.

State of play: Medicare's innovation center announced on Friday that it will solicit applications from companies to run the prior authorization program starting Jan. 1.

• It will apply only to providers and patients in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington.

The change will apply to 17 items and services, including skin substitutes, deep brain stimulation for Parkinson's disease, impotence treatment and arthroscopy for knee osteoarthritis.

• CMS selected the services based on previous reports and evidence of fraud, waste and abuse, as well as what's already subject to prior authorization in Medicare Advantage.

Zoom in: The companies hired to manage the program will be paid based on how much they save the government by stopping payments for unnecessary services.

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Millions of Americans rely on their provider’s advice and choose to be vaccinated. Advisory Committee on Immunization Practices (ACIP) recommendations ensure they are covered by insurance. Don’t put millions of Americans’ vaccine coverage at risk.

Learn what’s at stake.

Apple Tree Partners has invested billions of dollars to launch and grow biotech companies, but now a legal dispute threatens to shut down many of them.

The big picture: Apple Tree has an unusual structure for a venture capital firm, according to court documents filed in Delaware and the Cayman Islands.

• Since 2012 it's been almost entirely funded by one man, a Russian oligarch named Dmitry Rybolovlev, best known for his unsuccessful art fraud allegations against auction house Sotheby's.
• Rybolovlev made more than $2.4 billion of commitments to Apple Tree, but not via a blind pool. Instead, Apple Tree would propose "budgets" for new portfolio companies for approval by Rybolovlev or a representative of his family office.

Behind the scenes: According to a lawsuit filed by Apple Tree, this arrangement worked fine until shortly after Russia's invasion of Ukraine.

• After that, Apple Tree claims that Rybolovlev got stingy. By September 2022, his family office allegedly said it only would approve "austerity" budgets going forward.

The bottom line: Up to 10 startups and hundreds of employees are stuck in limbo.

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