Podcasts about CMS

Silver and Gold – Still Going. Big week for earnings. Fed decision on Wednesday. Nat Gas price exploding higher. US Dollar drops hard over past few days. PLUS we are now on Spotify and Amazon Music/Podcasts! Click HERE for Show Notes and Links DHUnplugged is now streaming live - with listener chat. Click on link on the right sidebar. Love the Show? Then how about a Donation? Follow John C. Dvorak on Twitter Follow Andrew Horowitz on Twitter Warm-Up - What we learned from Davos - President Miyagi - tariffs on, tariffs off - January: stocks are trying to finish with gains - Small-caps flying - S&P  500: All-time highs going into earnings Markets - Silver and Gold - Still Going - Big week for earnings - Fed decision on Wednesday - Nat Gas price exploding - US Dollar drops hard over past few days Can't Keep Track Anymore -Trump has announced he is raising tariffs on South Korean imports to 25% after accusing Seoul of "not living up" to a trade deal reached last year. - In a post on social media, Trump said he would increase levies on South Korea from 15% across a range of products including automobiles, lumber, pharmaceuticals and "all other Reciprocal TARIFFS". - South Korea is planning on voting on the "agreement" with the US in February - KOSPI hits all-time high after being down 1% on the news - S. Korea President re-affirms their commitments Davos - 2026 - What we learned - Not much - Same bifurcated view of the world - Trump backed off the Greenland threats - Framework of a "deal" / "plan" - So, no tariffs - (Going to get a boy who cried wolf ....) Gold and Silver - Off to the races - Silver was up again in a big way Monday. Fell back down to earth (up 5% from up 15% earlier in the day - Hovering around $110 - that is impressive - parabolic move - GOLD! - Proving itself as a USD hedge and safety trade (Bitcoin in the dust) - Gold above $5,000 per ounce - - Plenty of reports that central banks are buying up| - USD weakness Economy - Still Strong - The US economy expanded in the third quarter by slightly more than initially reported, supported by stronger exports and a smaller drag from inventories. - Inflation-adjusted gross domestic product increased at a revised 4.4% annualized rate, the fastest in two years, according to Bureau of Economic Analysis data. - Consumer spending advanced at a 3.5% annualized pace last quarter, reflecting the fastest pace of outlays for services in three years, while spending on goods also accelerated from the previous quarter. Amazon - Trimming.... 30,000 jobs is plan - First half of that was in October and now trhery are laying off the remainder - CEO Jassey says that it is not financial of AI issues ---- Again - why so important to state that and make that a focal point? - Layoffs amount to 10% of the corporate workforce - Company still has 1.5 million employees Comeback? - Spirit Airlines is in talks with investment firm Castlelake for a potential takeover of the discount airline, CNBC has learned. - Remember, all started when Jetblue deal was blocked - Frontier tried - Spirit tried a few times to get head above water - nothing worked Booz Cancelled - Treasury Secretary Scott Bessent canceled department contracts with the consulting firm Booz Allen Hamilton, whose employee leaked President Donald Trump's tax records to The New York Times. - The department noted that between 2018 and 2020, Booz Allen employee Charles Edward Littlejohn “stole and leaked the confidential tax returns and return information of hundreds of thousands of taxpayers.” - Booz Allen Hamilton's stock price dropped by more than 10% on the heels of the Treasury Department's announcement. - Why does Booz have tax records in the first place? - Stock down 50% since end of 2024 Private Credit - BlackRock TCP Capital shares lower by 13% after it disclosed Friday night that net asset value declined approximately 19.0%; other private credit stocks falling in sympathy - The Company's net asset value per share as of December 31, 2025 to be between approximately $7.05 and $7.09, an anticipated decline of approximately 19.0% during the quarter ended December 31, 2025, compared to a net asset value per share of $8.71 as of September 30, 2025. - This decline is primarily driven by issuer-specific developments during the quarter. - The Company's net investment income per share to be between approximately $0.24 and $0.26 for the three months ended December 31, 2025. - Decliners: TCPC -13.40% OWL -3.07% ARES -3.30% KKR -2.08% BAM -0.41% CG -0.33% Zoom Communications - Valuation of Anthropic stake - The news is driving shares higher as analysts suggest ZM's $51 mln stake could now be worth between $2-$4 bln based on Anthropic's rumored $350 bln valuation, effectively acting as a "hidden gem" on its balance sheet. - From a fundamental perspective, the company's performance has also significantly improved, evidenced by its Q3 beat-and-raise report in late November where revenue rose 4.4% yr/yr to $1.23 bln. - This stronger financial performance is being driven by robust growth in the Enterprise segment, the rapid adoption of AI Companion features, and the scaling of adjacent growth businesses like Zoom Contact Center and Workvivo. - Consequently, the combination of high-margin operational rigor -- highlighted by a 41.2% non-GAAP operating margin -- and the massive unrealized gains from its AI investments has shifted investor sentiment firmly back toward growth. UNH and Health Stocks - DOWN 20% today - The administration's proposal (via the Centers for Medicare & Medicaid Services, or CMS) for Medicare Advantage reimbursement rates to rise by only 0.09% in 2027. This was far below Wall Street expectations of 4-6% (or higher), following a more generous ~5% increase for 2026. - The near-flat rate aims to improve payment accuracy, curb overbilling practices, and protect taxpayers, according to CMS statements, but it sparked widespread concerns about squeezed insurer margins, potential benefit cuts for seniors, reduced plan offerings, or market exits. - UnitedHealth has significant exposure to Medicare Advantage (roughly 30% of national enrollment), making it particularly vulnerable. The proposal, announced late Monday (January 26), led to a broader sell-off in health insurers: - - Humana (HUM) plunged over 20-21%. - - CVS Health (CVS) and Elevance Health (ELV) each dropped around 13-14%. Tech Earnings Microsoft (MSFT) Reports: Wednesday, January 28 (After Market Close) - Wall Street Expectations:  Earnings per share (EPS): about $3.86 and Revenue: about $80 billion - Growth: high teens year over year revenue growth - Investors are focused on Azure and broader cloud growth, particularly how much of that growth is coming from AI related demand. Microsoft has built a reputation for consistent execution, which also means expectations are high. The critical issues will be cloud growth sustainability, margin stability, and how aggressively management plans to keep spending on AI infrastructure. Meta Platforms (META) Reports: Wednesday, January 28 (After Market Close) - Wall Street Expectations:  EPS: about $8.15–$8.20 and Revenue: about $58–$59 billion - Growth: roughly 20–21% year over year revenue growth - Advertising remains the core driver, with AI driven ad targeting continuing to improve returns for advertisers. While topline growth expectations remain strong, investors are closely watching expense growth. The biggest question is whether rising AI and infrastructure spending can be managed without eroding margins or spooking investors, as Meta works through the next phase of its AI strategy. Tesla (TSLA) Reports: Wednesday, January 28 (After Market Close) - Wall Street Expectations:  EPS (non GAAP): about $0.40–$0.45 and Revenue: about $24.5–$25 billion - Trend: earnings expected to be sharply lower than a year ago - Tesla enters earnings with the weakest expectations among the major tech names this week. Vehicle deliveries declined year over year, and automotive margins remain under pressure. While the energy and services segments continue to grow, they are not yet large enough to offset slowing EV demand. - Investors will be far more focused on forward guidance than on the quarter itself—particularly updates on Full Self Driving, robotaxis, and the broader AI roadmap. Apple (AAPL) Reports: Thursday, January 29 (After Market Close) Wall Street Expectations -  EPS: about $2.65–$2.67 and Revenue: about $138 billion Growth: approximately 11–12% year over year revenue growth - This is Apple's most important quarter of the year. Expectations call for record revenue driven by the iPhone 17 cycle and continued Services growth. The focus will be on margins, China demand, and forward guidance—particularly how higher costs (memory prices and tariffs) may impact profitability. Apple typically beats expectations, but the stock reaction will hinge on what management says about growth beyond this quarter. Company Ticker Report Date Est. EPS Key Focus Area Microsoft MSFT Wed, Jan 28 (AMC) $3.92 Azure AI revenue growth & CapEx spending Meta Platforms META Wed, Jan 28 (AMC) $8.17 Ad monetization of AI & 2026 CapEx guidance Tesla TSLA Wed, Jan 28 (AMC) $0.45 Full Self-Driving (FSD) & Robotaxi updates Apple AAPL Thu, Jan 29 (AMC) Varies iPhone 17 demand & Apple Intelligence rollout ServiceNow NOW Wed, Jan 28 (AMC) $0.88 Enterprise AI software adoption rates IBM IBM Wed, Jan 28 (AMC) $4.28 Hybrid cloud and watsonx performance *AMC = After Market Close; EPS = Earnings Per Share (Consensus Estimates) Boeing - The company's airplane deliveries last year were the highest since 2018, helping drive revenue. Boeing brought in $23.9 billion in the last three months of 2025, a 57% increase over the same period in 2024 and topping analysts' expectations. Cash flow of $400 million was roughly double what Wall Street was expecting. - Boeing brought in $23.9 billion in the last three months of 2025, a 57% increase over the same period in 2024. The airplane manufacturer delivered 600 airplanes last year, up from 348 a year earlier. Another MoonShot - U.S. natural gas prices surged over 17% on Monday morning, climbing above $6 for the first time since late 2022. - It comes as Winter Storm Fern leaves hundreds of thousands without power and forces mass flight cancellations. - The National Weather Service has forecast wind chills as low as -50 degrees Fahrenheit (-45.56 degrees Celsius) across the eastern two-thirds of the U.S. this week. -Up 68% YTD - Nat gas is used in a whole lot of things - electrical grid 43% is fueled by Nat Gas Government - Not Again! - Seems like Dems are threatening a shutdown again - A partial U.S. government shutdown is set to begin on Friday, January 30, 2026. - The Senate is expected to vote on a funding package to avert this shutdown, with delays from a winter storm pushing initial votes to at least January 27, 2026 - The issue is being exacerbated with the ICE / Minnesota issues This is precious - Ex-finance minister Noda currently co-heads largest opposition party - He says that Japan unlikely to get international consent for intervention - Yen, bond selloff requires Japan to be in crisis mode, he says - Government must vow to restore fiscal discipline to end yen fall, Noda says - Japan must create environment allowing for steady BOJ rate hikes, he says - THIS shows us all that the whole thing with these guys/gals is all political. - NEVER EVER if he was in the role would he say anything like this.       Love the Show? Then how about a Donation? ANNOUNCING THE WINNER OF THE THE CLOSEST TO THE PIN CUP 2025 Winners will be getting great stuff like the new "OFFICIAL" DHUnplugged Shirt!     FED AND CRYPTO LIMERICKS   See this week's stock picks HERE Follow John C. Dvorak on Twitter Follow Andrew Horowitz on Twitter

Vets Salute VA Nurse Hero. VA Sec Collins' Shameful Statement. Kennedy, Oz & Measles. Flu Season Health Tips. America's ICE Breakers. Allies Furious Worldwide. After the Storm. In this urgent all–new episode of Independent Americans, host Paul Rieckhoff is joined by returning champion Dr. Vin Gupta — Harvard–trained pulmonologist, Air Force Reserve officer, VA ICU doctor and one of America's most trusted medical voices — to break down Trump's escalating war on public health, the VA, and even gun owners themselves. They dig into the murder of Minneapolis VA ICU nurse and veteran caregiver Alex Pretti, what his life and final act of courage mean for nurses, veterans and families nationwide, and how the White House's propaganda machine tried to smear him as a “domestic terrorist” before the truth came out.​ From the flu and measles outbreaks slamming hospitals, to RFK Jr. at HHS, Dr. Oz at CMS, and an EPA that's gutting the Clean Air Act while pretending to “make America healthy again,” Dr. Gupta lays out how this administration is quietly making you and your family less safe — and what you can actually do right now if you're insured, under–insured or have no insurance at all. He explains why VA ICU work is “double service,” why VA nurses like Pretti are unsung heroes of our democracy, and why the VA hospital where Alex worked should bear his name.​ Rieckhoff also rips into VA Secretary Doug Collins' disgraceful response, Trump's new war on gun owners, ICE's spreading abuses, and the chilling implications of a president eager to invoke the Insurrection Act while deploying ICE even to the Winter Olympics. They connect it all to the global fallout from Trump's insults of US allies, the latest from Ukraine and Gaza, Holocaust Remembrance Day, and why California is now working directly with the WHO as a counterweight to DC. And, issue a call to the ⅓ of ICE agents that are veterans.  Because every episode of Independent Americans with Paul Rieckhoff breaks down the most important news stories--and offers light to contrast the heat of other politics and news shows. It's independent content for independent Americans. In these trying times especially, Independent Americans is your trusted place for independent news, politics, inspiration and hope. The podcast that helps you stay ahead of the curve--and stay vigilant. -WATCH video of this episode on YouTube now. -Learn more about Paul's work to elect a new generation of independent leaders with Independent Veterans of America. -Join the movement. Hook into our exclusive Patreon community of Independent Americans. Get extra content, connect with guests, meet other Independent Americans, attend events, get merch discounts, and support this show that speaks truth to power.  -Check the hashtag #LookForTheHelpers. And share yours.  -Find us on social media or www.IndependentAmericans.us.  -And get cool IA and Righteous hats, t-shirts and other merch now in time for the new year.  -Check out other Righteous podcasts like The Firefighters Podcast with Rob Serra, Uncle Montel - The OG of Weed and B Dorm.  Independent Americans is powered by veteran-owned and led Righteous Media.  And now part of the BLEAV network!  Ways to listen: Spotify • Apple Podcasts • Amazon Podcasts  Ways to watch: YouTube • Instagram  Social channels: X/Twitter • BlueSky • Facebook  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Listen to JCO's Art of Oncology article, "A Chance to Heal with Cold Hard Steel" by Dr. Taylor Goodstein, who is a fellow at Emory University. The article is followed by an interview with Goodstein and host Dr. Mikkael Sekeres. Dr. Goodstein shares a story about surgery, grief, and being courageous in the face of one's own fallibility. TRANSCRIPT Narrator: A Chance to Heal with Cold Hard Steel, Taylor Goodstein, MD Mikkael Sekeres: Welcome back to JCO's Cancer Stories: The Art of Oncology. This ASCO podcast features intimate narratives and perspectives from authors exploring their experiences in oncology. I am your host, Mikkael Sekeres. I am Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. Joining us today is Dr. Taylor Goodstein, urologic oncology fellow at Emory University and our first Narrative Medicine Contest winner, to discuss her Journal of Clinical Oncology article, "A Chance to Heal with Cold Hard Steel." Dr. Goodstein and I have agreed to address each other by first names. Taylor, thank you for contributing to the Journal of Clinical Oncology, to our contest, and for joining us to discuss your winning article. Taylor Goodstein: Thank you so much for having me. This is a great honor. Mikkael Sekeres: The honor was ours, actually. We had, if you haven't heard, a very competitive contest. We had a total of 159 entries. We went through a couple of iterations of evaluating every entry to make it to our top five, and then you were the winner. So thank you so much for contributing this outstanding essay both to our Art of Oncology Narrative Medicine Contest and also ultimately to JCO. Taylor Goodstein: Oh, thank you so much. Mikkael Sekeres: So, I was wondering if we could start by asking you to tell us something about yourself. Where are you from, and walk us through your career and how you made it to this point? Taylor Goodstein: Well, I grew up in a small town in Colorado - Glenwood Springs, Colorado. It is on the Western Slope, about 45 minutes north of Aspen. I went all the way to the east coast for college, where I ended up minoring in creative writing. So writing has been a part of my medical journey kind of throughout. I went to medical school back in Colorado at University of Colorado in Aurora, and then I did my residency training at he Ohio State University in Columbus, Ohio. And now I am at Emory University for fellowship. And I have been kind of writing all throughout, trying to make sense of the various journeys we go on throughout the experiences we have with going through our medical training. Mikkael Sekeres: That is amazing, and I noticed how you emphasized the "The" in Ohio State University. Taylor Goodstein: Yes, we fought hard for that "The." Mikkael Sekeres: Right, as do we at The University of Miami. Yes. What drew you to surgery, and specifically surgical oncology? Taylor Goodstein: My dad is a surgeon. My dad is an ear, nose, and throat doctor. And I am essentially him. We are the same person, and it made him very, very happy. So when I was looking at different medical specialties, I knew I was going to do a surgical subspecialty, and that is what I was drawn to. And then I was looking for the one that felt right, ended up finding urology, and then throughout my residency journey, I really gravitated towards cancer care. I really loved the patient population taking care of cancer patients, and surgically it felt like a way that I was going to be engaged and challenged throughout my career as there is so much that is always changing in oncology, almost too fast to keep up with all of it. But that is what really, ultimately, drew me to that career path. Mikkael Sekeres: It is great that you had a role model in your dad as well to bring you into this field. Taylor Goodstein: Well, he is very disappointed that I did urology rather than ENT, and he's in private and I am going into academics, so there is plenty of room for disappointment. Mikkael Sekeres: I am sure the last thing in the world he is is disappointed in you. And I will say, so I am able to see your background here, our listeners of course are listening to a podcast and they are not. You have a very impressive bookshelf with a lot of different types of books on it. Taylor Goodstein: This is your guys' background! This was the option of one of the backgrounds I could choose for coming onto this. I didn't want to do my real background because I have a cat who is wandering around and was going to be very distracting. Mikkael Sekeres: That's funny! Taylor Goodstein: But I did like the books. The books felt like a good option for me. I do have a big bookshelf; books are very important to me. I don't do anything on Kindle. I like the paper and stuff like that, so I do have a big bookshelf. Mikkael Sekeres: There is something rewarding in the tactile feel of actually turning a page of a book. You did writing from a very early stage as well. I was an English minor undergrad and then focused on creative writing as well and continued taking creative writing courses in medical school. Were you able to continue that during medical school and then in your training? Taylor Goodstein: Yeah, I thought that is what I was going to do when I first went to college. Like, I thought I was going to be a journalist or writer of some kind, and then I think maybe the crisis of job security hit me a little bit, and then also my desire to work with my hands and work with people. I wanted something to write about, something about my life that would be very interesting to write about, and that sort of led me initially to medicine. But then yes, to answer your question, I have been participating in a lot of writing competitions, like through the AUA, the American Urological Association, they do one every year that I have been doing in residency. And then in medical school we had some electives that involved writing and medical literature that we did. There was a collection of student writings, a book that got published during my last year of medical school that I had a couple of essays in. And the journey changes over time. When you are a medical student, you are on this grand journey and you are so excited to be there, but at the same time you feel so incredibly unprepared and useless in a lot of ways. You are just this medical student. The whole medical machinery is this well-oiled cog rotating together, and you are just this wild little- by yourself just trying to fit in. And that experience really resonated with me. And then residency has its own things that you are trying to make sense of. I think it all pales in comparison to what it is like to be a new surgeon for the first time, taking not necessarily your first big case but early in your career and having complications and making difficult decisions. I think is one of the hardest things that we probably have to deal with. Mikkael Sekeres: Well, you write about this in an absolutely riveting way. When you and your attending, you are a fellow on this case with your attending, realize that in the mess of this aggressive tumor that you are trying to resect, you have removed the patient's external iliac artery and vein, you write, and I am going to quote you now to you, which is always a little awkward, but I am going to do it anyway: "It is hard to explain what it feels like. Belly drops, hands shake, lungs slow down, and heart speeds up. It takes several seconds, marked out by the beeping metronome of the patient's own heartbeat, but eventually we return to our bodies, ready to face the error we cannot undo." As a reader, you are transported with you into that moment when, oh my God, you realize what did we do in this tremendous tumor resection you were undertaking? What was going through your mind at that moment? Taylor Goodstein: This is going to sound maybe a little bit funny, but I always think about this line from Frozen 2. I don't know if you have any kids or you have seen Frozen 2. Mikkael Sekeres: I have kids, and I have seen Frozen, but I have to admit I have not seen Frozen 2, and that is obviously lacking in my library of experiences. Taylor Goodstein: Frozen 2 is incredible, way better than Frozen 1. The adult themes in Frozen 2 go above and beyond anything in Frozen 1. But they are faced with some really big challenges and one of the themes that happens in that movie is all you can do is the next right thing. And it gets said several times. I remember connecting to that when I saw the movie, and I have said it to myself so many times in the OR since. You can't go backwards, you can't change what just happened. So all you can do is the next right thing. And so I think once the shock of what had happened kind of fades, all I am thinking in my head is like, "Okay, what is the next right thing to do here?" And obviously that was calling the vascular surgeon, and thankfully he was there and able to come in and do what needed to be done to restore flow to the patient's leg. Mikkael Sekeres: It is so interesting how we are able to compartmentalize in the moment our emotions. The way you write about this and the way you express yourself in this essay, you are horrified by what has happened. This is a terrible thing, yet you are able to separate yourself from that and move forward and just do the right thing for the patient at that time and get your patient out of this and yourself out of this situation. Taylor Goodstein: I think that is honestly, and maybe not for everybody, but for me that has been one of the challenges of becoming a surgeon is learning that level of emotional control, because all you want to do is cry and scream and pull your hair out and hit your fists against the table, but you can't do that. You have to remain in charge of that ship and keep things moving forward. And it is one of those hidden skills that you have to learn when you are going to be a surgeon that you don't get taught in medical school, and you kind of learn on the job in residency, but there is not as much explicit training that goes into that level of emotional control that you have to have. And I have kind of gone on my own self-journey to get there that has been very deliberate for me. Mikkael Sekeres: That is amazing. Do you think as we progress through our careers, and I don't want to use a term that is so dismissive, but maybe I will try it anyway, that we become more nonchalant about surgeries or writing for chemotherapy or radiation therapy to deal with cancer, or is that fear, that notion of "with great power comes great responsibility," to loosely quote Spider-Man, is that always there? Do we always pause before we start the surgery, write for the chemotherapy, or write for the radiation therapy and say, "Wait a second, what am I doing here?" Taylor Goodstein: I think it is always there, and I would argue that it even grows as you get farther along in your practice and you gain this collection of experiences that you have as a surgeon where you develop complications and from that you change your practice, you change the way you operate, the way you consider certain operative characteristics. I would argue that, as time goes on, you probably get more cautious approaching surgery for patients, more cautious considering the side effects of different treatment options that people have. Mikkael Sekeres: I think that is right. There is danger in reflecting on the anecdotes of your career experience to guide future treatments, but there is also some value to remembering those times when something went wrong or when it almost went wrong and why we have to check ourselves before doing what may become routine at one point in our careers, and that routineness may be doing a surgery or writing for chemotherapy, but always remembering that there is great danger in what we are about to embark on. Taylor Goodstein: Always, yeah. Mikkael Sekeres: Taylor, what makes this story really special and one of the reasons it won our Art of Oncology Narrative Medicine Contest is just how deep you plunged into reflecting on this surgery. And you write, I am going to quote you to you again, you reflect on how people may criticize you and your attending for embarking on this surgery, but you say: "They never met him, not like you did. They did not see him buckled over in pain, desperation in his eyes. They did not hand his wife tissues or look at photos of his pregnant daughter or hear about his dream of making it to Italy one day. They did not hug his family at the end of it all and cry together as he rattled out sharp breaths. And they certainly did not know how much it meant to get two months free of pain and just enough time to meet his granddaughter." There is a hard truth you write it just perfectly, there is a hard truth to why we don't always follow CMS guidelines for not offering treatment at the end of life, isn't there? Taylor Goodstein: Yeah, it is tough. And you know, I think a lot about this because I have heard a few times to be cautious of the armchair quarterbacks, specifically when you are talking about M&Ms. It is so easy to come in at the other side of a bad outcome and talk about how you shouldn't have done this, you shouldn't have done that. And to be fair, during the M&M in question, as I think back to it, the feedback for the most part was very constructive and ways to maybe be more prepared coming into a surgery like this. Like, there were questions about whether - here at Emory, we operate over various different hospitals - of whether the hospital, it should have been done at an even different hospital was like one of the questions, that maybe had more resources. So things like that, but it is hard I think when you get that question like, maybe you shouldn't have operated. And there is- I think one of the lessons I learned here is being unresectable doesn't mean you can't resect the tumor. We say the word 'unresectable', like we obviously we resected it, but what was the cost of that, obviously? Like we can resect a lot of things, but how much collateral gets damaged in the process of doing that? However, it is a very challenging question. I mean, this guy had one option really. I mean, chemo wasn't going to work, radiation wasn't going to work, and his goals were different than our goals are necessarily when we talk about cancer care. He wanted to be free of pain, he wanted to be able to go home. He was admitted to the hospital, he was on an IV, like Dilaudid, like he could not get off of a PCA because of how much pain he was in. And he just wanted to go home and be there for the birth of his granddaughter, and that is what we tried to do for him. In which case we were successful, but in everything else, we were not. Mikkael Sekeres: And you were successful. I could imagine that when people are in pain, their immediate goal of course is to get rid of the pain. Being in pain is an awful place to be. But with the impending birth of his granddaughter, I have to imagine you realign what your goals are, and that must have been primary for him, and you got him there. Taylor Goodstein: We did. I also talked a little bit about this later on, this idea of providing peace for families. I think that there is this sense of maybe peace and acceptance that comes from having tried to do the long shot surgery, that if you had never tried, if you come to them right away and you say, "Oh, this is- I can guarantee that this isn't ultimately going to end up well," there is still like that what's going to linger in the back of their mind if it never gets attempted versus, okay, we tried, it failed, and now we can come with this almost like satisfaction or comfort knowing that we did everything we could. So I guess I think a little bit about that as well. Mikkael Sekeres: Well, I think that is a beautiful place to end this as well. There are so many factors we have to consider when we embark on this cancer journey with our patients and when we make recommendations for treatment, and it sounds like, and it is so beautifully reflected in your essay that you thought extremely holistically about this patient and what his goals were and appreciated that those goals had to be severely modified once he had his cancer diagnosis. Taylor Goodstein: I think the most important sentence is, "I still don't know what the right answer is." And I think that is important for me to end on. Mikkael Sekeres: Well, and you are still in training. I think it is so important to acknowledge that. When you are training, it is important to acknowledge it when you are at my stage of my career as well. There are still encounters where I come out and I think to myself, I am just still not 100 percent sure what the right thing to do is. But often we let our patients guide us, and we let their goals guide us, and then we know that at least it is right for that person. Taylor Goodstein: Yeah, exactly. Mikkael Sekeres: Well, it has been such a pleasure to have Dr. Taylor Goodstein, who is a fellow at Emory University, to discuss her outstanding essay, "A Chance to Heal with Cold Hard Steel." Taylor, thank you so much for submitting your entry to our first Art of Oncology Narrative Medicine Contest, for winning it, and for joining us today. Taylor Goodstein: Thank you so much for having me. Mikkael Sekeres: If you have enjoyed this episode, consider sharing it with a friend or colleague, or leave us a review. Your feedback and support help us continue to have these important conversations. If you are looking for more episodes and context, follow our show on Apple, Spotify, or wherever you listen, and explore more from ASCO at asco.org/podcasts. Until next time, this has been Mikkael Sekeres for JCO Cancer Stories: The Art of Oncology. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes:   Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Dr Taylor Goodstein is a Fellow at Emory University.

Send us a textWhen evaluating the CRM category, our analysis intentionally moves beyond CRM modules embedded within ERP systems and instead focuses on best-of-breed CRM platforms and the full spectrum of capabilities that define modern customer engagement. This includes not only core operational CRM functions such as sales force automation and pipeline management, but also upstream marketing automation, downstream customer experience and service workflows, contact center operations, events, search, and the increasing convergence with CMS and website capabilities that anchor the digital customer journey. While vendors may brand these pillars as Sales Cloud, Marketing Cloud, or reposition them around AI- and agentic-workflow narratives, the underlying architecture remains consistent, and strategic orientation matters: some platforms are designed for specific micro-verticals with tightly integrated suites, while others pursue broad horizontal coverage. These choices materially affect extensibility, process design, and long-term fit, particularly across B2B versus B2C use cases, where many CRM systems struggle with complex B2B sales cycles—driving continued demand for low-code and no-code customization and deeper integration across CRM, eCommerce, and CMS ecosystems.In this episode, our host Sam Gupta discusses the top 10 CRM systems in 2026. He also discusses several variables that influence the rankings of these CRM systems. Finally, he shares the pros and cons of each CRM system.Video: https://www.youtube.com/watch?v=kBLUBdDuWQcRead: https://www.elevatiq.com/post/top-erp-systems/Questions for Panelists?

In this episode, Rob and Greg are joined by guest Andy Ruskin, healthcare attorney and government payer expert from K&L Gates. They'll be discussing the 2026 CMS OPPS Final Rule, focusing on the provision related to the ODACS, or Outpatient Drug Acquisition Cost Survey. They'll review the statutory landscape surrounding the survey, recap past attempts by CMS to lower 340B hospital reimbursement, and discuss considerations for hospitals as they contemplate how to respond this time around. In the intro, the guys review updates to manufacturer 340B policies. Specifically, they discuss a new policy from one manufacturer that conditions 340B pricing access for in-house pharmacies on claim submission requirements. 

This week I Talk About Clients Vs Contracts [powerpress]

Andy Cumpstey takes the chair to speak with Professor Lee Fleischer, Emeritus Professor of Anesthesia and Critical Care at the University of Pennsylvania and the former Chief Medical Officer and Director of the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services. Lee shares his remarkable journey, from his early interest in science and medicine to his pivotal roles in clinical research, healthcare policy, and national advisory boards. He discusses his efforts during the COVID-19 pandemic, the importance of balancing professional commitments with family life, and his ongoing passion for advancing evidence-based perioperative practice. The conversation also explores his work with the CMS, contributions to healthcare policy, and his future aspirations. -- Super Early Bird registration is now open for The Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London, but it ends on 31 January! We are right now offering the best available rates to attend the Congress. We encourage you to register early and take advantage of this opportunity while you still can. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

Watch The X22 Report On Video No videos found (function(w,d,s,i){w.ldAdInit=w.ldAdInit||[];w.ldAdInit.push({slot:17532056201798502,size:[0, 0],id:"ld-9437-3289"});if(!d.getElementById(i)){var j=d.createElement(s),p=d.getElementsByTagName(s)[0];j.async=true;j.src="https://cdn2.decide.dev/_js/ajs.js";j.id=i;p.parentNode.insertBefore(j,p);}})(window,document,"script","ld-ajs");pt> Click On Picture To See Larger Picture Trump trolls the climate people, temps are going down and there incredible amount of snow. China pushes forward with Silk road. Canada/China try to go around Trump’s tariff system and he warns Carney to stop. The people have been dependent on the government and its because of the [CB]. The [CB]/China are trying to stop Trump’s tariffs. Countries want their gold back. The [DS] is taking the information war and now moving to a physical war. The war is between the American people and the criminal syndicate. The [DS] want Trump to use the insurrection act during the midterms, this way they can use the narrative that he is going to stop the elections. Hold the line, the people are waking up. Trump’s counterinsurgency is getting bigger. Trump will not act until he has the leverage, buckle up its going to get bumpy.   Economy https://twitter.com/disclosetv/status/2015283109235732576?s=20 (function(w,d,s,i){w.ldAdInit=w.ldAdInit||[];w.ldAdInit.push({slot:18510697282300316,size:[0, 0],id:"ld-8599-9832"});if(!d.getElementById(i)){var j=d.createElement(s),p=d.getElementsByTagName(s)[0];j.async=true;j.src="https://cdn2.decide.dev/_js/ajs.js";j.id=i;p.parentNode.insertBefore(j,p);}})(window,document,"script","ld-ajs");   https://twitter.com/WallStreetApes/status/2014838127677030845?s=20  work, I lose my food stamps, I lose my health insurance and we’re only getting $100 back on taxes. Huh? This is why people don’t want to work because why am I working my butt off and losing all that stuff and still living paycheck to paycheck when I was living paycheck to paycheck before, but I at least had food stamps and health insurance and got $7,000 back. Yeah, how’s that math mathing?”  Repatriate The Gold’: German Economists Urge Withdrawal From US Vaults Shift in relations and unpredictability of Donald Trump make it ‘risky to store so much gold in the US', say experts  Germany is facing calls to withdraw its billions of euros' worth of gold from US vaults, spurred on by the shift in transatlantic relations and the unpredictability of Donald Trump. Germany holds the world's second biggest national gold reserves after the US, of which approximately €164bn (£122bn) worth – 1,236 tonnes – is stored in New York. Emanuel Mönch, a leading economist and former head of research at Germany's federal bank, the Bundesbank, called for the gold to be brought home, saying it was too “risky” for it to be kept in the US under the current administration.  “In the interest of greater strategic independence from the US, the Bundesbank would therefore be well advised to consider repatriating the gold.” Source: zerohedge.com Trump Suggests He Can Send $2,000 Tariff Rebate Checks Without Congress  Bessent has also suggested the $2,000 benefit might not take the form of direct cash disbursements.  the Treasury secretary said while he had not yet finalized details with Trump, the “dividend could come in lots of forms,” such as through tax reductions already under consideration—including exemptions for tips, overtime pay, and Social Security benefits, among other deductions. Source: zerohedge.com Political/Rights Anti-ICE Singer Bad Bunny Reportedly Planning to Wear a Dress at Super Bowl Halftime Show to ‘Honor Queer Icons'  Bad Bunny, the anti-Trump, anti-ICE, Puerto Rican rapper, whose real name is Benito Antonio Martínez Ocasio, is reportedly planning to wear a dress to “honor queer icons” during his Super Bowl halftime performance. The artist has a history of wearing skirts, dresses, and other bizarre costumes. According to a Radar Online report, Ocasio will wear the dress at the NFL's biggest game of the year to “honor Puerto Rican queer icons and generations of drag, resistance and cultural rebellion.” The report states: Source: thegatewaypundit.com https://twitter.com/mrddmia/status/2014745821682483678?s=20 https://twitter.com/disclosetv/status/2014735703490334753?s=20 DOGE  dramatic, final, and beautiful conclusion. I would also like to thank President Xi, of China, for working with us and, ultimately, approving the Deal. He could have gone the other way, but didn't, and is appreciated for his decision. PRESIDENT DONALD J. TRUMP Geopolitical https://twitter.com/KurtSchlichter/status/2015086947782525422?s=20    War/Peace   DONALD J. TRUMP PRESIDENT OF THE UNITED STATES OF AMERICA Medical/False Flags https://twitter.com/TheChiefNerd/status/2014517087830491440?s=20 [DS] Agenda https://twitter.com/gatewaypundit/status/2015410989953433956?s=20    BREAKING: Magistrate Judge Orders Release of Minnesota Church Protestor William Kelly All three Minnesota church protestors have now been released from federal custody. Nekima Levy-Armstrong, Chauntyll Allen, and William Kelly, A federal magistrate judge on Friday ordered the release of William Kelly, the far-left agitator who stormed a St. Paul church and harassed parishioners on Sunday. William Kelly was arrested and charged with conspiracy to deprive rights, a federal crime, and violating the FACE Act 18 USC 248 for his involvement in the St. Paul church riots. Kelly was wearing his signature “F*ck Trump” beanie when he was taken into custody. On Friday, Magistrate Shannon Elkins said there was no basis for pretrial detention.   Source: thegatewaypundit.com https://twitter.com/AAGDhillon/status/2015140496344314364?s=20  https://twitter.com/StephenM/status/2014479574847967639?s=20    https://twitter.com/AGPamBondi/status/2015219042441699797?s=20 https://twitter.com/MrAndyNgo/status/2015263298669707666?s=20   to protect people of color. Renee Good was shot dead two weeks earlier after accelerating her SUV toward a federal agent. https://twitter.com/amuse/status/2015259764800770348?s=20   were merely carrying for self-protection he wouldn’t have had that many rounds on him – it is clear he was prepared to kill as many officers as possible. He didn’t bring his permit or ID (it is illegal to carry in MN without both).   https://twitter.com/redsteeze/status/2015275183591010331?s=20 https://twitter.com/joeybeastmarket/status/2015154134849028324?s=20  his gun. Leftists cannot comprehend agency and therefore believe instead that he literally spawned on the sidewalk and through a series of fascist coincidences he was executed for exercising his constitutional right to do whatever he wants without consequences   1. Pretti engaged in obstructive behavior. 2. Pretti committed a felony assault against a federal officer while armed. 3. Pretti resisted arrest while armed. 4. The fact that Pretti had a gun was revealed to all Officers there. So a person for whom there was PC he had committed a violent felony, was resisting arrest, and was armed with a firearm were among the totality of circumstances known to the Officer at the time he used deadly force. Use of deadly force policy does not require the Officers to wait until they are attacked. https://twitter.com/prayingmedic/status/2015144823909728529?s=20 and assumes the suspect is going to begin shooting, so the cop kills him.   Great State of Minnesota? We are there because of massive Monetary Fraud, with Billions of Dollars missing, and Illegal Criminals that were allowed to infiltrate the State through the Democrats' Open Border Policy. We want the money back, and we want it back, NOW. Those Fraudsters who stole the money are going to jail, where they belong! This is no different than a really big Bank Robbery. Much of what you're witnessing is a COVER UP for this Theft and Fraud. The Mayor and the Governor are inciting Insurrection, with their pompous, dangerous, and arrogant rhetoric! Instead, these sanctimonious political fools should be looking for the Billions of Dollars that has been stolen from the people of Minnesota, and the United States of America. LET OUR ICE PATRIOTS DO THEIR JOB! 12,000 Illegal Alien Criminals, many of them violent, have been arrested and taken out of Minnesota. If they were still there, you would see something far worse than you are witnessing today https://twitter.com/MrAndyNgo/status/2015288336189952066?s=20     https://twitter.com/DHSgov/status/2015273624174023098?s=20   was found in possession of a bag containing several similar devices. The subject was arrested. https://twitter.com/amuse/status/2015293685336846546?s=20   https://twitter.com/MrAndyNgo/status/2015217649442013493?s=20   , which has become popular for the far-left in organizing violence due to its reach with mainstream liberals. Wagner has branded himself on the neck with the gang tattoo of the Antifa “Iron Front” logo, similar to how neo-Nazis brand themselves with fascist symbols. https://twitter.com/JackPosobiec/status/2015223657593716965?s=20 https://twitter.com/GoldenAgeTimes2/status/2015181318053581196?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E2015181318053581196%7Ctwgr%5Ec578672a0fd7f78278c6fea2c4ab03241a2a7051%7Ctwcon%5Es1_c10&ref_url=https%3A%2F%2Fwww.thegatewaypundit.com%2F2026%2F01%2Ftexas-democrat-senate-frontrunner-jasmine-crockett-says-ice%2F   blanche ability to do so.”  or several signals. Let's start with a screen recording of all members of the south side group to start.  to distract the public. Same Deep State playbook. https://twitter.com/MrAndyNgo/status/2015365238862786572?s=20   https://twitter.com/ElectionWiz/status/2015245963648962850?s=20     https://twitter.com/amuse/status/2015259080470802833?s=20 Neon vests for all feds immediately.

Would you like access to our advanced agency training for FREE? https://www.agencymastery360.com/training Most agencies don't have a marketing problem. They have a sameness problem. Their websites, their services, their "award-winning team" language. It's all the same. They even have the same promises that sound impressive but mean absolutely nothing to a prospect who's heard it 50 times this week. Today's featured guest has a pretty good idea of why agencies are blending into the background and how the ones that win are doing the opposite. He'll get into differentiation, AI, pricing confidence, RFPs, and why playing it safe is the fastest way to disappear. David Brier is the the branding expert CEOs call when their marketing hits a wall. He calls himself "rehab for brands" to help get them profitable. He is the author of Brand Intervention and Rich Brand, Poor Brand, and he's built a career around one core idea most agencies completely miss: branding isn't about looking better but about being different. After realizing there were more than 25,000 branding books and no agreed-upon definition, David distilled branding down to four words: the art of differentiation. That idea alone reframes how agencies should think about positioning, pricing, and growth, especially right now. In this episode, we'll discuss: Why Differentiation Isn't Optional in the Age of Lazy Thinking. Get Rid of the Agency Speak Saying 'No' as a Strategic Advantage Different is Better Than Better Subscribe Apple | Spotify | iHeart Radio Sponsors and Resources This episode is brought to you by Wix Studio: If you're leveling up your team and your client experience, your site builder should keep up too. That's why successful agencies use Wix Studio — built to adapt the way your agency does: AI-powered site mapping, responsive design, flexible workflows, and scalable CMS tools so you spend less on plugins and more on growth. Ready to design faster and smarter? Go to wix.com/studio to get started. Why Branding and Differentiation Are No Longer Optional for Agencies David's definition of branding cuts through the noise because it mirrors how humans actually behave. We notice what's different. We ignore what feels familiar. If your agency sounds like a remix of every other agency, your prospects' brains will quietly check out. That's why brands like Apple feel predictable in a good way. As Seth Godin once said, you know what an Apple sneaker would be like. You don't know what a Marriott sneaker would be like—and that's the problem. One owns a point of view. The other plays it safe. For agencies, differentiation means making a choice and being willing to lose people who aren't a fit. That's uncomfortable, especially if you're used to trying to appeal to everyone. But the agencies that scale aren't trying to be a choice. They're working to become the choice for the right clients. How "Agency Speak" Is Killing Your Sales Ask most agency owners what makes them different and you'll hear the same three things: our people, our process, our portfolio. That language doesn't differentiate you, it only anesthetizes the conversation. You wouldn't advise your clients to use the language of the competition, so why would you? Additionally, David also believes that brands that take a stand and aren't afraid to be bold will automatically stand out from the many many agencies that are too timid and too afraid to offend. This doesn't mean you have to be divisive. You can be bold in a way that actually brings people together. This fear of being truly different comes from the way we're all wired to believe that an amazing portfolio will be enough to draw people in. But the portfolio isn't the most important thing in the room, is the person sitting across from you. Stop leading with your work and start leading with questions. When you ask better questions and actually listen, prospects feel seen. By the time you show your portfolio, if you even need to, they've already decided whether they trust you. That kind of confidence signals maturity—and it instantly separates you from the agencies still performing their pitch deck like a talent show. Why AI Is Fueling a Sea of Sameness in Agency Marketing AI isn't the enemy… but lazy thinking is. David sees it as everyone is now outsourcing their ingenuity to the same tools, using the same prompts, producing the same safe output. The result is, of course, a sea of indistinguishable brands with no soul and no pulse. What he calls "The Great Wall of Beige." The mistake agencies make is thinking AI replaces brilliance. It doesn't. It amplifies whatever you bring to it. If you don't have a point of view, AI will happily help you sound like everyone else faster. The agencies that win in this era will use AI as a tool, not a crutch. They'll still ask, "Why the hell not?" They'll still challenge assumptions. And they'll still bring conviction, creativity, and human judgment to the table, because that's the part clients can't automate. The Power of Saying No: Reclaiming Pricing and Positioning When a buying process is run by a committee, the goal isn't excellence, it's consensus. And consensus is where great ideas go to die. This is why David stopped participating in RFPs. The most powerful move an agency can make isn't trying harder to win bad deals. It's being willing to walk away. The ability to say no signals strength. It reframes the relationship. When you stop chasing every opportunity and start choosing your clients, pricing objections lose their power. As David put it, when prospects ask why he's so expensive, he flips the script: "Why is everyone else so cheap?" That mindset shift alone changes how clients perceive your value. What's Next for Agencies to Stay Profitable in a Changing Market The landscape is changing even from week to week with new technologies, which makes it harder to predict how the industry will change in years to come. For David, it all boils down to knowing what you're selling. Agencies that sell themselves as commodities will basically go out of business. As he points out, AI is accelerating output but not judgment, taste, or leadership. When everyone has access to the same tools and prompts, the middle ground disappears fast. Agencies that sell "deliverables" instead of thinking will find themselves racing to the bottom on price, competing with software instead of strategy. In a market flooded with instant, AI-generated work, the real differentiator becomes the ability to think on your feet, challenge assumptions, and connect dots in real time. The greatest athletes, actors, comedians, and entrepreneurs in the world were able to think for themselves and could take something unexpected and work with it and improvise. Can you give people something unexpected? That's something no tool can replicate, and it's why experience is becoming more valuable, not less. Why Different Beats Better: Escaping the Race to the Bottom David strongly believes that in these times of sameness and an abundance of content that lacks pulse and personality, different is better than better. Agencies that have completely given up trying to create something unique and have instead relegated the thinking to AI will try to stand out by repeatedly stating they're better, faster, or bigger. David, however, prefers to offer something different. This gives him the confidence to face clients that come to a meeting with rehearsed questions they got from other creators to assess him and counter with "actually, you're asking the wrong question. What you should be asking is…" No framework replaces conviction. The best leaders don't answer scripted questions—they redirect them. That's how you elevate the conversation. That's how you escape commodity pricing. And that's how you build a brand people remember. Do You Want to Transform Your Agency from a Liability to an Asset? Looking to dig deeper into your agency's potential? Check out our Agency Blueprint. Designed for agency owners like you, our Agency Blueprint helps you uncover growth opportunities, tackle obstacles, and craft a customized blueprint for your agency's success.

On this episode Gil and Gregg welcome Mendel Erlenwein, Founder & CEO of CareCo and CEO of Previva Health Group, to unpack why care coordination is the hidden engine of value-based care, and why AI's most important job in healthcare may be restoring time, trust, and humanity to the patient relationship. They explore Mendel's “brain amplifies heart” thesis, the operational realities of chronic care management and care transitions, and why CMS's newly announced ACCESS Model signals a faster move toward outcome-aligned, technology-supported care in Original Medicare. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Is 2026 really the new 2016? Join Sarah as she talks about this internet trend, takes the time machine back to 2016 to compare data, and explains how agents can get in on the fun while it lasts!   Get Connected:

In this episode of The Landscaper's Guide Podcast, Jack Jostes sits down with Abe Faria, General Manager of CMS Landscape (Chris Mark and Sons) in Massachusetts, a multi-generation landscape company that's been operating since 1973. Abe shares how CMS has grown to over 50 employees by making hard—but strategic—decisions about who they serve and how they protect their team.You'll hear a candid conversation about identifying toxic or misaligned clients, the internal process CMS uses to evaluate them, and how the “Better Served By Others” (BSBO) framework helps preserve employee morale, improve service quality, and increase profitability. This episode is a must-listen for landscape and snow business owners who feel stretched thin, overworked, or trapped serving the wrong customers.You'll Learn:What “Better Served By Others” really means—and when to use itHow toxic or misaligned clients impact morale and productivityA practical process for evaluating whether a client should stay or goHow firing clients can actually improve service and profitabilityWhy focusing on your best clients solves staffing and growth problemsConnect With Today's Guest:

In this episode, we discuss the 'Drupal in a Day' initiative, aimed at introducing computer science students to Drupal and invigorating the community with new energy. Martin Anderson-Clutz and Hilmar Hallbjörnsson talk about its origins, development, and the specifics of condensing a comprehensive university course into a single-day curriculum. They also cover the enthusiasm and logistics behind the events, insights from past sessions in Vienna and Drupal Jam, and future plans for expanding the scope of this program. Tune in to hear the vision for bringing more students into the Drupal community and the benefits for universities and organizations alike. For show notes visit: https://www.talkingDrupal.com/cafe013 Topics What is Drupal in a Day? Origins and Development of Drupal in a Day Target Audience and Curriculum Teaching Methodology and Community Impact Student Engagement and Event Comparisons Momentum and Future Plans for Drupal in a Day Logistics and Volunteer Involvement Open Source and Community Contributions Personal Stories and Final Thoughts Hilmar Hallbjörnsson Hilmar Kári Hallbjörnsson is a senior Drupal developer, educator, and open-source advocate based in Iceland. He works as a Senior Drupal Developer at the University of Iceland and is the CEO/CTO of the Drupal consultancy Um að gera. Hilmar is also an adjunct professor at Reykjavík University, where he teaches "Designing open-sourced web software with Drupal and PHP." Deeply involved in the Drupal ecosystem, Hilmar is an active contributor and community organizer, with a particular focus on Drupal 11, modern configuration management, and the emerging Recipes initiative. He is a co-founder of the Drupal Open University Initiative and Drupal-in-a-Day, and has served on the organizing committee for DrupalCon Europe. His work bridges real-world engineering, teaching, and community leadership, with a strong interest in both the technical evolution and philosophical direction of Drupal as an open-source platform. Martin Anderson-Clutz Martin is a highly respected figure in the Drupal community, known for his extensive contributions as a developer, speaker, and advocate for open-source innovation. Based in London, Ontario, Canada, Martin began his career as a graphic designer before transitioning into web development. His journey with Drupal started in late 2005 when he was seeking a robust multilingual CMS solution, leading him to embrace Drupal's capabilities. Martin holds the distinction of being the world's first Triple Drupal Grand Master, certified across Drupal 7, 8, and 9 as a Developer, Front-End Specialist, and Back-End Specialist. (TheDropTimes) He also possesses certifications in various Acquia products and is UX certified by the Nielsen Norman Group. Currently serving as a Senior Solutions Engineer at Acquia, Martin has been instrumental in advancing Drupal's ecosystem. He has developed and maintains several contributed modules, including Smart Date and Search Overrides, and has been actively involved in the Drupal Recipes initiative, particularly focusing on event management solutions. His current work on the Event Platform aims to streamline the creation and management of event-based websites within Drupal. Beyond development, Martin is a prominent speaker and educator, having presented at numerous Drupal events such as DrupalCon Barcelona and EvolveDrupal. He is also a co-host of the "Talking Drupal" podcast, where he leads the "Module of the Week" segment, sharing insights on various Drupal modules. Martin's dedication to the Drupal community is evident through his continuous efforts to mentor, innovate, and promote best practices within the open-source landscape. Guests Hilmar Hallbjörnsson - drupalviking Martin Anderson-Clutz - mandclu

This podcast explores how the Inflation Reduction Act's (IRA) drug price negotiation program is reshaping the relationship between CMS, drug manufacturers, and providers. We'll explore what the proposed IRA implementation framework means for our healthcare system, highlighting the financial, legal, and transparency implications for pharmacies and patients. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Allen and Joel are joined by Mathieu Cōté from CanREA to preview the upcoming Operators Summit in Toronto. With many Canadian wind projects reaching 17-20 years old, the industry faces critical decisions about extending, repowering, or decommissioning assets. Register now! Sign up now for Uptime Tech News, our weekly newsletter on all things wind technology. This episode is sponsored by Weather Guard Lightning Tech. Learn more about Weather Guard’s StrikeTape Wind Turbine LPS retrofit. Follow the show on YouTube, Linkedin and visit Weather Guard on the web. And subscribe to Rosemary’s “Engineering with Rosie” YouTube channel here. Have a question we can answer on the show? Email us! Welcome to Uptime Spotlight, shining Light on Wind. Energy’s brightest innovators. This is the Progress Powering tomorrow. Allen Hall: Matt, welcome to the program. Thanks for having me. Well, the theme of this Year’s Operator Summit is coming of age and. There’s a lot of things happening in the renewable side up in Canada. What does that mean for Canadian renewable energy operators right now?  Mathieu Cōté: Well, we came up with coming of age because, um, the fleet in Canada is in a bit of a different space than it is in the States where, uh, right now we’ve got a lot of projects that are on the cusp of coming to their end of initial lifetime. Right. They’re in that. 17 to 20 year range. There’s some that are a little bit past, and so you, as an operator, you gotta be asking yourself, is this the time to extend this project? What do I have to do [00:01:00] if I need to extend? Um, or am I repowering, am I taking things down, putting them up? And I mean, there’s a lot of different variables there. Sometimes it’s just a re topping, sometimes it’s everything down to ground level and go again. Or it’s, maybe it’s a decommissioning and those decisions are on the cusp of being made in the operation space in Canada. So that’s, that’s a super important part of it. But the other side of it, and the reason we liked, uh, coming of age is from the industry perspective itself. We are no longer the new kid on the block, right? We are now a reliable, uh, professional industry that can deliver power when you need it. Uh, so that’s what we’re trying to, to convey with this coming of age. And, and we’ve got some really good speakers who are gonna talk about that, uh, from. The grid operator’s perspective saying, why is it that renewables are one of the first things they reach for now when they realize they need more power? Joel Saxum: I think it’s an interesting space and I think to, to [00:02:00]comment more deeply on that, right? That you guys are in that, you  Mathieu Cōté: know,  Joel Saxum: 2005, six you started installing a  Mathieu Cōté: lot of the, a lot of wind assets. There was a curve of, as it as every year you get more and more. Trickle and then becomes a flood quite quickly. Joel Saxum: Yeah. And, and, and you know, from, from the operation standpoint, we deal with some of the wind farms in Canada. We love working with, uh, the operators up there because they do exude that professionalism. They’re on top of their game. They know they’ve gotta maintain these things. Whereas in the states, we’ve been a little bit nascent sometimes and, oh, we got PTC coming so we don’t have to do these certain things. Little bit more cowboy. Yeah. Yeah. And up in Canada, they’re, they’re, they’ve been doing the right things for a long time. Um, and I think it’s a good, good model to follow, but you’re a hundred percent correct. We’re coming to that time when it’s like decision time to be made here. And I think we, in our, in our uh, kind of off air chat, you had mentioned that, you know, repower in Canada is. Pretty early stages. I  Mathieu Cōté: only know about  Joel Saxum: one,  Mathieu Cōté: to [00:03:00] be honest, and I try and keep track of these things,  Joel Saxum: but that’s coming down the pipeline,  Mathieu Cōté: right? So there’s gonna be more and more of these happening. And I mean, there are a lot of operators that have one foot on either side of the border, so some people have some operational experience on what steps you need to take, but it’s also from the regulatory side, like what is your grid operator gonna insist on? So on and so on. But, uh, so we’ve got some panels to talk about things like, one of my favorites is, uh, how much life is left in your machine? And that’s sort of a deeper dive from an engineering standpoint. Like what math do the engineers do to assess, is this foundation good to go for another 10 years? Is this tower gonna stand up to whatever? Should we replace the blades and all those components? We, we’ve got a foundation expert, uh, someone who does. Digital twin sort of things as well as, um, a panelist from, uh, Nordex, so the OEM sort of perspective as well, and how they assess how much [00:04:00] life is left in a machine. So like that’s the sort of panels that we’re trying to put together that we’re pretty excited about.  Joel Saxum: Well, I think that’s a good one too, because I know Alan and I we’re talking around the industry globally. A lot of it is around CMS. And when we say CMS, we’re not just talking drive train anymore, we’re talking everything you can in the turbine, right? So the, the concept of remaining useful life, r ul, that always comes up, where are we at with this, right? Because from a global perspective in Europe, they have, you know, in Spanish wind farms are all, a lot of ’em are at that 25 year mark. What are we doing here? So you guys are bringing that conversation to the Canadian market at this operator summit in Toronto here in February. It’s, it’s timely, right? Because it’s February and everybody’s getting ready for spring, so you got a little bit of time to come to the conference.  Mathieu Cōté: Well, and that’s one of the things that we actually used to do is show in April and we’ve moved it back after hearing feedback from our, from our audience that April’s almost too late, right? Like, if you’re doing your assessments for your [00:05:00] blades, it where? Where’s your manpower coming up? Coming from in the summertime? Those contracts are already signed. By the time you hit April, February, you’ve still got time. Your RFP might be out so you can meet all the proponents on site at once. It, it just makes a lot more sense for us to do it in February. Allen Hall: Well, there’s a wide range of technology in Canada in regards to wind to energy. That adds to the complexity where a lot of turbines, unlike the United States, are maybe even sub one megawatt, and with new turbines coming online, they’re gonna be in the five, six, maybe even seven megawatt range. That’s a huge dispersed. Industry to try to maintain massive range. Yeah. Right. And I, and, and I think one of the dilemmas about that is trying to find people who understand that tho all those different kinds of machines and the intricacies of each one of them and how to operate them more efficiently, which is where Canada is. Quite honestly. The, the thing [00:06:00] about that and the challenge for Canada Head, and this is why the conference is so important, is. If there’s someone in Canada that has the answer, as Joel and I have talked to a number of Canadian operators, you may not know them. I know it’s a smaller marketplace in general, but unless you’re talking to one another, you probably, uh, don’t realize there’s, there’s help within Canada. And these conferences really highlight that quite a bit. Wanna talk about some of the, sort of the interactions you guys create at the conference?  Mathieu Cōté: Yeah. Oh, well, it’s one of the things that can RIA tries to do is play that connector role, right? Like, we don’t know everything, but like you say, we know someone who knows something and we can put you in touch with all. I know a guy who knows a guy. Um, but we’re, we’re always able to, to, to connect those dots. And I mean, we, we do a lot of, uh. Things like working groups and uh, regional meetings. And, uh, we’ve even got, uh, different summits for different things. Getting a little bit outside of operations, but like we [00:07:00] have an Atlantic operators group that gathers together and has a chat just sometimes, usually there’s a focus topic, but then we have, oh, how do you guys deal with the storm that came through? Or that sort of thing, or what, what do you do for if you need a new blade or has anyone got a good vendor for this thing or that thing? Those sorts of things always happen in the margins. And I mean, the ops summit is the, the best one of those because it’s the entire Canadian industry that gets together. We’ve got folks from bc, we’ve got folks from Atlantic Canada, there’s gonna be people from Quebec, and there’s vendors from all those places as well. Right? So. It’s covering all your bases and it’s the one place that you can talk to everybody and meet everybody in like a 48 hour period.  Joel Saxum: Well, I think that if, you know, just doing a little bit of deep dive into the agenda and the program here, that’s one of the things that you guys are focusing on. Targeted networking. So morning breakfasts, evening receptions, there, you know, structured and informal, uh, opportunities to actually connect with the o and m [00:08:00] community. Um, one of them that you had mentioned was kind of, um. Hands-on demonstrations and, and for me, when, when I see these things, ’cause I’ve seen them kind of slightly not, I don’t think I’ve ever seen anybody do it perfectly well. I’m excited to see what you guys do. But you get, you get a group of people standing around, like you get people kind of standing around. Rubbing elbows going, like, what do you think about that? What is, does this, is this gonna work? And, and those to me are great, great conversations for networking and kind of figuring things out together. The collaboration part.  Mathieu Cōté: Absolutely. Uh, well on those two points, the, the networking has always been a huge part of this show, and we’ve always built into the program. Okay. There’s some stuff on stage, but then there’s a break. And I mean, you can wander around the showroom floor and you can, but you can talk to the other people. And, uh, that’s a big part of this. That’s an important part of this. And then on the, the demonstrations and so on, we used to have what we called, uh, elevator pitches, uh, where, and we’ve done it various different ways where people get five minutes, one slide, you’re on [00:09:00] stage, you say your piece, you give us your elevator pitch, and then you get off and someone else gets up and talks. And we found that, that, and the feedback we got was that that was good because that condensed all of the salesy parts and kept it away from the panels. ’cause the panels, we want them to be informative, not. Selling you something. We want you to learn something. But the sales pitch is, there is some sense of like someone’s trying to sell you a thing. But we’re evolving that a little bit this year where we’re going towards demonstrations. So on the showroom floor, there will be someone who will have a tangible thing, whether it’s here’s the new fireproof coat that we’ve come up with, or here’s how this, uh, sling works, or here’s this piece of kit that fits on your machine that catches bolts when they break, or whatever it is. Here’s how it actually works, and they’ve got it in their hands and they can play with the go until it, uh, really, like you say, gets that light bulb moment that gets you to see how it works. And you can see that ROI [00:10:00] right away going, oh, okay. That if it catches the bolts when they break, then it doesn’t rattle around. And then I’ve gotta spend X amount less time fixing, missed out. Or the other thing, like it’s, it, it’s a, it’s a better way of doing it is, uh, what we feel. And like you say, then you get. Being on the showroom floor, it’s in amongst the booths. So people who are on the showroom floor can just sort of look over their shoulder, see that, okay, I really gotta go check out that guy. Joel Saxum: I like the idea of the format and there’s a couple other things like lessons learned track we talked about a little bit too. But one of the things for me for trade shows is when Alan and I went to ETC in Calgary a few years ago, two years ago I think. Yep. You actually had the. The conversations, the panel conversations, the discussions, the knowledge sharing happening on the showroom floor. I don’t like going to a conference where I have to go in, like I’m talking with some people, but, oh, I gotta run across this thing across over here, a mile away into some back room to listen to someone talk about something. I like, I like being where the information is [00:11:00] happening and sharing, and I can stand off to the side and listen a bit and, and still engage. Um, and you guys are doing some more of that too through the lessons learned track. Um, can you explain that a little bit to us?  Mathieu Cōté: Well, we’ve always had, uh, like a, some split in concurrent sessions and so on. But to your point of not running off to the other end, we’re in a pretty intimate space where we’ve got like a room for lunch and the plenaries, we’ve got a room for the exhibit hall, and then right next to it is any of the, uh, off to the side stuff. It’s all within a one minute walk of, of itself, which is much better. So we’ve got the concurrent, uh, sessions and. This year we split them instead of into two. We split ’em into three though that then we’ve got one for specific to wind. We’ve got one specific to solar and storage. ’cause we are renewable energy, not just wind. And then we’ve got one, uh, that’s a bit of a grab bag and it’s a bit of a different format. So instead of your traditional three [00:12:00] panelists plus a moderator, everyone’s got a slide, everyone’s gotta talk, blah, blah, blah. This thing, it, it’s much more focused. You’ve got one person who’s got a real important thing to say, whether it’s, here’s, uh, lessons learned on how our hub fell off and here’s what we learned from it. Here’s our root cause analysis, or here’s, uh, a much better way of doing, uh, our health and safety program has worked much better for us. Here’s what we gain from it, or whatever happens to be. And then one moderator to ask them some questions, pick apart. So this part, how to, uh, and get a bit of a, a flow there. So, and it’s much shorter. Instead of an hour long, it’s only a half hour. So then you don’t have to sit through two people. You don’t care about to listen to the one person that you do is the intent of these, uh, lessons learned? I,  Joel Saxum: I do really like the concept simply because when I go to an event or like, um, putting something together, I want people to be able to go. Learn something, take it back to their respective [00:13:00] organization, be able to implement it tomorrow. And it sounds like you guys are really moving towards that with the lessons learned, the collaboration and the knowledge sharing.  Mathieu Cōté: That’s, that’s the intent. And that, and that’s really what it is, is I, I’m, I think I’m a smart guy, but I don’t have all the answers. So we’re really trying to shine a light on the people who do, and like, here’s a thing that the industry as a whole should learn about. And give them some time to talk about it. And like you say, then you’ll get some of those conversations in the margins and in in between going, yeah, this guy had this thing to say. We get that sort of dialogue going. That’s, that’s the intent. It’s all about, uh, discussions and learning from each other.  Joel Saxum: To me, it sounds like even, um, for lack of a, maybe a trip to get some poutine and maybe an American, American should go out there and listen to some of the stuff you guys have to say as well. Mathieu Cōté: Honestly, it’s, it’s worth it for, uh, Americans to come by and we do have a significant number, proportion of the, the audience comes from the states as well. Because like you say, it’s, it’s worth it and it’s good information and it’s a good [00:14:00] portion of the thing. And it’s really not that far. And I mean, um, not to put it lightly, we do tend to lean a little heavier on some of the more, uh, Canadian elements like weather. Like we do have a panel this year, um, on the solar side, solar operations and adverse conditions. And that one, um. Because that one came from, uh, I know a guy at, uh, natural Resources Canada, who was part of a working group at the International Energy Agency in their photovoltaic power systems group, where they came up with, uh, a report on operations in all kinds of adverse conditions around the world. So he’s gonna present that report and we’ll have a panel discussion. The other panelists there, we’ve got, um. Ben Power, the CEO of ves, who is the number one installer of solar in the Yukon, right next to Alaska. So they know a lot about adverse conditions and then, uh, polar racking, they’ve got a lot of experience, uh, with that sort of thing too. And they’ve got some data that they’re gonna bring to the [00:15:00] panel as well. So it should be a really good discussion about how do we deal with bad things happening in solar specifically.  Allen Hall: Well, sure. Uh, Canada’s been running assets a lot longer than we have been in the States. In fact, to Joel’s earlier point, we’re repairing. Disassembling putting new stuff up all the time. Canada has been more focused on keeping existing equipment running in some crazy, harsh conditions. The US is moving that way. You wanna know about ice? We could tell you about ice. Exactly. Like how many times has the US run into trouble with icing on wind turbines and we should have been talking to, or her neighbors through the north, but in a lot of cases, yeah. The I, I find that the time I went. I learned a whole bunch about Canadian operations, how to think about some of these problems differently. That was the beauty of a attending a Kria event, and I know there’s gonna be a lot of people attending this event. Who is it for in general? Obviously [00:16:00] it’s for operators, but is there some value here for like asset managers? Some of the engineers, some of the service providers,  Mathieu Cōté: yeah. That our, our core market, if you want, is your site managers and your technical people, but engineers, 100%, they will learn something. Your asset managers will definitely have some value in it, whether it’s learning about the technology or learning about, uh, the, the latest things coming out or even just. Best practices from other folks, right? We’ve also got, uh, more and more we’re getting people from the insurance industry getting involved because some of these, uh, lessons learned and so on, is really valuable to them. And we’re even running, um, if, if people are in insurance, we have a special meeting for insurance. The, the day before where we’ll be having a, a dialogue between the insurance industry and the operators and like, here’s how we deal with this. This is why the prices are that. And, uh, talk about that risk transfer type stuff. There are the odd developer who comes out. Um, but it’s more for the, [00:17:00] like, once it’s in the ground, the technical people, uh, the tooling manufacturers, the service providers, the, all, all of those folks. Joel Saxum: What about ISPs? Oh, a hundred percent. We know quite a few ISPs up in Canada. Every one of them that I’ve talked to is coming. So ev I’ve had the conversations and like I, you know, we’re, we’re doing some other things in February as well around here, and I was, Hey, what are you guys? Oh, we’re all going to the Candry Ops summit. We’re going to the Candry Ops summit, so to Toronto and February. Um, bring your warm jacket. I suppose it could be cold. Yeah, the, the ISPs will be there in, in full force. And so I think that. To me, it’s like the, the, the cousin to the A-C-P-O-M-S. We like OMS in the states because that’s where the real discussions happen around operations and maintenance. Mathieu Cōté: The technical stuff happens. Yeah. And it, I like to say it’s the, the, the younger cousin, if you will, and the maple syrup cousin.  Allen Hall: Well, I do think though, that when we’re at, uh, o, M and S Joel, that [00:18:00] those discussions are a little bit different than what I see up at Kria. Like Kria is a. Community OMS is, yeah, we, we all know one another and maybe it’s just there’s this, a bigger event or more people, but it, I don’t feel the sort of connection I do when I’m at Kria. Like I know the people, I understand what’s going on at Kria. That’s what makes it fun that I get to see people that I, I know once in a while, but at the same time there is a huge, massive amount of. Sharing  Mathieu Cōté: that community that you speak to, that that’s really what we’re trying to, to gather in. And there’s a difference of scale too. I mean, uh, the OMS is like 3000 people and we’re three to 400. So there, there’s a difference there. But that sort of intimacy leads to a fair bit more of that sharing that you’re talking about and like that Oh yeah, there’s that guy. Oh, there’s Derek from Capstone, or there’s Dan from EDF or there, you know, and then you. You run into them and then you, you catch [00:19:00] up on all the latest and, um, what’s going on, how are things going? And so on and so on. And there’s time for all of that in the, in the two day show that we have.  Joel Saxum: Well, I think collaboration in a smaller, like the right size group is, is much easier and flows better. Right? Once you get to that thousand two, three, 4,000, it’s like, yeah, you’re there, you’re seeing the people, but like it’s just not the same.  Mathieu Cōté: Et c is somewhere around 3000 people and it, it, it’s got that heft. It’s a different audience as well. Right? The o and m crowd isn’t there as much. It’s not quite as technical, so it it, it’s a speaking to a different group of people. Allen Hall: Well, Canada is on a growth spurt for renewables. There’s a lot of wind energy  Mathieu Cōté: headed up towards Quebec. There are procurement’s open right now in Quebec, Nova Scotia, new Brunswick. Uh, Ontario, BC and Manitoba  Joel Saxum: Plus, what was it? Fi what was it? Five offshore lease areas off of Nova Scotia.  Mathieu Cōté: Yeah, they’re looking at up to five gigawatts offshore in Nova Scotia. We don’t have [00:20:00] any yet in Nova in, uh, offshore. And there’s some, they need to figure out what the offtake is and where the transmission goes. Uh, but there’s a lot of people working in the background on MA putting that together. So it’s growing. Oh, a hundred percent. It’s growing and across the board, right. And the. Wind or solar or storage or all three. And that, that a lot of the, the procurements these days are starting to move in a direction of, uh, sort of a technology agnostic where they say, we need megawatts. We don’t care how you make them. We just want electricity. Well, electricity, uh, but also electricity capacity. So in the one case we figure wind and solar will do quite well, and in the other we’ll figure the battery storage will do quite well. So no matter what and in the timelines that they’re asking for, we’re looking at if you want it in the next five years, it’s probably gonna be wind and solar because anything else is gonna be a seven plus year timeline to get into the ground. So [00:21:00] there, there’s a lot. There’s a lot coming.  Allen Hall: Well, up to 20% of the energy, electricity in Canada nationally is gonna be generated by renewables in less than 10 years.  Mathieu Cōté: Canada’s split up a lot, remember like, and Quebec is already at 90 plus with their hydro and bc same thing.  Joel Saxum: And I, and I think that that’s something to be, to be shared as well here is from an o and m standpoint. The, the varied geographies of Canada and how spread apart it is, there’s specialized knowledge up there to, to, to, you know, till the cow come home. So it’s a great place to go and learn. I would encourage people, hey, if you’re, if you’re in anywhere around Michigan, the Great Lakes Toronto’s a three hour drive. Go there, do the conference and learn something,  Mathieu Cōté: and hey, we’re right next to the airport. It’s quick flight. Almost anywhere from North America, right? So Toronto’s easy to get in and  Allen Hall: out of, and this is gonna be a great event. The Can Operators Summit. It’s February 11th and 12th at the Delta Hotel by [00:22:00] Marriott, Toronto, right at the airport. So you, you can’t miss it. It’s easy to get in, easy to get out. You’re gonna have a great time. Matt, how do they connect and register for this event?  Mathieu Cōté: We have a registration link that I’m sure we’ll put somewhere. Um, or come to our website, kenia.ca?  Allen Hall: Yeah, just Google Can Operator Summit. That’s what I did. And that takes you right to the registration. Get signed up there. It’s inexpensive in Toronto is a really cool city. February 11th and 12th. At the Delta Hotels by Marriott, right at the airport. The Canary Operator Summer is going to be a lot of fun. Matt, thank you so much for being on the podcast. Really enjoyed having you. Well, thanks for having [00:23:00] me.

This week I Share How Talking Can Solve Problems [powerpress]

Learn more about the Medicare prescription payment plan program. Get the information you need now so you can answer questions from your clients.  

Would you like access to our advanced agency training for FREE? https://www.agencymastery360.com/training Running an agency today looks nothing like it did even a few years ago. What used to work: SEO-driven inbound leads, tight vertical niches, and predictable platforms, has shifted fast. Today's featured guest has learned to adapt to these changes and went from having a clear and defined niche to letting clients' needs guide the next steps for her business. She'll talk about navigating those changes, evolving your positioning, and deciding whether you're actually willing to do what adaptation requires. Laryssa Wirstiuk is the owner of Joy Joya, a boutique email and SMS marketing agency that serves women-focused, product-based e-commerce brands. With more than 15 years in marketing and over a decade running her own agency, Laryssa has lived through multiple shifts in platforms, buyer behavior, and agency models. Her background as a marketing generalist, working across SEO, social, and email, gave her the flexibility to adapt as the market changed. That adaptability, combined with a strong point of view on branding, inbound marketing, and outbound growth, made her a great guest for agency owners questioning what's next for their own businesses. In this episode, we'll discuss: Starting out with a clear niche and evolving along the way. Adopting a hybrid growth strategy. Personal brand vs. clear offers. Subscribe Apple | Spotify | iHeart Radio Sponsors and Resources This episode is brought to you by Wix Studio: If you're leveling up your team and your client experience, your site builder should keep up too. That's why successful agencies use Wix Studio — built to adapt the way your agency does: AI-powered site mapping, responsive design, flexible workflows, and scalable CMS tools so you spend less on plugins and more on growth. Ready to design faster and smarter? Go to wix.com/studio to get started. How to Choose a Niche Without Getting Stuck In It Laryssa didn't stumble into her original niche by accident. After working across industries like tech, education, and healthcare, she realized none of them truly excited her. Jewelry stood out because of its mix of fashion, storytelling, and creativity. Rather than guessing, she intentionally took in-house and freelance roles in the jewelry industry to build credibility before going all in. That vertical focus paid off. By committing to a specific industry, Laryssa was able to build a strong referral network, speak at trade shows, and create highly targeted content that drove inbound leads. But after nine years in the jewelry space, she noticed that the biggest results she delivered for clients consistently came from email marketing. What started as one service among many became the clear driver of ROI. The shift from a vertical niche (jewelry) to a horizontal specialization (email and SMS marketing) wasn't a sudden pivot. It was a response to real performance data. Stronger results, clearer processes, and deeper expertise made the decision feel natural. Your niche should serve your strengths, not trap you in yesterday's model. Why Inbound Alone Is No Longer Enough For most of Joy Joya's history, inbound marketing did the heavy lifting. Content, SEO, YouTube, and a podcast tailored to the jewelry industry created steady deal flow without much outbound effort. That's one of the biggest benefits of vertical focus: you can dominate a small pond with the right content and relationships. But the market shifted. Search behavior changed. Social algorithms changed and AI entered the picture. Laryssa realized that relying solely on inbound was no longer enough. Over the past year or two, she intentionally started building outbound muscles: cold email, cold calling, LinkedIn outreach, and systems that allowed her team to support those efforts. The key insight here isn't that inbound is dead, it's that inbound alone is risky. Agencies that survived and grew were willing to adapt their acquisition mix, even when it meant doing uncomfortable things. The Hard Question Every Agency Owner Faces Adapting isn't just about strategy. You should also ask yourself whether you want to do what's required next. New platforms, new sales motions, and new expectations can trigger an existential crisis for long-time owners. You don't have to love every part of running an agency, but you do need the discipline to face the things you'd rather avoid. The solution isn't grinding forever but rather identifying what you don't enjoy, systemizing it, delegating it, or removing it altogether. Agency owners should get comfortable with change as a necessary part of running an agency. The hard part is that change often targets the things you already tolerate but don't love. That's why many agencies stall. The owners don't hate their situation enough to change it but they don't love it enough to stay fully committed either. When Personal Brand Creates Attention But Not Conversions As AI and recommendation engines influence buying decisions, developing a personal brand becomes vital when it comes to being recommended by these tools. People want to work with leaders whose beliefs, values, and perspectives they understand. That's why podcasts, long-form content, and consistent points of view matter more than ever. In her case, Laryssa shared an unexpected challenge after developing her personal brand. She had built such a strong personal and brand identity that many people understood her perspective but didn't fully understand what her agency actually did. In some cases, prospects were more familiar with the brand name than the services behind it. The lesson for agency owners is balance. Thought leadership without clear offers creates attention without conversion. As platforms evolve, it's not enough to educate—you need to connect that education to the right services, for the right audience, at the right time. Do You Want to Transform Your Agency from a Liability to an Asset? Looking to dig deeper into your agency's potential? Check out our Agency Blueprint. Designed for agency owners like you, our Agency Blueprint helps you uncover growth opportunities, tackle obstacles, and craft a customized blueprint for your agency's success.

Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to explore the recent 2024 health care spending report from the Centers for Medicare and Medicaid Services (CMS).To kick off the new year, we are offering podcast videos of A Health Podyssey. Subscribe to our YouTube channel to watch those episodes. Let us know what you think about the videos by emailing us at communications@healthaffairs.org.Join us on January 21 for an exclusive Insider virtual event exploring the latest drug policies with the University of Utah's Joey Mattingly. Become an Insider to get access to this event.Related Articles:National Health Care Spending Increased 7.2 Percent In 2024 As Utilization Remained Elevated (Health Affairs)Growth In National Health Expenditures: It's Not The Prices, Stupid (Health Affairs Forefront)

The Friday Five for January 16, 2026: Instagram “Your Algorithm” Personalization Apple Health+ on the Horizon? Apple Creator Studio ACA Subsidy Extension Passes House 2026 ACA Enrollment Snapshot #2   Get Connected:

Jenny Bristow and Vice President of Data & Technology Mark Brandes of Hedy & Hopp discuss their proprietary solution, Epic UTM Connect*, developed to help healthcare marketers bridge the long-standing data gap between digital marketing campaigns and patient acquisition and revenue within their Electronic Health Record (EHR) system. They explain the challenges of achieving true marketing ROI in a privacy-forward world and detail how this one-time project allows for patient-level attribution and improved performance measurement.Episode notes:The Data Disconnect: Hedy & Hopp created Epic UTM Connect to help healthcare marketers overcome the persistent struggle to access and show true business impact data (patient appointments, revenue) versus engagement metrics marketers can break down by UTM parameters.What Epic UTM Connect Is: A tool that captures UTM parameters from digital campaigns, packages them, and securely inserts them into the Epic patient record.Achieving True ROI: The ability to track a patient's journey from a marketing touchpoint all the way through appointment and fulfillment to calculate the return on investment (ROI).Easy & Fast Implementation: The tool is fast and lightweight to implement and doesn't require Hedy & Hopp to gain analyst access to Epic. Implementation only requires access to website analytics and the CMS.Technology & Compliance: The solution is HIPAA compliant and secure, leveraging the healthcare organization's existing Business Associate Agreement (BAA) with Epic. It works with any web analytics platform (Google Analytics, Adobe Analytics, Site Improve, etc.) by pulling data directly from the website.Use Case Requirements: The solution's effectiveness is dependent on the organization having a consistent and well-defined UTM parameter strategy in place.Attribution Limitations: The tool primarily provides last-touch attribution, meaning it will not capture the source of every conversion and will show gaps in the full multi-touch patient journey.Standalone Value: Epic UTM Connect is a standalone, one-time implementation that is valuable for improving visibility and does not require healthcare marketing teams to use other Epic marketing tools.Learn more about Hedy & Hopp's Epic capabilities: https://hedyandhopp.com/our-expertise/epic-for-healthcare-marketing/ Contact Hedy & Hopp to chat with us about how Epic UTM Connect can support your marketing efforts: https://hedyandhopp.com/connect-with-us/ Connect with Jenny:Email: jenny@hedyandhopp.comLinkedIn: https://www.linkedin.com/in/jennybristow/Connect with Mark:Email: mark.brandes@hedyandhopp.com LinkedIn: https://www.linkedin.com/in/markbrandes/ If you enjoyed this episode, we'd love to hear your feedback! Please consider leaving us a review on your preferred listening platform and sharing it with others.*Epic®, Epic Systems, and related product names and logos are trademarks or registered trademarks of Epic Systems Corporation. This content is not affiliated with, sponsored by, or endorsed by Epic Systems Corporation.

Enrollment for 2026 brought major shifts for health plans, driven by new CMS rules, rising consumer expectations, and the growing pressure to modernize operations. This episode explores how plans are rethinking enrollment integrity, broker oversight, digital shopping, data quality, and how emerging interoperability requirements will reshape eligibility, provider data, and automation in the seasons ahead.Tune in to understand how these changes affect the future of enrollment, and how leading plans are preparing now.About Our Guest:Alex Loera oversees the enrollment and billing operations aspect of the BPaaS ecosystem. He specializes in scaling enrollment and billing operations, improving data integrity, and strengthening compliance in high-growth, regulated environments. 

In the 200th episode of the Osterholm Update, Dr. Osterholm and Chris Dall discuss recent changes to the childhood immunization schedule, the latest data on this year's influenza season, and an update on CIDRAP's Vaccine Integrity Project. Osterholm Update producers Dr. Sydney Redepenning and Elise Holmes also join to discuss this milestone episode and reflect on how the podcast has evolved over the years.  CMS to stop requiring states to report childhood vaccination levels (Liz Szabo, CIDRAP News) U.S. vaccination rates are plunging. Look up where your school stands (Weber et al., The Washington Post) Resources for vaccine and public health advocacy: Voices for Vaccines Families Fighting Flu Vaccinate Your Family Shot@Life Medical Reserve Corps Learn more about the Vaccine Integrity Project MORE EPISODES       SUPPORT THIS PODCAST

After three decades working to deliver easy, fast and cost-effective patient experiences through technology, Ryan Howells is more optimistic about the future than he's ever been before.At a time when healthcare has been at the center of polarizing and partisan politics, Ryan is focused on an area foundational to digital health that he says draws consensus across party lines: data exchange and interoperability. Freely moving data can unlock innovation in technology, payment models, and regulation to make healthcare work better for everyone, and Ryan is extremely encouraged by the openness to ideas and volume of activity he's seeing from the second Trump Administration in these areas.As Principal at Leavitt Partners since 2015, Ryan collaborates with the private sector, the White House, Congress, HHS, and the VHA to improve health care nationwide. For the past ten years, he has also led the CARIN Alliance, a bi-partisan, multi-sector alliance uniting industry leaders to advance the adoption of consumer-directed exchange across the U.S.In January 2023, Ryan joined Keith Figlioli on the podcast to discuss the myriad of new possibilities emerging in healthcare as a result of better access to data. In this episode, he recounts the progress and obstacles since that conversation, but more importantly, helps unpack the flurry of new activity.Topics Ryan and Keith covered include:ACCESS & TEMPO. These are the latest examples of two new government programs that Ryan believes will remove barriers to innovation. ACCESS is a CMS initiative that now makes it possible for technology companies to bill Medicare directly for digital health services – and get paid only when patients achieve specific, measurable clinical outcomes. Ryan explains how ACCESS is a breakthrough for transparency and has the potential to change contracting for digital health vendors as health system may now ask to share risk. TEMPO is a program from the FDA that complements ACCESS by allowing participating companies to bypass traditional device clearance processes through “enforcement discretion,” provided they share real time data with the FDA. Ryan explains how this oversight lowers cost and complexity for startups and accelerates the path to market for new digital health solutions.Removing administrative roadblocks. In early 2025, Ryan's team at Leavitt Partners published a paper titled, “Kill the Clipboard” that offered recommendations to cut administrative costs, lower the burden on consumers and providers, and modernize the health care data exchange ecosystem. Ryan discussed recommendations like the need for stronger enforcement of information blocking rules and suggestions for the government to change its certification program to focus on APIs, versus functionality of EHRs. He explained how these things would allow health systems to control their own data, build cloud-based workflows, and integrate with payers and innovative companies more easily.Linchpins for data liquidity. Ryan believes that achieving true data liquidity in healthcare requires three foundational elements: a cloud-based data store, an API endpoint, and robust digital identity credentials. With these in place, he says organizations can exchange data securely and efficiently, supporting everything from public health to quality measurement and pharmacy exchange. He says these are the linchpins to finally achieve the data liquidity needed for innovation, interoperability, and improved patient outcomes.To hear Ryan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for

The Centers for Medicare and Medicaid Services has finalized the 2026 Outpatient Perspective Payment System (OPPS) rule, with most policies taking effect on January 1, 2026. Jenna Stern, Vice President of Regulatory Affairs and Public Policy at Vizient, joins host Carolyn Liptak, Pharmacy Executive Director in Vizient's Center for Pharmacy Practice Excellence, to discuss key updates to payment policies, payment rates, and quality provisions affecting Medicare beneficiaries receiving care in hospital outpatient departments and ambulatory surgical centers.   Guest speaker:    Jenna Stern Vice President of Regulatory Affairs and Public Policy Vizient Host:   Carolyn Liptak, MBA, RPh  Pharmacy Executive Director Vizient  Verified Rx Host   Show Notes: 00:05 — Introduction Announcer welcomes listeners to VerifiedRx. Host Carolyn Liptak, Pharmacy Executive Director at Vizient, introduces the episode focus: the 2026 CMS Outpatient Prospective Payment System (OPPS) Final Rule. Guest: Jenna Stern, VP of Regulatory Affairs and Public Policy at Vizient.   01:12 — Overview of the OPPS Final Rule OPPS sets Medicare payment for most hospital outpatient services. Published annually (typically November), effective January 1. Covers payment rates, policies, quality programs, and compliance requirements. Note: CMS delayed enforcement of hospital price transparency requirements until April 1, 2026.   01:34 — Key Takeaways From the 2026 Final Rule Jenna's high-level insights: Hospitals will continue facing financial pressure in 2026. Modest payment rate increase combined with reimbursement-reducing policies. Expansion of site-neutral payment policies will be particularly impactful. Rule reflects emerging administration priorities shaping future policy.   02:21 — OPPS Payment Rate Update for 2026 CMS finalized a 2.6% OPPS schedule increase factor for hospitals meeting quality reporting requirements.   02:40 — What the 2.6% Increase means Based on: 3% market basket update –0.7% productivity adjustment Results in a modest net increase. Slightly better than the proposed 2.4% increase, though still viewed as inadequate. CMS estimates $8 billion increase in total OPPS payments compared to 2025.   03:37 — 340B Remedy Offset: Background From 2018–2022, CMS paid for 340B drugs at ASP –22.5%. Prior Supreme Court decision from 2022 found that CMS lacked authority to vary rates as finalized in prior rulemaking (e.g., without using drug acquisition cost surveys to inform policy).   04:13 — 340B Remedy Offset in the 2026 Final Rule CMS considered increasing the remedy offset from 0.5% to 2%. Stakeholders strongly opposed the increase due to hospital financial strain.   05:10 — Final Outcome CMS retained the 0.5% offset for 2026. CMS signaled that larger offsets may be proposed for 2027. This marks the first year the remedy offset takes effect,   06:00 — Site-Neutral Payment Policy: What It Is Concept: same service = same payment, regardless of site of care. Hospital concern: policy reduces hospital reimbursement without accounting for site of care differences, patient acuity, overhead, or service complexity.   06:15 — Site-Neutral Expansion in the 2026 Rule CMS expanded site-neutral payment to include drug administration services at excepted off-campus provider-based departments.   07:08 — Financial Impact Reimbursement aligns with Physician Fee Schedule rates. CMS estimates $290 million reduction in outpatient spending for 2026. $220 million of savings accrue directly to Medicare. Not implemented in a budget-neutral manner.   08:14 — Non-Opioid Pain Management Payments Temporary additional payments began January 1, 2025. Authorized under the NO PAIN Act (Consolidated Appropriations Act of 2023).   08:28 — What's New for 2026 CMS finalized the renewal of: 5 drugs 13 medical devices eligible for separate payment in HOPD and ASC settings. Per statue, payments available through December 31, 2027.   09:32 — Process Improvements CMS will allow more frequent consideration of new qualifying products (not limited to annual updates). Quality criteria unchanged; timing flexibility added. CMS released guidance on how stakeholders can engage for inclusion.   10:58 — OPPS Drug Acquisition Cost Survey CMS finalized plans to survey hospitals on acquisition costs for separately payable OPPS drugs.   11:21 — Why CMS Is Advancing the Survey Addresses Supreme Court requirements from prior 340B litigation. Aligns with White House Executive Order on lowering drug prices. Positions CMS to use survey data for 2027 rulemaking.   12:47 — OPPS Packaging Thresholds for 2026 Drugs and biologics: Threshold remains at $140. Diagnostic radiopharmaceuticals: Increased to $655 (from $630). Products below thresholds retain Status Indicator “N” (packaged payment).   13:26 — Why Billing Packaged Drugs Still Matters Even though not separately payable, hospitals must bill for packaged drugs. Billing data feeds cost reports used to calculate future bundled payments. Failure to bill can result in inaccurately low reimbursement.   14:14 — Elimination of the Inpatient-Only (IPO) List CMS finalized a three-year transition to eliminate the IPO list by January 1, 2029.   14:32 — Why This Change Is Significant IPO list historically ensured certain services were provided inpatient only. CMS emphasizes provider judgment in determining site of care. Raises concerns about: Patient safety Payer coverage changes Pressure to move services outpatient   16:28 — ASC Covered Procedure List Expansion CMS expanded the ASC Covered Procedure List. Enables more Medicare covered services to be performed in the ASC settings.   16:48 — Price Transparency: Still a Priority No major overhaul, but continued refinement. CMS exploring new uses of price transparency data beyond patient comparison.   17:46 — Most Critical Policies to Watch Jenna highlights: Modest OPPS payment increase Site-neutral payment expansion 340B remedy offset Drug acquisition cost survey Broader regulatory activity beyond OPPS   18:43 — Available Vizient Resources OPPS Final Rule Summary Government Relations & Public Policy Summaries  Advocacy   19:20 — Closing Carolyn thanks Jenna for her insights. Reminder to subscribe, like, and share feedback. VerifiedRx is produced by the Vizient Center for Pharmacy Practice Excellence.   Links | Resources:  Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Rating; Hospital Price Transparency; and Notice of Closure of a Teaching Hospital and Opportunity To Apply for Available Slots: Click Here CMS fact sheet on the Final Rule: Click Here Outpatient Prospective Payment System (OPPS) Drug Acquisition Cost Survey: Click Here Vizient Office of Public Policy and Government Relations final rule summary:  Click Here Final List of Qualifying Products for Separate Payment for non-opioid pain medications: (Table 136, pgs. 1138-1140)   VerifiedRx Listener Feedback Survey: We would love to hear from you - Please click here   Subscribe Today! Apple Podcasts Spotify YouTube RSS Feed    

Agency is the Power to Act | CMS Book Club Live at #IMSH2026 Roxane Gardner and Grace Ng react to Shawn Kanungo's keynote talk on innovation at #IMSH2026. Watch here: https://youtu.be/tbUfYHhM3kE Roxane and Grace both felt that the content of the talk was surprisingly supportive, especially for an ‘innovator' who was speaking about the role of AI in the changing industry. Much in the way that we talk at CMS about not imposing simulation from the top down as a prepackaged education solution, but instead partnering with teams to learn what they need to help them feel ready and then using simulation as a tool among many to get them there, Shawn helped to position agentic and generative AI in the same way. Grace was pleased to hear the discussion of agency, and tools that empower people to do things rather than replacing them—her PhD work on nursing agency and how nurses can be empowered to activate rapid response teams, and that seemed very relevant to the moment as we figure out how these tools will shape our work. Listen and subscribe on Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822 #curiousnow #healthcaresimulation #medicine #nursing

This week I Update The Terminology List [powerpress]

Expand your Affordable Care Act client base with these six lead generation strategies!   Read the text version  

Alex Bores of CMS discusses how they are using AI to help fabricators with their machines.

Would you like access to our advanced agency training for FREE? https://www.agencymastery360.com/training How big do you actually want your agency to become? Does the idea of running a massive team sound exciting or completely exhausting? For many agency owners, scaling feels less like growth and more like trading freedom for complexity. Scaling an agency isn't about hustle. It's about surviving the moments that almost break you, building systems that actually work, and accepting that what got you here won't get you there. Today's featured guest understands that running a big agency is about structure and leadership. He's grown a global agency to 700 people without losing profitability, sanity, or culture and now he'll unpack the hard-earned lessons that most agency owners don't think about until it's too late. Nital Shah is the co-founder of Mavlers, a full-service, lifecycle digital agency headquartered in India, with operations supporting global brands and agencies across multiple geographies. Today, Nital leads a 700-person organization focused on marketing operations, delivery excellence, and scalable systems for agencies around the world. Having experienced both sides of the agency equation, client-side pressure and operational scale, Nital brings a grounded, operator-first perspective to growth, profitability, and leadership. In this episode, we'll discuss: An early principle: Profit should be intentional. Achieving operational excellence at scale. Structuring scale to make it manageable. Why alignment beats micromanagement. Subscribe Apple | Spotify | iHeart Radio Sponsors and Resources This episode is brought to you by Wix Studio: If you're leveling up your team and your client experience, your site builder should keep up too. That's why successful agencies use Wix Studio — built to adapt the way your agency does: AI-powered site mapping, responsive design, flexible workflows, and scalable CMS tools so you spend less on plugins and more on growth. Ready to design faster and smarter? Go to wix.com/studio to get started. The Wake-Up Call: COVID, Cash Flow, and Retainers Like many agencies, Nital's biggest inflection point came during COVID. Before the disruption, the agency was focused heavily on top-line revenue rather than predictable recurring income. When 40 percent of revenue disappeared almost overnight, the weakness in that model became painfully obvious. Luckily, the agency's consistent focus on profit from day one helped them overcome this ordeal. However, it changed Nital's perspective on retainers and helped him understand that, without retainers, any similar unexpected bump in the road could destroy the agency. The agency had enough cash flow to survive the shock and rebuild and the lesson was clear: at scale, a large team without consistent recurring revenue is fragile. Retainers aren't just about stability; they are about survival. The other advantage that helped soften the blow was diversification. By spreading clients across industries and geographies, the agency avoided being wiped out by a single market downturn. When one region slowed, others carried the load. That balance didn't eliminate pain, but it reduced risk in a way most agencies underestimate until they feel it firsthand. Profit Is Not an Afterthought One of the most important principles Nital and his co-founder agreed on early was: profit must be intentional. It's not something you hope shows up at the end of the year. It's something you design into the business. That mindset shapes everything from service selection to client qualification. The agency actively avoids hyper-competitive, race-to-the-bottom services and continually evolves its offerings as markets become saturated. When a service becomes unprofitable, they pivot. When a client isn't aligned or drains margin, they say no. Profit isn't just about owner income. It funds experimentation, innovation, and future growth. Without margin, you can't test new services, pivot when the market shifts, or invest in better systems. You just stay busy. And busy is often the enemy of profitable. Operational Excellence at Scale Running a 700-person agency isn't about heroics but about process. Nital is clear that consistent, documented, and enforced workflows are what reduce mistakes, rework, and delivery friction. The agency is structured into service-based business units, each with its own leadership and accountability. On top of that sits a customer success layer that ensures delivery stays aligned with expectations. Everyone is trained on defined protocols, and those protocols exist to protect quality, not bureaucracy. When processes are clear and followed, the probability of hitting client outcomes increases. That reduces rework, lowers internal stress, and improves margins. In a people-driven business, operational discipline is what turns chaos into leverage. Alignment Beats Micromanagement One of the hardest challenges for Nital's agency came after rapid post-COVID growth, when the team doubled in size and remote work became the norm. Processes broke, alignment slipped, and as a result, communication suffered. The turning point came with adopting the Scaling Up framework by Vern Harnish. This framework, aimed at businesses ready to scale in a more structured manner, forced clarity across four areas: people, strategy, execution, and cash. More importantly, it created alignment from leadership all the way down to individual contributors. Every team member understands how their work connects to departmental goals, quarterly priorities, and long-term vision. When people understand the why behind the process, ownership replaces micromanagement. Accountability becomes cultural, not enforced. Leadership, Tough Calls, and A-Players When it comes to mistakes in team alignment, Nital openly acknowledges that the team that gets you to one stage may not be the team that gets you to the next. That realization isn't easy, especially when loyalty and shared history are involved. But over the last two years Nital has embraced the fact that growth demands adaptability. The agency now prioritizes agility, learning speed, and ownership. When someone can't evolve with the business, they are given time, feedback, and support, but the standard doesn't change. You don't win championships by protecting weak links. You win by putting the best players on the field while still treating people with respect and empathy. It's not cold. It's responsible leadership. Structuring Scale So It's Manageable When Nital decided to go back to India and start an agency, his mentor back in Australia offered him the chance to run their offshore center. From there, he started supporting other agencies in several countries and expanded his team to where they are now. Seven hundred people sounds overwhelming until you understand the structure. Instead of one massive organization, the agency operates as multiple business units, each capped around 100 to 150 people and run as its own P&L. This turns an impossible leadership problem into a manageable one. Leaders focus on coaching their direct reports, not managing hundreds of individuals. Each layer carries responsibility downward, creating clarity instead of bottlenecks. As Nital points out, no founder manages 700 people directly. You manage your leadership team. And if that team is strong, aligned, and accountable, scale becomes less scary and far more sustainable. The Future: AI, Change, and Opportunity Despite the uncertainty surrounding AI and marketing technology, Nital is optimistic. The pace of change has leveled the playing field. Years of experience no longer guarantee an advantage. Everyone is adapting at the same time. For smaller agencies, this creates opportunity. They can adopt tools and workflows faster than large organizations. For larger agencies, the challenge is moving faster without breaking structure. Either way, the shift toward complex marketing technology orchestration opens doors for agencies willing to master it. For him, the future belongs to agencies that can adapt, systemize, and evolve without clinging to what used to work. Do You Want to Transform Your Agency from a Liability to an Asset? Looking to dig deeper into your agency's potential? Check out our Agency Blueprint. Designed for agency owners like you, our Agency Blueprint helps you uncover growth opportunities, tackle obstacles, and craft a customized blueprint for your agency's success.

2026 PREDICTIONS SERIES: Jane Sarasohn-Kahn & Amy Heymans Join hosts Jared Johnson and Zain Ismail for their annual Predictions Series with popular returning guests Jane Sarasohn-Kahn and Amy Heymans sharing where they see consumer health heading in the coming months and years, including some pretty big trends that may surprise you. All that, plus the Flava of the Week about CMS' new ACCESS model. What chronic conditions is it targeting, and could this be a pivotal moment for digital health? Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

It's only January and we're already pissed. Your Feminist Buzzkills are officially BACK with our first pod of 2026, and we're ready to fuck some shit up. Lizz and Moji are lacing up their boots and standing elbow-to-elbow with y'all every single day they come for one of us. From the latest escalation of the “there's abortions in our water” panic to a huge abortion win in Wyoming, a LOT went down while we were busy baking, wrapping, and just trying to survive. GUEST ROLL CALL! It feels like the world is BURNING; with heartbreaking news pouring out of the North Star State, we're starting the new year with the best person we know to break it all down: Minnesota State House Representative, Leigh Finke. The first openly trans member in the Minnesota State Legislature and chair of the Reproductive Freedom Caucus dives into all of the anti-trans healthcare assaults that the Trump Administration dropped over the holidays, and brings us updates on the tragic ICE shooting of Renee Nicole Good.  We know we say this often (and it's always true ofc), but this is absolutely a pod you won't want to miss! Times are heavy, but knowledge is power, y'all. We gotchu. OPERATION SAVE ABORTION: Check out our NEW Operation Save Abortion workshop, recorded a live  from Netroots Nation 2025 that'll train you in coming for anti-abobo lawmakers, spotting and fighting against fake clinics, AND gears you up on how to help someone in a banned state access abortion. You can still join the 10,000+ womb warriors fighting the patriarchy by listening to past Operation Save Abortion trainings by clicking HERE for episodes, your toolkit, marching orders, and more. HOSTS:Lizz Winstead IG: @LizzWinstead Bluesky: @LizzWinstead.bsky.socialMoji Alawode-El IG: @Mojilocks Bluesky: @Mojilocks.bsky.social SPECIAL GUEST:Leigh Finke IG: @LeighForMN Bluesky: @LeighFinke.bsky.social GUEST LINKS:Leigh Finke WebsiteLeigh Finke LinktreeMinnesota House WebsiteMary Jam Deap Vally: “Femejism” NEWS DUMP:Minnesota Day Care Hoax Is Fueled by MAGA Psychosexual WeirdnessFetal Homicide Charge Dismissed, Bond Lowered for KY Woman Charged After AbortionWisconsin's 1849 Law Does Not Ban Abortion, the State Supreme Court RulesAbortion Stays Legal in Wyoming as Its Top Court Strikes Down Laws, Including First Us Pill BanWhite House Walks Back Trump Comments After Abortion BlowbackTrump Administration Bans Abortions Through Department of Veterans AffairsWeaponizing Water: How the Campaign Against Medication Abortion Co-Opts Environmental PolicyAnti-Transgender Bill Passes House; Rfk Jr. Announces Restrictions EPISODE LINKS:My Voice, My ChoiceOperation Save AbortionExpose Fake ClinicsBUY AAF MERCH!EMAIL your abobo questions to The Feminist BuzzkillsAAF's Abortion-Themed Rage Playlist SHOULD I BE SCARED? Text or call us with the abortion news that is scaring you: (201) 574-7402 FOLLOW US:Listen to us ~ FBK Podcast Instagram ~ @AbortionFrontBluesky ~ @AbortionFrontTikTok ~ @AbortionFrontFacebook ~ @AbortionFrontYouTube ~ @AbortionAccessFront TALK TO THE CHARLEY BOT FOR ABOBO OPTIONS & RESOURCES HERE!PATREON HERE! Support our work, get exclusive merch and more! DONATE TO AAF HERE!ACTIVIST CALENDAR HERE!VOLUNTEER WITH US HERE!ADOPT-A-CLINIC HERE!GET ABOBO PILLS FROM PLAN C PILLS HERE!When BS is poppin', we pop off! Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The Friday Five for January 9, 2026: Rural Health Transformation Program Allocations Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model Global Benchmark for Efficient Drug Pricing (GLOBE) Model Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model Clear, Accurate, and Actionable Health Care Prices      Get Connected:

For Episode 96 of Astonishing Healthcare, Jason Barretto, our SVP of Government Programs, returns to the show for a discussion about what's happening on the health plan side of the business. As a company, we spend a lot of time talking about and showing how modern technology streamlines benefit administration workflows and overall operating efficiency, solves longstanding problems, and helps clients stay nimble to meet the intent of new regulations. Well, Jason's experience managing PBM relationships at health plans helps him - and our team - add real value when working with our clients. And, thankfully, he loves to talk about it!During this episode, we discuss:Intensifying demand for transparency (beyond just price transparency)The Inflation Reduction Act (IRA) and the implementation of Maximum Fair Prices (MFP)Slow adoption of the Medicare Prescription Payment Plan (MPPP) and how CMS is removing barriersA streamlined approach to managing Dual Special Needs Programs (D-SNPs), something Jason "wanted to solve" when he started hereA really interesting observation about the popularity of GLP-1sCMS changing its audit approach and the importance of audit readiness in 2026Related ContentHow Our Favorite New Judi® Features Aid Government ProgramsJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM ReformJudi® is a Tech-Enabler – A Case StudyAH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya LomsadzePartnership & Collaboration: Why PBMs and Health Plans Should Sync on Regulatory Change ManagementFor more information about Capital Rx and this episode, please visit Judi Health - Insights.

Allen and Joel are joined by Nathan Davies from Lloyd Warwick to discuss the world of wind energy insurance. Topics include market cycles, the risks of insuring larger turbines, how critical spares can reduce downtime and costs, why lightning claims often end up with insurers rather than OEMs, and how AI may transform claims data analysis. Sign up now for Uptime Tech News, our weekly newsletter on all things wind technology. This episode is sponsored by Weather Guard Lightning Tech. Learn more about Weather Guard’s StrikeTape Wind Turbine LPS retrofit. Follow the show on YouTube, Linkedin and visit Weather Guard on the web. And subscribe to Rosemary’s “Engineering with Rosie” YouTube channel here. Have a question we can answer on the show? Email us! Welcome to Uptime Spotlight, shining light on wind. Energy’s brightest innovators. This is the Progress Powering tomorrow. Allen Hall: Nathan, welcome to the program. Thank you for having me. So you are, you’re our link to the insurance world, Nathan, and there’s been so many changes over the past 12, 24 months, uh, not just in the United States but worldwide. Before we get too deep into any one subject, can you just give us a top level like, Hey, this is what’s happening in the insurance world that we need to know. So there’s  Nathan Davies: obviously a lot of scope, a lot of development, um, in the wind world. Um, you know, there’s the race to scale. Um, and from an insurance perspective, I think everybody’s pretty tentative about where that’s going. Um. You know, the, the theory that are we trying to [00:01:00] run before we can walk? Um, what’s gonna happen when these things inevitably go wrong? Uh, and what are the costs gonna be that are associated with that? ’cause, you know, at the moment we are used to, to claims on turbines that are circa five megawatts. But when we start seeing 15 megawatt turbines falling over. Yeah, it’s, it’s not gonna be a good day at the office. So, um, in the insurance world, that’s the big concern. Certainly from a win perspective at least.  Joel Saxum: Well, I think it’s, it’s a valid, uh, I don’t know, valid bad, dream. Valid, valid risk to be worried about. Well, just simply because of like the, the way, uh, so I’ve been following or been a part of the, that side of the industry for a little while here the last five, six years. Um. You’ve seen The insurance world is young in renewables, to be honest with you. Right. Compared to a lot of other places that like say the Lord Lloyd’s market, they’ve been writing insurance for hundreds of years on certain [00:02:00] things that have, like, we kind of know, we know what the risks are. We, and if it develops something new, it’s not crazily new, but renewables and in wind in specific haven’t been around that long. And the early stuff was like, like you said, right? If a one megawatt turbine goes down, like. That sucks. Yeah. For everybody, right? But it’s not the end of the world. We can, we can make this thing happen. You’re talking, you know, you may have a, you know, your million, million and a half dollars here, $2 million here for a complete failure. And then the business interruption costs as a, you know, with a one megawatt producing machine isn’t, again, it’s not awesome, but it’s not like it, uh, it doesn’t break the books. Right. But then when we’re talking 3, 4, 5, 6. Seven megawatts. We just saw Siemens cesa sell the first of their seven megawatt onshore platforms the other day. Um, that is kind of changing the game and heightening the risk and makes things a little bit more worrisome, especially in light of, I mean, as we scaled just the last five, [00:03:00] 10 years, the amount of. Failures that have been happening. So if you look at that and you start expanding it, that, that, that hockey stick starts to grow. Nathan Davies: Yeah, yeah, of course. And you know, we, we all know that these things sort of happen in cycles, right? It’s, you go, I mean, in, in the insurance world, we go through soft markets. We go through hard markets, um, you know, deductibles come up, the, the clauses, the restrictions, all those things get tighter. Claims reduce. Um, and then you get sort of disruptors come into the market and they start bringing in, you know, challenging rates and they start challenging the big players on deductibles and preferential rates and stuff like that. And, and then you get a softening of the market, um, and then you start seeing the claims around up again. But when you twin that with the rate of development that we see in the renewables worlds, it’s, it’s fraught for all sorts of. Weird and wonderful things happening, and most of them are quite expensive.  Joel Saxum: Where in that cycle are we, in [00:04:00] your opinion right now? So we, like when I first came into the market and I started dealing with insurance, it was very, we kept hearing hardening, market hardening, market hardening market. But not too long ago, I heard from someone else that was like, Hey, the market’s actually getting kind of soft right now. What are your thoughts on that? And, and or may, and maybe we let, let’s precursor that there’s a lot of people that are listening right now that don’t know the difference. What is a hard market? What is a soft market? Can you give us that first?  Nathan Davies: When you’re going through a soft market, it’s, it’s a period where they’ve either been, um, a limited volume of claims or the claim values have been quite small. Um, so, you know, everybody gets. It’s almost like becoming complacent with it, right? It’s like, oh, you know, things are going pretty well. We’re having it. It looks like the operators, it looks like the maintainers are, are doing a pretty good job and they know all of the issues that are gonna be working through in the lifetime of these products. So for the next however many years, we can anticipate that things are gonna gonna go pretty well. But as you see those [00:05:00] deductibles come down, you start getting more of the attritional claims, like the smaller values, um, the smaller downtime periods, all that sort of thing, start coming in as claims. And all of a sudden insurers are like, well, hang on a second. All of a sudden we’ve got loads and loads of claims coming in. Um. All of the premium that we were taking as being bled dry by, by these, these attritional claim. Um, and then you get like a big claim coming. You get a major issue come through, whether it’s, you know, a, a serial issue with a gearbox or a generator or a specific blade manufacturer, and all of a sudden the market starts to change. Um, and insurers are like, well, hang on a second. We’ve got a major problem on our hands here. We’re starting to see more of this, this specific piece of technology being rolled out, um, worldwide. Um, we are in for a lot of potential claims on this specific matter in the future, and therefore we need to protect ourselves. And the way that insurers do that is by [00:06:00] increasing or deductibles, um, increasing their premiums, all that sort of thing. So it’s basically that. Uh, raises the threshold at which a claim can be presented and therefore minimizes the, the outlay for insurers. So that’s sort of this, this cycle that we see. Um, I mean, I can’t, I’ve, I’ve only been in loss adjusting for six years, so I can’t say that I’ve seen, you know, um, multiple cycles. I’ve, I’m probably at the end of my first cycle from a hardening to a softening market. Um. But also, again, I’m not in the underwriting side of things. I’m on the claims side of things, so I own, I’m only seeing it when it’s gone wrong. I don’t know about everything else that the insurance market sees.  Joel Saxum: Yeah, the, the softening part, I think as well from a macro perspective, when there’s a softening market, it tends to bring in more capital. Right. You start to see more, more and more companies coming in saying, Hey, I’ve got, [00:07:00] and when I say companies, I mean other capital holders to beat for insurance, right? Like these, the big ones you see, the big Swiss and German guys come in and going, like, I got, I got $500 million I’ll throw into renewables. It seems like to be a good, pretty good bet right now. And then the market starts to change and then they go, uh, oops. Yeah.  Nathan Davies: And that’s it. You know, you’ve got the, the StoreWatch of the renewable insurance market like your G cubes and, and companies like that who’ve been in the game for a very long time. They’ve got a lot of experience. They’ve been burned. Um, they know what they want to touch and what they don’t want to touch. And then you get. Renewables, everybody wants to be involved. It covers their ESG targets. It’s, it’s a good look to move away from, you know, your, your oil and your coal and all the rest of it. So, of course, companies are gonna come into it. Um, and if they’re not experienced.  Allen Hall: They will get banned. How much reliance do operators have at the moment on insurance? Because it does seem like, uh, Joel and I talk [00:08:00]to a lot of operators that insurance is part of their annual revenue. They depend upon getting paid a certain amount, which then opens up the door to how sort of nitpicky I’ll describe it as the claim. They’ll file. Are you seeing more and more of that as, uh, some of the operators are struggling for cash flow, that there are going after more kind of questionable claims? Um, I think it depends on  Nathan Davies: the size of the operator. So you’ve, you’ve obviously got your, your big players, you’ve got your alls and your rws and all of those sort of guys who, the way that they manage their insurance, they’ve probably got, you know, special purpose vehicles. They’ve got, um, sites or clusters of sites that they manage finances independently. They don’t just have the one big or pot. It’s, it’s, it’s managed sort of subdivisions. Um. Those, those guys, we don’t typically tend to see like a big push for a [00:09:00] payment on account partway through a claim. It’s, it’s typically sort of the smaller end of the scale where you might have, um, an operator that manages a handful of smaller, um, assets. The way that we look at it is if you don’t ask, you don’t get, so when we talk to an insured, it’s like. Present your costs, you know, we’ll review them and it’s, it’s better that you present all of your costs and insurers turn around and say, you’re not eligible for this. You know, that that element of it will be adjusted, um, rather than not present something. And it’s like, well, you know, your, your broker then comes further down the line when they say you could have claimed that element of, of the cost. So, um. Typically that’s the approach that we take is, is present everything and we’ll work through and let you know which elements aren’t claimable.  Joel Saxum: When we’re talking insurance policies, there can be, you know, like an operator, an owner of a turbine asset can have them. Then there is construction policies and [00:10:00] there’s the EPC company might have a policy and ISP may have a policy. So, so many policies because at the end of the day, everybody’s trying to protect themselves. Like, we’re trying to protect the bottom line. Tr that’s what insurance us for, that’s why we’re here. Um, but so, so, so, so gimme a couple things. Like in your opinion as, let’s look, well, I wanna stay in the operator camp right now, say, during a non non-commission policy, a actual operating policy, wind farm is in the ground, we’re moving along. What are some of the things that, from an, from a loss adjuster’s perspective, that a operator should be doing to protect themselves? I mean, besides. Signing an insurance contract. Yes. But is it, is it good record keeping? Is it having spares on site? Is it, what does that look like from your perspective when you walk into something,  Nathan Davies: if you were to take the insurer’s dream operator, that would be somebody who, and you, you’ve kind of hit the nail on the head with a lot of those points, Joel, the, the. The golden [00:11:00] operator would have like a stash of critical spares because the last thing they want to be relying on is, um, an OEM who, you know, they, they’ve, they’ve stopped manufacturing that bit of kit three years ago. They now want to sell you the latest and greatest. It’s 18 months lead time or something like that. Oh yeah, absolutely. And so you are now having to look at potentially refurbishment through. Whether that’s through sort of approved, um, processes or not. Um, you might be looking at, um, sort of, um, aftermarket providers. You know, there, there’s, as soon as you are looking at an aged asset, you are, you are in a really complicated position in terms of your repairability. Um, because, you know, a as we know, you get to sort of that three, five year period after you’ve purchased the product, you’re in real jeopardy of whether or not it’s gonna be. Gonna have that continued support from the original equipment manufacturer. So [00:12:00] critical spares is a really good thing to, it’s, it’s just obviously a really good thing to have. Um, and how you can manage that as well is if you have, um, a customer of sites that are all using the, the same equipment, you could sort of share that between you. There, there could be. Um, so we, we’ve sinned that where, um. An umbrella company has multiple sites, multiple SPVs. Um, they were all constructed at the same sort of time. They’ve got the same transformers, you know, the same switchgear, same infrastructure, and they hold a set of spares that cover these, all these sites. ’cause the last thing you want to do is buy a load of individual components for one site. You are then paying to maintain them, to store them to, you know, there’s, there’s a lot of costs that come with. Along with that, that you, you don’t wanna be covering. If that’s just for the one site and it’s the [00:13:00] eventualities, that may never happen. So if you’ve got multiple sites and you can spread those costs, all of a sudden it’s a lot more, um. Could  Joel Saxum: you see a reality where insurers did that? Right? Where like a, like a, like a consortium of insurance companies gets together and buys, uh, half a dozen sets of blades and generators and stuff that they know are failures that come up, or they have a pool to pull from themselves to, to avoid these massive bi claims. Nathan Davies: Yeah. I mean maybe there’s, maybe there’s the potential for a renewables pool. I mean, it’s always. Complicated. As soon as you start trying to bring sort of multiple companies together with an agreement of that sort of scale, it’s gonna be challenging. But, um, I mean, yeah, in an ideal world, that would be be a great place to be. Um, so critical spares is, that’s, that’s a key thing we, we have seen. So we, we’ve got, um, one account that we work with that they’ve actually got a warehouse full of critical spares. [00:14:00] So they, they have a lot of, um, older turbine models, um, sort of typically, um, 2015 through to, well, yeah, from about 2012 to 2015. Um, these sites were commissioned so they knew there was a, a finite lifetime, uh, replacement blades, generators, gear, boxes, what have you, and it’s like we’ve. A huge number of assets. So what we should do is retain certainly a number of gearboxes and generators that you, we can utilize across, um, the fleet. And obviously they then keep a rolling stock of refurbishment and repairs on those. But they, they basically included in their, their premium spreadsheet, they’ve got all of their individual sites. Then they’ve got a warehouse that is full of all their spares, and that is an inuring asset, is their warehouse full of critical spares. Joel Saxum: So what  Nathan Davies: happens to  Joel Saxum: that  Nathan Davies: person then? Does  Joel Saxum: their premiums go [00:15:00] down? Because they have those spares, they’ve got really low deductibles on their bi. So there’s a business case for it probably, right? Like if you’re sitting there, if you’re, if you’re, you’re an accountant, you can figure that out and say like, if we hold these spares for this fleet, like if you’re, if you’re a fleet, if you have a homogenous fleet, say you’ve got a thousand turbines that are basically all the same model. W you should have centrally located amongst those wind farms, a couple of blade sets, a couple of generators, couple of pitch bearings, couple of this, couple of that. And you can use them operationally if you need to, but it’s there as spares, uh, for insurance cases. ’cause you’ll be able to re reduce your insurance premiums or your insurance deductibles. Allen Hall: That’s remarkable. I don’t know a lot of operators in, at least in the United States that have done that, I’m thinking more of like Australia where it’s hard to get. Parts, uh, you, you probably do have a little bit of a warehouse situation. That’s really interesting because I, I know a lot of operators are thinking about trying to reduce their premiums and simple things like that would, I would imagine it make a huge difference [00:16:00] in what they’re paying each year and that that’s a smart move. I, I wanna ask about the IEC and the role of certification in premiums. What does it mean and how do you look at it as an industry? Uh, one of the things that’s happening right now is there’s a number of, I think some of the major IEC documents in, in our world, in the lightning world are going through revision. Does that, how do, how do you assess that risk that the IEC specs or the sort of the gold standard and you have the certification bodies that are using them to show that the turbines are fit for purpose. Is there a reliance upon them? Does, does it help reduce premiums if there’s an I-E-C-I-I, I’m not even sure how the industry, the insurance industry looks at it. Or is it more of how the turbines perform in the first year or two, is how, what’s gonna really gonna drive the premium numbers? I mean, insofar as  Nathan Davies: I eecs, it’s, that’s a really tough question. It’s, it’s [00:17:00]interesting that you ask that. ’cause um, I mean certainly from the lightning perspective, the, the IEC. We look at on that the blades need to withstand a lightning strike of a known value, but even within that, they, within the IEC, there’s an allowance of like 2%, I think, um, for blade strikes that can still cause damage even if they’re within the rate of capacity of the LPS. Um, so in the insurance world, this is a big gray area because each, um, operator has a, a turbine, uh, has a blade failure because of a lightning strike. They’ll then immediately go to the OEM and say, um, you know, we’ve had had a lightning strike, we’ve had a blade failure. Can you come and repair or replace the blade? Sure, no bother. Um, down the line, we have an insurance claim for this repair or replacement. And insurers are like, well, what’s the lightning data? And if that’s within the [00:18:00] LPS standard, it’s like, well, why have. Why is this not covered under warranty? And, you know, you, your OEMs will always turn around and say, force majeure. Um, it’s, it’s that 2%. So the IEC, even though that’s, you know, it’s, it’s best standards, it still has a degree of allowance that, um, the OEMs can slip through and be like, well this, this falls with insurance. And again, I can only speak for what I’ve seen, but that is. We see, I’d say, um, Lloyd Warwick, we probably see 50 plus notifications a year for blade damage from lightning and, um, almost every time if it’s within the capabilities of the LPX, the OEM or say towards majeure and Atlanta with insurers. Allen Hall: Well, is there a force majeure for gearboxes or generators or transformers? [00:19:00] Is, is there a 2% rule for transformers? I don’t, I don’t think so. Maybe there is, but it is, it, it is a little odd, right, that, that there’s so many things that are happening in the insurance world that rely upon the certification of the turbine and the sort of the expected rates of failure. I have not seen an operator go back and say, we have a 3% rate of, of damage of my transformers, so therefore I wanna file a claim. But that, that doesn’t seem to occur nearly as often as on the lightning side where it’s force majeure is used probably daily, worldwide. How do we think about that? How do we, how do we think about the transformer that fails versus the lightning damage? Are they just considered just two separate things and uncontrollable? Is that how the insurance industry looks at it? If we, if we would  Nathan Davies: talk about transformers. So the fact is that we see on those can vary from, you know, it’s, it’s a minor electrical component that that goes, um, [00:20:00] which is relatively easy to pin down. But then at the other end of the spectrum, you’ve got a fire where it’s. You know, with all, all the will in the world, you could go in and investigate, but you’re not gonna find the cause of that fire. Um, you know, the damage is so great that you, you could probably say, well, the ignition point is there because that’s where the most damages occurred and it’s spread out. But, but how is that occurred? The know, and we, we do have that, that happens not frequently, but um. You know, as an engineer, I, I want to get to the bottom of what’s caused things, but, but all too often we come away from a claim where it’s like we don’t know exactly what’s caused it, but we can’t confirm that it’s excluded in the policy and therefore it, it must be covered and, you know, the claim is valid. Um, so in, in terms of causation and the standards and all the rest of it.  Joel Saxum: It goes to an extent. So this is a, this is another [00:21:00] one. So Alan was talking about lightning and blades. Then we talked about transformers a little bit. I wanna talk about gear boxes for just a second, because gearbox usually, um, in, in my, my experience in, in the wind world, claims wise, it’s pretty black and white. Was it, did it, did it fail? This is how it failed. Okay. Blah, blah, blah. Did was maintenance done at blah? So I heard the other day from someone who was talking about, uh, using CMS. On their, on their gener, on their, uh, gearbox, sorry. So it was an operator said, Hey, we should be, and, and a company coming to them saying, well, you should be monitoring CMS. This is all the good things it can do for you operationally. And the operator, the owner of the turbine said, I don’t want it, because if I know there’s something wrong, then I can’t claim it on insurance if it fails. Does that ring  Nathan Davies: true to you? Part of our process would be to look at the data. Um, so we know nine times out of 10 there is condition [00:22:00] monitoring, there is start out there, there, all this stuff. The operator, um, assistance tools, and if we can look at a gearbox vibration trend. Um, along with, you know, bearing temperature, uh, monitoring and all that sort of thing. And if you can see a trend where the vibrations are increasing, the temperatures are increasing, um, and there’s no operator maintain maintenance intervention, then, you know, if, if you, if you’ve received an alarm to say, Hey, there’s something wrong with me, you should probably come and have a look and you’ve done nothing about it, then. It’s,  Joel Saxum: it’s not great. Okay. So, so that, so that it rings, it kind of in a sense, rings true, right? That what that operator was saying, like the way their mind was working at that stage. ’cause this is, this is during, again, like, so we, Alan and I from the uptime network and just who we are, like we know a ton of people, we know [00:23:00] solutions that are being sold and, and this her about this. And I was like, man, that seems like really shortsighted, but there’s a reality to it that kind of makes sense, right? If they don’t have. I, it, it just seems unethical, right? It seems like if I don’t have the budget to fix this and I don’t wanna look at it, so I’m just waiting for it to fail. I don’t want the notifications so then I can claim it on insurance. ’cause I don’t wanna spend the money to go fix it. Like, seems, seems not cool.  Nathan Davies: Yeah. So the, I mean the, the process, the process of the insurance claim, if, if you want to look at it in almost an over simplistic way, um, a claim is notified. Um, to trigger an operational policy, there needs to be proof of damage, right? So in this instance, your gearbox has failed, whether that’s gear, teeth have have been pulled off, you’ve had a major bearing failure, whatever it is. So there’s your damage. So insurers are now [00:24:00] engaged. Um, the rules of the game. It’s now on insurers to prove that whatever has caused that damage is an exclusion. So in this instance, um, you know, that might be wear and tear, gradual deterioration, uh, could be rust. Um, and, and part of that is poor workmanship. Um, so if they have knowingly like. Cover their shut, their eyes covered, their ears just ignored this gearbox slowly crunching its way to, its, its inevitable death. You know, it, it’s not reasonably unforeseen. It’s not an unpredictable event. This was going to happen if you can see that, that trend, um, towards the failure, um, and in that light, it would, in theory be an uninsured event. Um, but [00:25:00] we know that. 90 plus percent of owner operators have, at least on their drive train, they have some sort of condition monitoring, whether that’s, you know, temperature sensors, vibration sensors, uh, noise sensors, you know, all that sort of stuff. We know that it’s there, but what’s really interesting in the claims process is. The first thing that we’ll ask is, where’s your proof of damage? Let’s see your alarm data, your scarda data, all this sort of thing.  Joel Saxum: Does the RFI get responded to?  Nathan Davies: Yeah, yeah, yeah. Um, and it’s like, oh no, we, you know, we don’t have the SCARDA data. And we’ve had instances where a company, a company had turned around and said, oh, we don’t have any SCARDA data for the time of this event. It’s like, oh, that’s interesting. And worked our way through the process. And eventually insurers were like, you know what? We’re, we’re gonna deny this one. We’re not. Things aren’t adding up, we are not happy with it. Um, and all of a sudden out the woodwork, we get scar data, we get the, the insured’s, um, failure report, [00:26:00] which I mean, there was computational flow dynamics. There were, there were like all sorts of weird and wonderful data that had been thrown into the, this failure analysis. And it’s like, well, you’ve done our jobs for us. Why did you not just hand this over at the beginning? We know that this stuff exists, so. Just, just playing, playing dumb itch. It’s just a frustration really.  Allen Hall: It does seem like the operators think of loss adjustment in insurance companies as having a warehouse full of actuaries with mechanical calculators and they’re back there punching numbers in and doing these calculations on. I lost this gearbox from this manufacturer at, at this timeframe, and, and I understand all this data. That’s not how it works, but I do think there’s this, uh, assumption that that. Uh, there’s a in wind energy that because of the scale of it, there’s a lot of, of backend research that’s happening. I, I don’t think that’s true, or, I mean, you can tell me if it’s true or not, [00:27:00] but I don’t think so. But now, in the world of AI where I can start to accumulate large sets of data and I have the ability to process it with just a single person sitting in front of a laptop, is it gonna get a little harder for some of these claims that have Mercury, just really shady histories to get? Approved.  Nathan Davies: I, I think that’s inevitable. You know, whenever we go and speak to an insurer, you know, insurers are always interested, are interested in what’s the latest claims data, what are the trends that we’re seeing, all this sort of thing. So we’ll sit down with them for an hour and a half and we’ll say, oh, this was interesting. This is what went well, this is what didn’t go so well. And then they always sort of grab us just as we’re about to leave and we’ve, we’ve said our goodbyes, and they’re like, so you guys have a. Claims database. Right? Every time. Yep. And it’s like, how’d you feel about, about sharing your data? And it’s, it’s every insurer without failure. They’re like, let’s see your claims [00:28:00] database. Okay. Right. So we can share, we can share some information. Obviously it needs to be sanitized. We don’t want to provide identifying information, all that sort of stuff. You’re looking at thousands and thousands of lines of data. And the big problem that we have with any database like this is, it’s only as good as the data that’s been entered, right? So if, if every claims handler, if every loss adjuster is entering their own data into this database, my interpretation of, of a root cause failure, maybe different to somebody else’s. So what we are gonna start seeing in the next year to three years. Is the application of AI to these databases, to to sort of finesse the poor quality data that’s been entered by multiple, you know, it’s, it’s too many cooks. Spoiled broth. All of these people have entered their own interpretation of data, will start to see AI finesse [00:29:00] that, and all of a sudden the output of it will be. Really, really powerful, much better risk models. Yeah. And I think that’s, that’s inevitable in the next two to five years. Um, and I think insurers will, but again, the, we go back to the cyclic thing. So the, the data that we have is the claims that we’ve had over the past however many years, but all the while that the OEMs are manufacturing. New gearboxes, new generators, new blades. We don’t know about the problems that are gonna come out the woodwork. We can tell you about failures that might happen on aged assets, but we can’t tell you about what’s gonna fail in the future. Allen Hall: Well, is there an appetite to do what the automobile world is doing on the automobile insurance? Have basically a plugin to monitor how the driver is doing the State Farm drive safe and [00:30:00] save. Yeah. Your little black box is, is that where eventually this all goes? Is that every turbine’s gonna have a little black box for the insurance company to monitor the asset on some large scale, but then that allows you then to basically to assess properly what the rates should be based on the actual. Data coming from the actual turbines so that you, you can get a better view of what’s happening.  Nathan Davies: I mean, it’s challenging because obviously you can only get so much from, from that monitoring data. So arguably that’s, that’s like the scarda data. But then there’s, there’s the multiple other inputs that we’re looking at. I’d say the vast majority of claims come from some form of human intervention. And how do you record that? Human intervention.  Allen Hall: Right? You, it’s like getting an oil change in your car. If the guy forgets to put the oil plug in. Pretty much you’re, you’re gonna get a mount down the road and engine’s gone. [00:31:00] And that’s, that may be the, that may be ultimately where this all goes. Is that a lot of it’s just human error.  Nathan Davies: Yeah. It’s, you know, we, we can take the, the operating data, you can start to finesse maintenance reports and, and try to plug that into this data stream. But you can guarantee, like you can absolutely bet your bottom dollar, but when there’s an insurance claim and it’s like. That one key document that you need that will answer that question, nobody knows  Allen Hall: where it is. This has been a great discussion and Nathan, we need to have you back on because you provide such great insights as to what’s happening in the insurance world and and the broader wind energy world and. That’s where I like talking to you so much. Nathan, how do people get a hold of you? Can they reach you via LinkedIn?  Nathan Davies: Yeah, I’m on LinkedIn. Um, you can also find me, um, on the Lloyd Warwick website. Sounds great.  Allen Hall: Nathan, thank you so much for being on  Nathan Davies: the podcast. Right. Appreciate it. Thank you so much [00:32:00] guys.

What if solving a widespread medical condition didn't require surgery, expensive implants, or harsh medications—but could be done by simply putting on a sock? In this episode of Med Tech Gurus, we sit down with Isaac Oppenheim, CEO and Founder of Zida, a company pioneering wearable neuromodulation at the intersection of aging, textiles, and healthcare. Inspired by his grandfather's struggle with overactive bladder (OAB), Isaac developed the Zida Control Sock—the first FDA-cleared, Medicare-covered, home-use neuromodulation device for OAB. From his early career in textiles and wearable tech with brands like Nike and Lululemon, to navigating FDA clearance and CMS reimbursement without institutional capital, Isaac's journey shows what happens when design thinking, perseverance, and patient-centered innovation come together. Clinical trials show nearly 80% success rates, giving millions of patients renewed confidence, independence, and quality of life Whether you're an entrepreneur building medtech from scratch, a clinician seeking better therapies for aging populations, or an innovator curious about the future of neuromodulation, this episode is packed with lessons on resilience, creativity, and making healthcare more human.

Terry kicks off 2026 by clearing up a major misunderstanding in the provider and manufacturer community. Some believed that CMS's last‑minute withdrawal of the LCD for skin substitute products would delay or stop the 2026 reimbursement changes. That's not the case. The LCD withdrawal has no impact on the Final Rule, and the new 2026 reimbursement methodology for skin substitutes will move forward exactly as finalized, using an incident‑to payment structure. In this episode, Terry breaks down the difference between the policy halt and the reimbursement rules, and explains what providers need to know about the updated approach to skin substitutes and skin graft products and services. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX TuneIn – https://tunein.com/radio/CodeCast–Medical-Billing-p1056702/ YouTube – https://www.youtube.com/channel/UCoNm5vs6PFMIEDa5Undidlg YouTube Music – https://www.youtube.com/playlist?list=PLQ8tk23yZroZslhtTVe-PEIjQsAoJZJIQ Pandora – https://www.pandora.com/podcast/codecast-medical-billing-and-coding-insights/PC:1000156874 Amazon Podcasts – https://music.amazon.com/podcasts/c9d8dc99-fced-45a2-82b4-0efdf144c897/CodeCast-Medical-Billing-and-Coding-Insights iHeart Radio – https://www.iheart.com/podcast/256-codecast-medical-billing-a-31135434/ The post Skin Substitutes and Grafts LCD vs Reimbursement 2026 appeared first on Terry Fletcher Consulting, Inc..

Host Dr. Jay Anders welcomes back Amy Gleason, Acting Administrator of the U.S. DOGE Service and Strategic Advisor to the Centers for Medicare & Medicaid Services (CMS). Together they discuss healthcare data interoperability challenges and CMS's initiatives, including efforts to modernize systems and combat Medicare fraud through enhanced data access and AI implementation. This is a must-listen for anyone in health tech. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

This week I Share What 2026 Is Already Teaching Us [powerpress]

Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital. News sources for this episode: Ella Jeffries, “CMS approves rural health awards for all 50 states,” December 29, 2025, https://www.beckershospitalreview.com/financial/cms-awards-50b-to-states-for-rural-health-transformation/, Becker's Hospital Review. CMS.gov, “CMS Announces Establishment of the Office of Rural Health Transformation,” December 29, 2025, https://www.cms.gov/newsroom/press-releases/cms-announces-establishment-office-rural-health-transformation/ Erica Cerutti, “ED boarding in 2025: 4 notes,” December 29, 2025, https://www.beckershospitalreview.com/care-coordination/ed-boarding-in-2025-4-notes/, Becker's Hospital Review. Kara Gavin, “Wait times for emergency hospitalization keep getting higher,” August 4, 2025, https://www.michiganmedicine.org/health-lab/wait-times-emergency-hospitalization-keep-getting-higher, Michigan Medicine. Ella Jeffries, “Judge blocks 340B rebate pilot program,” December 29, 2025, https://www.beckershospitalreview.com/pharmacy/judge-blocks-340b-rebate-pilot-program/, Becker's Hospital Review. Elizabeth S. Eaton, “'Threadbare administrative record': Federal judge stops 340B rebate pilot,” December 30, 2025, https://firstwordpharma.com/story/7022857, FirstWord Pharma. Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ruralhealthtoday.com.

Rapid disenrollments don't have to happen to you! Learn how better communication can smooth over most Medicare plan disenrollment issues. We outline 8 strategies that are simple for agents to implement.   Read the text version  

Would you like access to our advanced agency training for FREE? https://www.agencymastery360.com/training Starting with a clearly defined niche can make all the difference when you're landing your first clients and deeply understanding that niche can carry you through the toughest seasons of agency life. Today's featured guest built his agency on exactly that foundation. Before launching his firm, he spent years working as a consultant for governments, UN agencies, and the European Commission. Along the way, he identified a clear gap in the market. That expertise proved invaluable during the pandemic. While uncertainty hit many agencies hard, he trusted his understanding of the space and chose to weather the slow months, confident the work would return. His patience paid off as demand surged later in the year. He'll share the lessons learned from more than 20 years of building and running a thriving niche agency in one of the most political and complex markets in the world—and why focus, patience, and deep domain knowledge remain his greatest competitive advantages. Filip Lugovic is the co-founder and CEO of The Right Street, an EU-focused digital communications agency based in Brussels. For the last 20 years, he's lived in the middle of the "Brussels bubble," where organizations, trade groups, and companies fight for attention from the European Commission, Parliament, and Council. His agency sits at the intersection of public affairs + digital communications, serving organizations trying to influence policies that impact nearly half a billion people across Europe. In this episode, we'll discuss: Identifying and owning a highly specific niche. Building a client list with the power of low-hanging fruit. Getting their best quarter during COVID. Keeping a creative team inspired during slow cycles. Subscribe Apple | Spotify | iHeart Radio Sponsors and Resources This episode is brought to you by Wix Studio: If you're leveling up your team and your client experience, your site builder should keep up too. That's why successful agencies use Wix Studio — built to adapt the way your agency does: AI-powered site mapping, responsive design, flexible workflows, and scalable CMS tools so you spend less on plugins and more on growth. Ready to design faster and smarter? Go to wix.com/studio to get started. From Door-to-Door Sales to the EU Policy Bubble Before he ever pitched a digital campaign, Filip was strangers' knocking on doors in Southern California selling heart-shaped pillows and screwdrivers with built-in flashlights. Not exactly glamorous, but it taught him the skill most agency owners run from: sales. When he landed in Brussels in 2005, he fell into a job selling ads for EU Observer, one of the leading political publications at the time. His clients were the same organizations trying to get in front of policymakers. Over the next decade, he built a deep network and a knack for relationship-based selling. Eventually, he left to consult on his own, but by 2017, he hit the same wall most consultants do: "I'm making money… but it all goes to someone else." A lunch with his current business partner (a seasoned communicator who had served as spokesperson for governments, UN agencies, and the European Commission) led to a plan to build something together. Building a Niche Agency: Where Marketing Meets Lobbying Once they figured out their roles and what they brought to the partnership, Filip and his partner started making plans and realized something: Most agencies in Brussels fell into one of two buckets: Lobbying firms who knew politics but didn't understand digital. Marketing agencies who knew digital but didn't understand politics. No one sat in the middle. So they built an agency that merged both worlds, pairing policy context with high-quality digital production. At the time, it was a hypothesis, and a risky one. Only a couple of competitors existed. But they saw the gap and took it. Landing the First Clients by Leveraging Existing Relationships Filip is no stranger to knocking on doors to sell a product, and he would have for his agency. However, this wasn't the right environment for that, so when it came time to start looking for clients, he relied on his network. Filip's approach to sales was never transactional and he very much enjoyed building lasting relationships. This is something many agency owners overcomplicate. Filip's first step wasn't SEO, funnels, or paid ads. It was: "Let me call every single person I already know and ask them to grab a coffee." That alone got him his first tiny clients. It wasn't a big account. Five hundred euros for hours of work, and zero profit. But it built the early case studies they needed. Most agencies try to skip this part. They want the big brand logo first. But every agency you admire started by leveraging relationships and building proof. Pro tip: You should always continue to revisit these relationships. Reach out to that client and buy them a coffee. This is the low-hanging fruit that can get your agency out of a tough spot. If you're not doing this, you're leaving money on the table. How Deep Market Knowledge Helps in Hard Times By January 2020, Filip's agency was growing at a healthy pace, had a new office and a seven-person team. Then we experience COVID shut downs. Their contracts froze, clients stopped paying, and their pipeline evaporated. Meanwhile, the agency had fixed expenses and a growing team relying on them. Most agencies would've cut staff and hoped to survive. Filip didn't. Luckily, he understood his market: EU organizations operate on annual budgets. If they don't spend it, they lose it the following year. So he and his partner made the hard call: No salaries for themselves (they relied on their wives for a while). Keep the team. Use that time to aggressively market. Their bet paid off and by Q4, every organization that couldn't run events was suddenly scrambling for digital support. Their best quarter ever happened during one of the scariest years on record. It was the foundation of everything that came afterwards. Keeping the Team Inspired During Slow Cycles How do you keep a creative team motivated when client work stops? Filip's answer: "Let them create whatever they want." There were no clients nitpicking colors or people demanding designers to make the logo bigger. It was a rare opportunity for pure, unfiltered creative expression. The team remembers that period as one of the most enjoyable times in the agency's history, despite the financial uncertainty. Why Big Name Clients Don't Always Make the Best Case Studies Most agency owners are probably familiar with this scenario: A famous brand comes in with big expectations and a big budget, and you brush off early concerns thinking their reputation would suffice to make the use of their case story all worthwhile. It happened to Filip and, unfortunately, after dismissing those concerns, the client rewrote everything and destroyed the design. Now they couldn't even put it on their website. Filip laughs about this now, because it still happens. Sometimes the smallest project gives you the best case study. Sometimes the biggest one becomes a "please-don't-put-our-name-on-that" situation. Just show the work you're proud of, not just the work you were paid for. Do You Want to Transform Your Agency from a Liability to an Asset? Looking to dig deeper into your agency's potential? Check out our Agency Blueprint. Designed for agency owners like you, our Agency Blueprint helps you uncover growth opportunities, tackle obstacles, and craft a customized blueprint for your agency's success.

Is your website still the front door to your business, or has AI already quietly changed where customers first meet your brand? In this episode of the Tech Talks Daily Podcast, I sit down with Dominik Angerer, Co-founder and CEO of Storyblok, to unpack how content, search, and discovery are shifting in an AI-first world. As search behavior moves away from blue links toward direct answers inside tools like ChatGPT and Google summaries, Dominik explains why many businesses are seeing traffic decline even while signups and conversions continue to grow. We explore how AI is reshaping the role of content management systems, from automation and orchestration to personalization at scale. Dominik shares why consistency now matters more than volume, how outdated content can actively harm brand visibility inside AI answers, and why the technical foundations built for SEO still play a major role as generative search takes hold. This conversation also dives into headless CMS architecture, why separating content from presentation has become even more valuable, and how structured, well maintained content gives AI systems something reliable to work with. Dominik also introduces the idea of joyful content, a belief that better tools lead to better work and ultimately better experiences for audiences. From AI-powered support workflows to personalized retail and loyalty experiences, he shares real examples of how forward-looking teams are already using content as an active system rather than a static archive. As businesses look toward 2026 and rethink how they show up across websites, apps, agents, and answer engines, this episode offers a grounded look at what needs to change and where to start. As AI becomes the place people go for answers rather than search results, how are you rethinking your content strategy, and what will you do differently after hearing this conversation? Connect with Dominik Angerer Learn more Storyblok Tech Talks Daily is Sponsored by Denodo

As home health agencies prepare for 2026, CMS is turning up the heat on fraud, compliance, and enforcement—and the consequences are more serious than ever.In this episode of Gravity Healthcare Hacks, host Melissa Brown, COO of Gravity Healthcare Consulting, is joined by Devin Kassi, VP of Home Health Operations, for a critical follow-up discussion on the Home Health Final Rule. This time, they dive deep into Medicare's expanded authority around fraud investigations, retroactive payment recoupment, and why even unintentional missteps can put agencies at risk.Melissa and Devin unpack:How CMS is redefining and enforcing fraudWhy documentation errors can trigger massive repayment demandsThe growing importance of homebound status documentationHow weak processes, outdated technology, and lack of education create dangerous blind spotsWhat agencies must do now to protect themselves and remain viableThis conversation is a must-listen for home health leaders—especially smaller and single-location agencies—who want to understand what's coming and how to adapt before it's too late.Because in today's regulatory environment, doing nothing is the biggest risk of all.Support the show

Episode 53 - Federal Rule to State Reality & National Impact: How MHDC Is Shaping Prior Authorization On this episode host Tony Schueth, CEO of Point-of-Care Partners (POCP), and co-host Ross Martin, MD, Senior Consultant with POCP are joined by guest, Denny Brennan, Executive Director of the Massachusetts Health Data Consortium (MHDC). Together, they examine how MHDC is translating national interoperability policy into practical, statewide action, specifically around the CMS 0057 rule. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

What happens when an entire industry rushes forward before science can catch up? In this episode of Ocean Science Radio, we sit down with Dr. Andrew Thaler, deep-sea ecologist and CEO of Blackbeard Biologic, to explore his groundbreaking report for the Convention on Migratory Species that reveals exactly how much we don't know about deep-sea mining's impacts on whales, dolphins, sharks, turtles, and other highly migratory species. While most deep-sea mining research has focused on the immediate destruction of seafloor ecosystems, Andrew's report exposes a more troubling reality: we have massive knowledge gaps about how mining operations—with their noise, sediment plumes, and habitat disruption—might affect species that travel thousands of miles across interconnected ocean basins. From sea turtles navigating by magnetic fields to whales relying on acoustic communication, these far-reaching impacts remain largely unstudied even as the industry accelerates toward commercial production. The conversation takes a timely turn as we discuss the Bureau of Ocean Energy Management's controversial Request for Information for mining in U.S. waters off the Commonwealth of the Northern Mariana Islands. Andrew breaks down why this represents a significant shift from international deep-sea mining debates, and what it means that communities near the Mariana Trench—with only a 30-day comment period and no guaranteed revenue sharing—are being asked to accept an industry that science hasn't fully evaluated. As the Trump administration pushes to fast-track deep-sea mining for critical minerals while international bodies like the CMS urge precaution, this episode asks the essential question: what's at stake when we mine what we haven't studied? Join us for a conversation that bridges cutting-edge marine science, environmental justice, and the real-world policy decisions happening right now in the deep ocean.

This week I Share Predictions, Wins & Struggles [powerpress]

Would you like access to our advanced agency training for FREE? https://www.agencymastery360.com/training Are you thinking about expanding your agency through acquisitions? Buying another firm can be one of the fastest ways to scale, but only if you choose the right partners and nail the cultural fit. Otherwise, growth can quickly turn into chaos. Today's featured guest has been through five acquisitions, each one teaching her a different (and sometimes painful) lesson about what truly makes a merger succeed. In this episode, she opens up about her biggest acquisition missteps, the cultural mismatches that nearly derailed integrations, forecasting errors she didn't see coming, and the identity challenges that arise when two teams collide. Kimberly Eberl is the Founder and CEO of The Motion Agency, a full service marketing and communications shop with offices in Chicago, Cincinnati, and Nashville. While the agency offers everything from creative to content, it is unusually strong in public relations with roughly 20 PR pros on staff. Kimberly has completed five acquisitions, navigated the cultural and financial highs and lows of M&A, and grown Motion into one of the most respected independent agencies in the Chicago market. In this episode, we'll discuss: When acquisitions help agencies scale—and when they backfire. Lessons learned from five agency acquisitions. Why agency owners often misjudge valuation and earnouts. Subscribe Apple | Spotify | iHeart Radio Sponsors and Resources This episode is brought to you by Wix Studio: If you're leveling up your team and your client experience, your site builder should keep up too. That's why successful agencies use Wix Studio — built to adapt the way your agency does: AI-powered site mapping, responsive design, flexible workflows, and scalable CMS tools so you spend less on plugins and more on growth. Ready to design faster and smarter? Go to wix.com/studio to get started. From Fired Account Director to Agency Founder Kimberly jokes that she is one of those founders who got fired into entrepreneurship. At her previous agency, the account director role was undefined and impossible to succeed in. The revolving door should have been a clue. She lasted a year before being let go and scrambling to figure out her next move. With no grand plan, she fell into freelancing in 2006. The economy was healthy. The demand came fast. And pretty quickly she reached that moment every accidental agency owner hits. Either say no to work or hire help. She chose to hire. That early decision set the tone for the next decade. Instead of trying to do it all herself, she leaned into building a team and letting the business grow past her personal capacity. Outgrowing a Single-Service Model: Moving Beyond One Specialty Kimberly started as a PR pro. That focus worked for a while, but eventually she noticed how much money she was leaving on the table. Clients wanted websites, creative, content, and she was constantly referring the work away. The big shift happened when she decided to expand beyond PR and bring more capabilities in-house. This meant hiring outside her comfort zone and learning how to oversee work she could not personally do. That decision opened the door to real growth. Many agency owners get stuck right there. They stay in their one specialty because it is safe. Kimberly pushed through that discomfort and built a service mix clients actually wanted. The Reality of Acquiring Another Agency: Lessons from 5 Acquisitions Kimberly opted to add these new services through acquisitions. So far, she has completed five and every one had a different lesson. Her first major acquisition was bold. She bought an agency twice the size of her own. Financially and emotionally, it was a lot. Looking back, she admits she may not do a deal that large again, especially in a specialty she did not personally understand. But she also learned that size does not determine complexity. A one-person agency with contractors had just as many integration headaches as a larger shop. What mattered most was agency culture. Some deals looked perfect on paper but fell apart because the values, expectations, and behaviors did not align. One deal in particular was financially great and culturally awful. She kept one client from that acquisition. Another deal was financially terrible but culturally perfect. Years later, most of those staff members are still with her. Her biggest warning: never ignore cultural red flags during the courting phase. Take time to hang out with the sellers, how they operate, and experience their company's culture. Go to dinner, Travel together. You'll notice small behaviors (snapping over minor problems, chronic lateness, lack of transparency) that won't disappear after the contract is signed. Valuation Mistakes That Kill Good Deals Kimberly also dove into how she approaches valuations and why so many sellers get this part wrong. She focuses on future performance, realistic forecasts, and removing costs that will not continue after the sale. She also pushes back on inflated projections. If an owner claims revenue will double, the earnout should reflect that. Big promises are fine, but they should come with big accountability. One agency she walked away from wanted a valuation equal to twice their gross revenue. They were using cash-based accounting and ignoring profitability. It was an immediate red flag. Kimberly's advice to owners is simple. Build a business that is sellable even if you never plan to sell. Get your financials clean. Use accrual accounting. And be realistic about your numbers. Leadership, Loyalty, and the Hardest Skill — Letting Go As the agency scaled, leadership challenges became just as complex as financial ones. Kimberly admits she is confused about why she is the largest woman-owned agency in Chicago at only seventy people. She is proud of the title, but she wonders why more women are not reaching similar scale. There are no differences in capability, but many female founders still hit a ceiling often tied to loyalty, delegation, or difficulty letting people go. Some owners, especially women, treat their team like family and struggle to make hard decisions around performance. She admitted she has been loyal to a fault at times and is working on finding a healthy balance. Agencies function more like all star sports teams. The roster changes every year. People get promoted, moved, or sometimes released. That does not mean you failed. It means you are adapting so the team as a whole can win. Kimberly is even working on building hobbies outside her agency because she noticed how much of her identity was tied to work. It is a relatable struggle for founders who have poured years into their companies. AI Changes the Work, Not the Need for Agencies Let's be clear, agencies are not going away because of AI. Kimberly certainly doesn't believe that. She treats AI like an intern. Helpful. Fast. But still needing quality control, creativity, and leadership. Clients still want real relationships. They want someone who understands context and nuance. Agencies serving tech-savvy individuals will feel churn from AI, but agencies serving plumbers, service-based businesses, and non marketers will be fine. These clients want to stay in their lane and hire experts for everything else. Marketing evolves, but agencies survive because the business model adapts. Do You Want to Transform Your Agency from a Liability to an Asset? Looking to dig deeper into your agency's potential? Check out our Agency Blueprint. Designed for agency owners like you, our Agency Blueprint helps you uncover growth opportunities, tackle obstacles, and craft a customized blueprint for your agency's success.

(Canción cantada por Carlos Rey en audio y en video) —Mamá, ¿dónde están los juguetes? Mamá, el Niño no los trajo. —Será que no vio tu cartica que pusiste en la noche sobre tus chancletitas. —Mamá, hoy me siento muy triste; Mamá, el Niño no me quiere. —Será que tú hiciste algo malo y el Niñito lo supo; por eso no los trajo. —Mi amor, ya no te sientas triste; mi amor, si a tu lado me tienes. //Y así esperaremos juntos, rezaremos al cielo hasta el año que viene.// «¿Qué hay de aquella voz que preguntaba a su mamá dónde están los juguetes? —pregunta Valentina Lares Martiz en Caracas como corresponsal de El Tiempo en diciembre de 2006, aludiendo a la canción del compositor venezolano Oswaldo Oropeza—.... Raquel Castaños se hizo célebre... con “Mamá, ¿dónde están los juguetes?”.... Su vida quedó enclavada en el mundo del espectáculo desde que grabó esa canción a los siete años, cuando era integrante del coro infantil Los Pájaros. »... Castaños [es] hoy referencia obligada para todo el que quiera saber de la canción venezolana. Más de treinta discos engrosan su hoja de vida.... “Raquelita”: Así la llaman aún muchísimos venezolanos, que no pueden dejar de verla como la niña prodigio....»1 De ahí que la periodista colombiana pregunte qué fue de la niña venezolana que interpretó la canción. Pero ¿qué de los niños de carne y hueso que representa aquel niño creado por su autor? Esos son los genuinos protagonistas de la canción, los que no reciben juguetes ni en la Nochebuena ni en el Día de los Reyes... mientras que otros niños alrededor del mundo reciben tantos juguetes que no saben ni qué hacer con ellos. A los niños que no reciben nada, la Navidad los decepciona por completo. Por razones ajenas a su voluntad y a la de quienes cuidan de ellos —si son lo bastante afortunados para tener a alguien que los cuide y los quiera— han de conformarse cada año con esperar a ver si el destino les depara algo mejor el año que viene. ¡Qué triste que, además de carecer de lo que otros dan por sentado, muchos de esos niños malnutridos crecen creyéndose el cuento de que la culpa de su privación la tiene Dios o la tienen ellos, presuntamente porque el Niño Dios pasó de largo por su casa, o se hizo el de la vista gorda, o no tenía tiempo para leer su carta, o los está castigando por haberse portado mal! Lo cierto es que Jesucristo, aquel Niño Dios que vino al mundo para hacerse hombre y vivir rodeado de niños como ellos, no los quiere castigar sino perdonar cuando hacen algo malo y le piden perdón, porque sí los quiere. Cristo ama tanto a los niños que dio su vida por ellos para que pudieran vivir en el cielo por toda la eternidad,2 que vale infinitamente más que todos los juguetes del mundo. Carlos ReyUn Mensaje a la Concienciawww.conciencia.net 1 Valentina Lares M., «“Himnos” navideños son venezolanos», eltiempo.com, 24 diciembre 2006 ; Valentina Lares Martiz, «Canciones de Navidad más famosas en América Latina y sus intérpretes son de origen venezolano», eltiempo.com, 26 diciembre 2006 . 2 Mr 8:36-37; 10:13-16; Jn 1:14; 3:16; 1Jn 1:9

Bureaucracy kills more transplant patients than shortage does. Jessica Wynn harvests the truth about organ donation's dark side here on Skeptical Sunday! Welcome to Skeptical Sunday, a special edition of The Jordan Harbinger Show where Jordan and a guest break down a topic that you may have never thought about, open things up, and debunk common misconceptions. This time around, we're joined by writer and researcher Jessica Wynn!Full show notes and resources can be found here: jordanharbinger.com/1253On This Week's Skeptical Sunday:Over 100,000 Americans wait for organs while 13 die daily — not from organ shortage, but from systemic inefficiency, poor matching protocols, and bureaucratic bottlenecks that waste thousands of usable organs annually.Living donation is safer than most realize. Donors can give kidneys, liver portions, even lungs while alive and generally recover well, but workplace protections vary wildly by state, creating real financial and career risks for altruistic donors.The organ matching system is a bureaucratic labyrinth. HRSA, OPTN, UNOS, CMS, and CDC all overlap in managing transplants, creating inefficiencies that prevent organs from reaching recipients in time despite available technology.Ethical nightmares haunt the system. Scandals include surgeons nearly harvesting from living patients, global black markets exploiting the poor, and allegations of forced organ harvesting from prisoners in countries like China without consent.Register as a donor and advocate for reform. One donor saves up to eight lives and helps 75+ through tissue donation. Push for automated referrals, airline transport mandates, and better tracking tech to transform a broken but lifesaving system.Connect with Jordan on Twitter, Instagram, and YouTube. If you have something you'd like us to tackle here on Skeptical Sunday, drop Jordan a line at jordan@jordanharbinger.com and let him know!Connect with Jessica Wynn at Instagram and Threads, and subscribe to her newsletters: Between the Lines and Where the Shadows Linger!And if you're still game to support us, please leave a review here — even one sentence helps! Sign up for Six-Minute Networking — our free networking and relationship development mini course — at jordanharbinger.com/course!Subscribe to our once-a-week Wee Bit Wiser newsletter today and start filling your Wednesdays with wisdom!Do you even Reddit, bro? Join us at r/JordanHarbinger!This Episode Is Brought To You By Our Fine Sponsors:Shopify: 3 months @ $1/month (select plans): shopify.com/jordanTonal: $200 off: tonal.com, code JORDANApretude: Learn more: Apretude.com or call 1-888-240-0340Land Rover: landroverusa.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.