The Healthcare Revolution with MHK

It was a busy year in 2022 for healthcare. In this edition of The Healthcare Revolution podcast, MHK President Marc S. Ryan reviews what happened in 2022 surrounding healthcare and what you can expect in 2023 given the split Congress.

With the Congress split in 2023 in terms of political control, the prospect for major healthcare legislation is in doubt. In this episode of the Healthcare Revolution, MHK president Marc S. Ryan covers what happened in the midterms and what we can expect over the next two years on the healthcare front.

Medicare Advantage Star ratings are in the news, with announcements that Star ratings dropped dramatically from 2022 to 2023. MHK's president Marc S. Ryan tells you all you need to know about Medicare Advantage, including the background on the program, why it is important to health plan financing, and recent controversies about whether Star truly improves quality or not. His view is clear – Yes it does. And, it's the most comprehensive and proven quality program in U.S. healthcare.

In this latest episode of The Healthcare Revolution with MHK, president Marc S. Ryan speaks with Dr. Marty Makary, MD MPH a leading healthcare reform expert and author of The New York Times bestseller The Price We Pay. It's an intriguing conversation you don't want to miss.

Two major healthcare provisions were included in the Democratic reconciliation bill known as the Inflation Reduction Act. They include extension of Exchange premium subsidies and Medicare drug price reforms. In this edition of the Healthcare Revolution with MHK, MHK President Marc Ryan discusses both important issues. Most importantly he asks: “Why all the fuss about drug price reform?”

In the latest edition of The Healthcare Revolution podcast, MHK president Marc S. Ryan reviews the recent Health and Human Services Office of Inspector General report regarding prior authorization in Medicare Advantage (MA) plans and the push for reforms and restrictions on utilization management in the MA private plan alternative to traditional fee-for-service (FFS). In addition, Marc provides an overview of the final 2023 MA and Part D rule. Major changes are in store for MA and Part D plans.

In this edition of The Healthcare Revolution podcast, MHK President Marc S. Ryan examines the recent controversy over the approval of Aduhelm and the backtracking the government did on coverage of the drug in Medicare. It is a microcosm about what is wrong with our drug approval and pricing process.

The Affordable Care Act turned 12. In this edition of The Healthcare Revolution podcast, MHK's President, Marc S. Ryan tells you about the history of the ACA, the turmoil from Obama to Trump to Biden, and the accomplishments in terms of healthcare coverage expansion. He then reviews some looming risks to coverage.

The federal government says health plans and providers should be in store for a big interoperability rule in the Spring of 2022. The rule promises to clarify some existing rules and bring about medical electronic prior authorization and data-sharing between payers and providers. It will clearly define integration standards to use. While it will take time and cost to implement, it is a key initiative to reduce healthcare costs and improve quality.

Health plan profit margins are out and they show that health insurers continue to be responsible players in the healthcare system. This is driven by the adoption of the Minimum Medical Loss Ratio (MLR) across the lines of business. Learn about the minimum MLR, how it limits margins, and the results for 2021.

The 2023 Medicare Advantage (MA) and Part D rule and advanced notice is out. Listen in as MHK President Marc S. Ryan details some of the major changes in store for the MA and Part D programs, including pass-through of retrospective pharmacy concessions at the point of sale, major Special Needs Plan changes, and a major rate increase.

Medicare Advantage growth has been huge over the past several years. Listen in to this edition of The Healthcare Revolution with MHK to hear MHK President Marc S. Ryan discuss the year-over-year growth in Medicare Advantage as well as his explanation for the reduction in standalone Part D prescription drug plans.

Many people say, “As California goes, so goes the nation.” So…will single-payer healthcare become reality in the Golden State in 2022? Listen to this edition of The Healthcare Revolution as MHK President Marc S. Ryan details the single-payer proposal in California as well as an alternative by Gov. Gavin Newsom. Marc offers predictions on what proposal will win the day.

Having trouble sorting out all the vaccine mandates in the nation? In this edition of the Healthcare Revolution with MHK, MHK President Marc S. Ryan details the three major federal vaccination mandates and their current status. He also discusses the potential for state and federal laws to collide given the fact that at least one federal mandate is now cleared to move forward.

The No Surprises Act is now in force and should mean few to no surprise bills in our lives in the future. But we are in the midst of implementation and it will be very messy. MHK President Marc S. Ryan tells you about what the No Surprises Act does, what implementation is inflight, a controversy over arbitration, and what you can do to protect yourself as the act rolls out.

In this episode of The Healthcare Revolution with MHK, MHK President Marc S. Ryan summarizes all that has happened in healthcare in 2021 and then plays Nostradamus, predicting some of what may happen in 2022. Hear about the COVID pandemic, coverage expansion, drug price reform, and other important healthcare matters.

The Build Back Better Act has passed the House on a close vote. It is now over in the Senate and may face a rough ride. MHK President Marc S. Ryan offers his views on the bill and discusses some of the healthcare provisions in the latest House version.

In this edition of The Healthcare Revolution with MHK, Marc S. Ryan explains about the fee-for-service (FFS) transaction system in healthcare and the migration to managed care. Learn about the failures of the system, adoption of strict managed care, the public backlash, and where we are today with softer forms of managed care. The subject matter is taken from his upcoming book, The Healthcare Labyrinth, due out in early 2022.

Medicare Advantage is seeing a great deal of payment scrutiny. Listen in as MHK president, Marc S. Ryan discusses how Medicare Advantage health plans get paid, what critics are saying, and what the future may hold.

According to The Commonwealth Fund, the U.S. healthcare system ranks dead last in terms of performance among 11 developed world countries. Listen to the Healthcare Revolution podcast as MHK president Marc S. Ryan goes through the findings to show the huge mismatch between U.S. healthcare spending and outcomes compared with other developed nations. Hear about the Commonwealth's recommendations as well as Marc's recommended reforms in his forthcoming book, The Healthcare Labyrinth.

Commercial and employer coverage dominate our unique health insurance system in America. Learn about how vast commercial and employer coverage are and the various forms of such coverage, including ERISA self-insured funds, large group risk coverage, and small group risk coverage.

During the COVID-19 pandemic, millions of Americans have retained employer coverage through a 100% COBRA subsidy or moved to Medicaid, the Children's Health Insurance Program, and the Exchanges. This has kept America's uninsured rate from skyrocketing. But when the public health emergency declared for the pandemic ends as early as at the end of this year, the ranks of the uninsured could markedly increase unless federal and state officials think wisely about how to transition Americans to other coverage. Hear more about this threat and what can be done about it. Keeping people covered is crucial.

President Biden's Executive Order on healthcare seeks to tackle the pernicious effects of hospital mergers, anti-competitive behaviors by brand drugmakers, and the complexity of health benefits. In this episode of The Healthcare Revolution with MHK, Marc S. Ryan, MHK's president, explains the details of Biden's order and why it is crucial to reform.

Have you ever been the victim of a surprise healthcare bill? If so, you're not alone. Many Americans get medical bills they were not expecting. Sometimes it is their fault but often it is simply due to the complexity of the healthcare system. Learn more about surprise billing in this edition of The Healthcare Revolution with MHK and hear how a new federal bill will make most of these huge headaches go away.

In this edition of The Healthcare Revolution with MHK, MHK President Marc S. Ryan discusses the myriad of health plan mandates that have been adopted for 2021, 2022, and 2023. The mandates cover a range of important areas, including interoperability, prescription drug safety, price transparency, special needs plans, and more. Listen in to learn more.

In this edition of the Healthcare Revolution with MHK, Marc S. Ryan, MHK's President, explains the State Children's Health Insurance Program and why it is important to ensure all children have affordable access to healthcare. He also shares about how he helped create the program in Connecticut and gives his wife long-overdue credit for the naming of the program in the Constitution State.

Health plans in Medicare Advantage and Part D have to tackle complex enrollment processes and voluminous data to ensure correct member onboarding and payment from CMS. MHK President Marc S. Ryan and MHK EVP and COO Alex Pauloski discuss the challenges of enrollment and payment reconciliation as well as MHK's MarketProminece™ solution in the Medicare space.

In this edition of The Healthcare Revolution with MHK, Marc Ryan talks about the fundamentals of Medicaid and why it's an important part of the U.S. healthcare system. It's time to set aside the political rancor over Medicaid and plot its long-term future.

President Biden is off to a fast start on healthcare. With the passage of the COVID relief bill under his belt, what is the prognosis on many of his healthcare promises? Listen in as we discuss the prospects for congressional action on big healthcare initiatives, as well as how Biden will use the regulatory process to bring about change in healthcare. As well, we think CMS will be allowed to continue on its regulatory journey to reform healthcare.  

In this episode of The Healthcare Revolution, MHK President, Marc S. Ryan covers how the $1.9 trillion COVID bill is a win for health plans and the public at large. The bill passed the Senate last week and although this must go back to the House due to changes, our prediction is that the Senate changes will be adopted by the House and get to the President next week. Find out how the bill expands subsidies for COBRA and the Exchanges and incentivizes states to expand Medicaid. Apart from the bill, Medicare Advantage also continues to grow exponentially – yet another win for health plans.

This podcast will cover these unique individuals – dual eligibles – who enroll in both Medicare and Medicaid and how their financial obligations in Medicare are paid for in whole or in part by the Medicaid program. These members face socio-economic barriers to healthcare. We will also look at some innovative programs that are better coordinating the financing and care of these individuals.

In this episode of The Healthcare Revolution, MHK President, Marc Ryan and SVP of Product and Innovation, Natalie Dougherty discuss the latest healthcare policy and technology trends and what health plans need to do to excel in the emerging value-based world.

In part one of this series, we broke down all the elements of Medicare, including Part A through D, as well as how to become eligible, the benefits you can receive, and the cost-sharing obligations. Now, listen to part two - We will dive into the Medicare Advantage program and explore how it benefits seniors, especially those of low income.

In this first of a two-part series, we break down all the elements of Medicare, including Part A through D, as well as how you become eligible, the benefits you can receive, and the cost-sharing obligations. Part two will dive into the Medicare Advantage program and explore how it benefits seniors, especially those of low income.

It is critical that the American healthcare system make the leap from utilization management to care management and population health. MHK President Marc S. Ryan and MHK Vice President Joan Gammercone, a clinician by trade, discuss various trends in utilization management, care management, and population health. Listen in and find out what health plans can do to take the leap and ensure success in value-based care. 

Why Do I Need Health Insurance Anyway? We are in the middle of open enrollment for a number of lines of business, so this podcast is timely. Learn about the economic and altruistic reasons you always need to have health insurance. Younger generations who have that Superman Complex should especially listen to this one.

With Joe Biden to possibly become the 46th President, what will healthcare policy look like under his administration? Learn about what a closely divided Congress will mean to Biden's premier coverage proposals, what might be accomplished by the new president regulatorily, and what nagging issues could gain bipartisan support.

Have you ever wondered how employer-based healthcare emerged in the United States? Listen to The Healthcare Revolution podcast to learn about the origins of social welfare programs. We will also cover the evolution of healthcare in America and discuss some of the presidents who have played a major role in shaping healthcare policy.

Election Day is a little more than a week away. Where do the presidential candidates stand on the Affordable Care Act? Hear both sides on this new edition of The Healthcare Revolution Podcast. Marc S. Ryan, MHK president, reviews President Trump's recent executive order on healthcare and covers a refresh from an earlier podcast on Joe Biden's positions.

Drug pricing is dominating the healthcare debate. The two political parties have differing views on approaches to control costs. Learn about how our drug prices compare with other developed nations and what we can do to reduce overall drug costs.

The new mandates on providers and payers will be costly, but it opens the door to true data interoperability in the U.S healthcare system. Learn why it is so important. 

It won't be easy and it will take a long time to mature. Learn about the small steps we are taking toward price transparency – these steps are critical to healthcare transformation. 

Learn the economic arguments in favor of universal access in the American healthcare system. It is all about saving money and improving quality.  

An in-depth review of what's wrong with America's healthcare system, from being the most expensive to having the worst outcomes.

Find out where President Trump and former Vice President Joe Biden line up on healthcare issues, and, more importantly, where they don't.  Medicare for All, fixing Obamacare, and more are all discussed.

The light is shining on America's healthcare woes during the pandemic. The COVID crisis has taught us that a lack of affordable access to healthcare has huge impacts on the nation's most vulnerable citizens.