Podcasts about cost of care

What does it actually cost when a doctor writes a verbal order over the phone instead of seeing the patient? Scott Middleton has the receipts — and the answer is going to make you rethink everything about how American healthcare spends its money. In this episode of The Disrupted Podcast, Scott announces a landmark three-way merger bringing Your Health together with Transitional Care Professionals of America (TCPA) out of Georgia and Providence Care, a hospice organization in South Carolina. The combined organization will serve approximately 55,000 active patients — not patients on a list, but people being seen regularly — and Scott lays out exactly how he's going to run it. What you'll hear in this episode: Why Scott's family owning 80% of the merged company changes everything about how decisions get made — and who they get made for The difference between fee-for-service and value-based care, and why the ACO model means every unnecessary hospitalization literally comes out of Your Health's pocket How Your Health's risk-adjustment-based visit model (16 visits per year per risk point) was independently validated by a new government study — and why it works The three things Scott is asking every new employee to do in the first weeks: align with a nurse practitioner, track every minute of care management, and recruit like their livelihood depends on it — because it does Why Scott's new management philosophy is six words: "Keep them out of the hospital and see your damn patients" This isn't a corporate announcement. It's a playbook for how healthcare can actually work when operators run the company, providers see their patients, and every minute of care gets counted. www.YourHealth.Org

Illness can affect more than your health, it can disrupt your financial stability, too. In this episode, we break down how to prepare ahead of the unexpected, from understanding insurance coverage to savings account options. We also explore federal benefits that can provide a safety net when you need it most, so you can focus on recovery, not financial stress.

The Nurses Report on America Out Loud with Ashley Caputo, RN, FMP – This episode of The Nurses Report explores how Pharmacy Benefit Managers shape access to medications, often leading to delays and denials. It examines carve-outs, ERISA limits, and real patient impacts while highlighting the growing need for transparency, advocacy, and patient-centered decision-making in today's healthcare system...

The Nurses Report on America Out Loud with Ashley Caputo, RN, FMP – This episode of The Nurses Report explores how Pharmacy Benefit Managers shape access to medications, often leading to delays and denials. It examines carve-outs, ERISA limits, and real patient impacts while highlighting the growing need for transparency, advocacy, and patient-centered decision-making in today's healthcare system...

What if the reason healthcare teams burn out isn't the workload — it's the org chart? On this episode of The Disrupted Podcast, Jamie and Scott, break down the evolution of The Care Group Model — and why the instinct to build a "separate hospice team" is exactly the wrong move. Scott walks through what a true care team looks like when nurse practitioners, nurses, community health workers, social workers, chaplains, and triage nurses are orchestrated around the patient — not siloed around a diagnosis. Inside the episode: Why adding hospice to existing care groups beats building a parallel hospice division The new non-clinical "administrator" role Your Health is rolling out — and why every nurse needs one at their side Using DISC assessments to build teams that actually function (and why nurses aren't the same personality type) How mutual accountability and group-based bonuses fix the "don't bill too much CCM" problem Why matching a chaplain to a patient's faith tradition matters more than checking the box The $110 million Medicare savings story the industry still doesn't understand If you lead a clinical team, run an operation, or care about what healthcare could look like when it's built around people instead of paperwork — press play. www.YourHealth.Org

Sriram Narayanan studies how operations and public policy intersect. His latest research looks at hospitals across the country and asks an interesting questions: when states change medical malpractice laws, what happens to hospital costs, staffing and patient experience? Download the "The Cost of Care" Episode Transcript Follow Sriram on LinkedIn and learn about more of his work on Google Scholar. For more episodes of Broad Matters, subscribe to our podcast on Apple Podcasts and Spotify.

According to an AARP report, the Department of Health and Human Services reported a 48% increase in cost for home care and assisted living from 2019-2024, while median household income for families 65 and older rose only 22%. That's an average 8% annual increase! And people doubt when we use 5% annual increases to project future needs.... View a summary of the report here See what current and projected cost of care where you live at https://www.carescout.com/cost-of-care Then schedule with me to learn how you can protect your family, assets and choices here

Send a textEver look at a medical bill and wonder who actually gets paid—and why the numbers make no sense? We sat down with Dr. Christopher Eamon, interventional pain physician, and Tim Groth, CEO of Groth Pain & Spine, to map the full journey from exam room to reimbursement, and the hidden incentives shaping your care. From CPT and ICD-10 codes to clearinghouses and payer edits, we break down the back-end machinery that turns a note into a claim, and a claim into money… or a denial.We get candid about audits and takebacks—how Medicare can pay without prior review, then claw funds back years later—forcing practices to repay money already used to run clinics and pay doctors. That risk pushes small practices to the brink while large health systems negotiate two to five times Medicare rates and pass higher coinsurance onto patients. The price gap explains why your deductible hits harder at a hospital than at an independent office, and why many clinicians feel trapped between quality and volume.Then we tackle approvals and gatekeeping: why evidence-based procedures like spinal cord stimulation stall under shifting rules, how “peer-to-peer” often means a non-specialist reading policy instead of the literature, and how hours spent appealing denials come straight out of patient time. We share real examples of arbitrary criteria, odd denials, and the emotional toll of telling a patient the best option won't be covered.So how do independent practices survive? By rethinking workflows with scribes and extended intakes, building multidisciplinary teams, and cross-subsidizing essential but underpaid services. We explore concierge care as a lifeline for time and access, the rise of MSOs to pool admin costs, and the hard truth that rate-setting often bears little relation to clinical complexity. Along the way, we confront the broken math of premiums, deductibles, and end-of-life spending—and ask what smarter tradeoffs could look like if we valued healthier years over bureaucratic churn.If you've ever felt lost in prior auths, frustrated by surprise bills, or curious why a surgeon might earn less than a device rep in the same case, this conversation will connect the dots and give you language to ask better questions. Subscribe, share this with a friend who's wrestling with the system, and leave a review with your biggest insurance or billing mystery—we'll tackle it in a future show.Support the showLearn More at: www.Redefine-Fitness.com

In this episode, Sierra Garvin, Senior Associate Director of Above Brand Marketing at Boehringer Ingelheim speaks with Mandy Leonard, Senior Director of Drug Use Policy and Formulary Management at Cleveland Clinic about the key drivers of rising healthcare costs, including chronic disease, multiple comorbidities, rare diseases, and wasteful spending. They explore practical strategies to lower total cost of care while maintaining quality and improving patient outcomes.This episode is sponsored by Boehringer Ingelheim.

Send us a textThe calls keep coming, but the solutions don't. We sit down with crisis clinician and EMDR therapist Morgan Yaskus to trace how a frayed safety net pushes first responders into impossible roles—and how that mismatch breeds moral injury. From long drives to the nearest DMV or ER to midnight discharges with no plan, we map the structural barriers that turn compassion into exhaustion and good intentions into public criticism.Morgan shares what mobile crisis teams can do well—resolving most calls on scene, staying with families after deaths, and offering a humane handoff—and where policy still ties everyone's hands. We talk about the revolving door of brief psychiatric evaluations, the bureaucratic maze of IDs and benefits, and the social media spotlight that amplifies one bad moment over a hundred quiet saves. Small towns feel this even harder: everyone knows everyone, scanners travel fast, and rumors outrun the facts.We also get practical. Morgan explains how EMDR intensives can speed recovery from single‑incident trauma, why embedded wellness trainings reduce stigma, and how family wellness programs give spouses and kids tools to navigate shift work, hypervigilance, and communication breakdowns. The theme isn't “do more with less.” It's “build a system that holds what responders are asked to carry,” with warm handoffs, guaranteed short holds, transport support, and streamlined ID recovery to break the cycle.If you care about first responder mental health, this conversation is a map and a motivator. Listen, share with your team, and send this to someone who thinks burnout is a willpower issue. Then tap follow, leave a quick review to help others find the show, and tell us: what single policy change would make the biggest difference where you live?To contact Morgan, go to her website at www.bewildandrooted.comFreed.ai: We'll Do Your SOAP Notes!Freed AI converts conversations into SOAP note.Use code Steve50 for $50 off the 1st month!Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showYouTube Channel For The Podcast

In this episode of The Disrupted Podcast, Scott Middleton returns from the JP Morgan healthcare conference with a blunt takeaway: the future of care is not a magic pill, another telehealth platform, or a clever financial structure — it's showing up. Scott breaks down why healthcare has become unnecessarily complicated, how fee-for-service incentives distort decision-making, and why “easy-entry” models won't hold up long-term.He makes the case that Your Health's home-based care model is hard to replicate because it requires operational excellence—routing, scheduling, team coordination, and intentional touchpoints. Scott also challenges internal culture issues: finger-pointing, poor communication, inefficient scheduling, and employees misunderstanding the mission. The solution is both simple and demanding: build systems that make weekly in-person encounters possible for high-risk patients and hold the line on execution. www.YourHealth.Org

Lady! This week Terri and Dr. Dom welcome powerhouse visionary Ashley McGirt-Adair to Cultivating H.E.R. Space to broaden your awareness to additional tools and resources available to you as you travel along your healing path. Ashley is a dynamic trailblazer who listened to her inner wisdom and allowed that internal voice to guide her as she built a thriving clinical practice and foundation geared towards helping Black women afford the mental health care we so often need. Ashley is the founder of the Therapy Fund Foundation, a nonprofit focused on eliminating barriers to mental health care in Black and historically excluded communities. She is also the author of the forthcoming book, The Cost of Healing in Silence: Navigating Racial Trauma and the Call for Culturally Responsive Care. Ashley keeps it real about the barriers that keep Black women from tending to themselves and how she found the courage to step out on faith and build the phenomenal service she’s offering to the world. Since slavery Black Americans have experienced a litany of traumatic events and have somehow managed to survive to this present day. The issue is that until we, collectively, address those numerous traumas and all of their manifestations we will continue to just do that – survive. Ashley and her team want us to thrive and they are committed to connecting Black women with culturally attuned and responsive providers who are equipped to navigate the complex and layered issues that we face. Lady, there are many forces in this world that are designed to weigh you down and discourage you from reaching your full potential. But, like the sea turtles making their pilgrimage to the water you, too, can make the arduous trek from being broken and in pieces to being in your power. Tune in to today’s episode for actionable steps and resources you can access right now! Don’t forget you can also book a consultation with Dr. Dom so that you can establish your team of providers ready to help you breakthrough to your next level. We love you for real, lady! Quote of the Day: "We need access, equity, and action that ensures healing isn’t a privilege, it’s a right." – Ashley McGirt-Adair Goal Mapping Starter Guide Cultivating H.E.R. Space Sanctuary Where to find Ashley McGirt-Adair: Website: Therapy Fund Foundation Instagram: @therpayfundfoundation Facebook: Therapy Fund Foundation Website: Ashley McGirt Book: The Cost of Healing in Silence: Navigating Racial Trauma and the Call for Culturally Responsive Care LinkedIn: Ashley McGirt Instagram: @therapywithash Facebook: Ashley McGirt Counseling Services LLC Twitter (X): @TherapywithAsh YouTube: Ashley McGirt Resources: Dr. Dom’s Therapy Practice Get That Pitch Workshop: Turn your story and expertise into speaking gigs, media features, and collaborations, without a publicist. Visit GetThatPitch.com and Use code HERSPACE for a special listener discount. Branding with Terri Melanin and Mental Health Therapy for Black Girls Psychology Today Therapy for QPOC Therapy Fund Foundation Where to find us: Twitter: @HERspacepodcast Instagram: @herspacepodcast Facebook: @herspacepodcast Website: cultivatingherspace.comSee omnystudio.com/listener for privacy information.

Michael Berry uncovers how cultural flashpoints—from drag‑queen visibility to controversial academic claims—intersect with institutional failures. Plus, a compelling expert breakdown of America’s healthcare crisis and the hidden forces driving runaway costs.See omnystudio.com/listener for privacy information.

Many people underestimate the costs associated with long-term care as they age, often assuming that Medicare will cover all their needs—a common misconception. This episode emphasizes the importance of planning to manage care expenses effectively. Listeners will explore various payment options, learn how to piece together multiple funding sources and gain insights into resources that can help ensure the needs of older individuals are met. While every financial situation and care need is unique, this episode provides valuable considerations and tools to help you plan for long-term care needs.

In this episode of Disruption/Interruption, host KJ interviews Matt Seefeld, CEO at MedEvolve, about the chaos and inefficiencies in the US healthcare revenue cycle. Matt shares how generative AI and a focus on human accountability can help providers achieve "zero touch" claims, reduce waste, and improve access to care, especially for small and rural hospitals. Four Key Takeaways: The Real Cost of Healthcare is Obscured (3:00)The US healthcare system lacks alignment between consumers, providers, and payers, making it nearly impossible to know the true cost of care. Administrative Waste is a Billion-Dollar Problem (04:01)Most providers touch claims multiple times, with 63% of those touches being wasted effort due to system inefficiencies and payer games. AI is a Tool, Not a Cure-All (31:50)While AI can automate and improve processes, more than half of claim errors still require human intervention, and technology alone won't solve systemic issues. Access to Care is Shrinking for Many Americans (24:00, 27:00)As costs rise and reimbursements fall, small and rural hospitals are closing, and more Americans are forced to seek care through emergency services or go without. Quote of the Show (31:50):"More than half—53%—of the errors that we see that humans have to get involved with come from AI solutions, so they're not smart enough yet." - Matt Seefeld Join our Anti-PR newsletter where we’re keeping a watchful and clever eye on PR trends, PR fails, and interesting news in tech so you don't have to. You're welcome. Want PR that actually matters? Get 30 minutes of expert advice in a fast-paced, zero-nonsense session from Karla Jo Helms, a veteran Crisis PR and Anti-PR Strategist who knows how to tell your story in the best possible light and get the exposure you need to disrupt your industry. Click here to book your call: https://info.jotopr.com/free-anti-pr-eval Ways to connect with Matt Seefeld: LinkedIn: https://www.linkedin.com/in/matt-seefeld-521319/ Company Website: https://medevolve.com How to get more Disruption/Interruption: Amazon Music - https://music.amazon.com/podcasts/eccda84d-4d5b-4c52-ba54-7fd8af3cbe87/disruption-interruption Apple Podcast - https://podcasts.apple.com/us/podcast/disruption-interruption/id1581985755 Spotify - https://open.spotify.com/show/6yGSwcSp8J354awJkCmJlDSee omnystudio.com/listener for privacy information.

 Join host Dr. Cougar Hall as he sits down with Alan Pruhs, Executive Director of the Association for Utah Community Health, for a powerful and heartfelt conversation about what it really means to make healthcare accessible for all. From the rural clinics of Bicknell to the streets of Salt Lake City, Alan shares inspiring stories from Utah's community and migrant health centers—where compassion, cultural humility, and collaboration drive the mission. Hear how Utah's “community health” model tackles social determinants of health, why affordable care matters to everyone (insured or not), and how we can take the politics out of health to focus on people. This episode is a reminder that health is not a privilege—it's a shared responsibility. Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, Madison McArthur, Kailey Hopkins, and Tanya Gale

Have you ever found yourself suddenly in the role of caring for someone you love, without a roadmap for what that really means? In this episode of It's a Mindset, I sit down with Casey Beros, award-winning health journalist, bestselling author, keynote speaker, and one of Australia's leading medical MCs. For two decades, Casey has been translating complex science into practical strategies that empower everyday people to live healthier, happier lives. But it was becoming the primary carer for her beloved dad that changed everything. That experience inspired her heartfelt new book, Next of Kin, a compassionate and practical “what to expect when you're expecting to care for someone you love.” Part memoir, part guide, it's a much-needed companion for navigating the emotional and often overwhelming toll of care. As a mum of two herself, Casey understands firsthand the unique strain of the sandwich generation, caring for ageing parents while raising children and trying to maintain a sense of self. She brings honesty, humour, and deep compassion to this conversation. For me, this episode was a reminder of how important it is to prepare for the inevitable, the loss of our parents, and how caring can challenge everything from our routines to our sense of self. My biggest takeaway? The most meaningful thing we can do is spend time with the people we love, and when we align to one clear purpose, it sustains us even when times are tough. Key Episode Takeaways The toll of care not only on the carer, but on those around them as well. Why it can feel impossible to maintain wellbeing routines while caring for someone with acute needs. The most meaningful time is always the time spent with those you love. How having one thing that is uniquely yours, your purpose, can create greater alignment and sustain you through difficult seasons. About the Guest Casey Beros is an award-winning health journalist, bestselling author, keynote speaker and one of Australia's leading medical MC's. She has spent the last 20 years asking our brightest minds how we can all live happier, healthier lives. Along the way she found some answers, and she shares them with the Australian public in a way that's both steeped in science and delightfully entertaining. She has hosted TV programs for the ABC and Channel 10, and written for many of our leading digital publications. She has a superhuman ability to translate complex science into practical and actionable strategies that empower the most important person in the health journey - you. Being the primary carer for her beloved Dad was the catalyst for Casey to write her new book Next Of Kin - a 'what to expect when you're expecting' to become a carer for someone you love. A heartfelt companion, it's a practical and compassionate guide to navigating the complex, emotional and challenging world of care. Mum to two little girls, Casey is Australia's self-proclaimed parallel parking champion and knows the words to more pop songs than is probably normal. Show Resources Learn more about Casey's new book, Next of Kin - HERE Check out Casey's website - HERE Follow Casey on Instagram - HERE Follow the Podcast Host, Emma Lagerlow on Instagram - HERE Learn more about 1:1 coaching with Emma - HERE If you LOVED the episode, make sure you share it on your Instagram stories and tag us @emmalagerlow and @caseyberos. Yours in Care and Compassion, Emma, X.

Right up front here, let me just state loudly that there are some amazing independent TPAs (third-party administrators) out there who have the expertise, the scrappy willfulness, and the deep desire to do right by their clients, their self-insured employer clients. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And look, they may be facing some of the same headwinds that plan sponsors themselves face, like anticompetitive contracts, brokers who are up to no good, etc. So, just keep that in mind as you listen. And the main point of all of this if you are a plan sponsor is, find a good TPA partner, which, as Bryce Platt has said about consultants but same rules apply about TPAs here, the difficulty is being informed enough to tell the difference. So, the goal of this show is to help with that, the “be informed enough to tell the difference.” All of this being said, this is technically a Take Two; but we trimmed it down and welcome to a whole new intro. So, call this a refresher and an update about a really, really important topic from last year that is becoming extremely (maybe even more) relevant this year. Really relevant. Consider, for example, the show with Claire Brockbank (EP453) about carrier/TPA RFPs (requests for proposal) and all of the landmines that are really expensive, that are buried in some of these contracts. Then there was the Cynthia Fisher show (EP457) from last year about the millions, maybe billions of dollars in aggregate going missing in medical (ie, TPA or ASO [administrative services only]) spread pricing. We had “The Mystery of the Weekly Claims Wire” show with Justin Leader (EP433), again, revealing money that's being disappeared when the TPA is withdrawing dollars from plan sponsor checking accounts. And then there's the payment integrity episode with Kimberly Carleson (EP480) from a few weeks ago with just another wrinkle on this, namely TPAs or ASOs who insist on auditing themselves and how that turns out for members and plan sponsors. Oh, and last, but certainly not least, is the whistleblower show with Ann Lewandowski (EP476) on how a TPA arm of an EBC (employee benefit consultant) allegedly pocketed $20 million—$20 million of their client's pharma rebates—and used that $20 million to fund their executive bonus pool. What a time to be alive! All of this just highlights the huge stakes for plan sponsors to really understand what their TPA is all about. And when I say high stakes, I mean from both a legal standpoint and also just vast dollars in play here. But this episode with Elizabeth Mitchell is also, I'm gonna say, extremely relevant given just a few ripped from the headlines and news articles such as these. I'm gonna start actually with a post from Kimberly Carleson, and I like the comment by Jeff Evans, who wrote, “How does $8,710 equal $104,266?” Spoiler alert, it doesn't. Lots of missing dollars there. Someone's hands are in the cookie jar. Oh, look, the TPA has entered the chat. In a nutshell, and I'm quoting something Peter Hayes wrote, he wrote, “TPAs have received relatively little public attention. [There's an article in Health Affairs] that describes how TPAs impose hidden fees, benefit from their own form of spread pricing, and otherwise prioritize their own financial interests over those of their plan clients.” Also, here's a totally other issue. Let me quote Luke Prettol highlighting something Jason Shafrin had written about a paper by Jeff Marr, Daniel Polsky, and Mark Meiselbach. Let me slightly rephrase what Luke said. He wrote, “Employers pay, on average, a 4.7% [so almost 5%] price markup when hospitals are in their TPA's [Medicare Advantage] network.” Right? Dr. Eric Bricker talked about this in that episode (EP472) just how TPAs with MA (Medicare Advantage) business negotiate their commercial clients to pay higher rates so that then they can pay lower rates for their own MA members. As Luke wrote, “On its face, this overpayment does not appear to be solely in the interest of participants.” No kidding. Now, let's spin the wheel here. There are barriers for TPAs themselves, even the ones who have a deep desire to do the right thing. As Patrick Moore wrote, “Most TPAs still can't do [many of the things that employers might want because there are] PPO contracts.” So, is it a rock in a hard place situation? I mean, if the TPA has no other options than using a carrier's PPO (preferred provider organization) network with all its attendant contractual issues, then yeah, that is one definite challenge. Along these lines, let me read a post by Rina Tikia, because I think she sums up this really well. “When independent TPAs … push for transparency, they're blocked under the banner of ‘fiduciary risk.' “Meanwhile, the largest carriers and PBMs, with Cayman shell subsidiaries, DOJ kickback probes, [huge] hedge fund ties, [$10 million-plus] lobbying budgets, and antitrust violations continue unchecked. They are not only allowed to operate but celebrated as mainstream options. “Why the double standard? Political donations? Foundation smokescreens? Nonprofit status as a PR shield?” These are excellent questions. And here's another challenge: brokers. Ramesh Kumar Budhani wrote about this one, just how hard it is sometimes to find—for TPA, an independent TPA, trying to do the right thing—to find brokers who prioritize doing the right thing for employers and helping their clients save money. The summary of all of this: There are TPAs and there are ASOs who aren't even trying. They are going to ride the flywheel, the gravy train, and catch all of the dollars flying off of it for as long as they can manage to cling to it with all 10 of their fingers. Then there are TPAs, mostly indies, trying super hard to do the right thing. But how successful they are is going to depend on how boxed in they are by the PPO networks or the carriers that the brokers or even plan sponsors may insist on. Just how courageous they are and just how smart they are and experienced they are about the market and how it actually operates. So, the show that follows is about all of this, including how we can inspire TPAs, which, in the show that follows, subsumes ASOs kind of into it. But in the show that follows, I hope it's inspiring to create an environment so that the market demands TPAs that do all of the things, and we make inertia not a viable business strategy. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. Also mentioned in this episode are Purchaser Business Group on Health; Bryce Platt; Claire Brockbank; Cynthia Fisher; Justin Leader; Kimberly Carleson; Ann Lewandowski; Jeff Evans; Peter Hayes; Luke Prettol; Jason Shafrin; Jeff Marr; Daniel Polsky; Mark Meiselbach; Eric Bricker, MD; Tom Nash; Patrick Moore; Rina Tikia; Ramesh Kumar Budhani; Mark Cuban; Harold Miller; Chris Deacon; Moby Parsons, MD; Benjamin Schwartz, MD, MBA; Mishe Health; Rik Renard; and Cora Opsahl. You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), advances its strategic focus areas of advanced primary care, functional markets, and purchasing value. She leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability. At PBGH, Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health (the Maine Health Management Coalition), worked within an integrated delivery system (MaineHealth), and was elected to the Maine State Legislature, serving as a State Representative. Elizabeth served as vice chairperson of the U.S. Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a guiding committee member for the Health Care Payment Learning & Action Network. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics.   08:06 What is the overarching context for health plans in healthcare purchasing? 11:31 Why is it important to reestablish a connection between the people paying for care and people providing care? 13:47 What are the needs of a self-insured employer when managing employee benefits? 19:00 Is it doable for employers to set their own contracts? 21:24 Is transparency presumed? 22:39 Will the new transparency upon us actually expose wasted expense? 24:23 EP408 with Chris Deacon. 25:58 “This is not about individual bad actors. … The systems … that is not aligned.” 27:39 Are there providers who want to work directly with employers? 30:53 Why is it important that incentives need to be aligned? 32:42 EP427 with Rik Renard. 33:51 What's missing from the conversation on changing health plans?   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan vs. #jumboemployer inertia on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts)  

First week of June, what'd you miss in vet med?Hill's launches Microbiome Portal with HarvardOklahoma State OK's $250M for new hospitalChewy pledges $1M to LMUMars studies patient safety eventsA call for more independenceSynchrony reports on Lifetime Costs of PetsHelpful links:The Bird Bath substackFrontiers - Making the case for a resurgent U.S. independent veterinary practice segment: a SWOT analysisThe One Health Microbiome ResourceAVMA Journals - Patient safety events cause harm across a variety of veterinary care settings: a global retrospective analysisSynchrony - Pet Lifetime of Care 2025

This week on the podcast, Cate connects with Charlotte Jacobs — a parent and  childcare provider at Seedlings to Sunflowers Nonprofit Childcare and Family Center in Gorham — and Hazel Willow, a Maine parent who has utilized Head Start and now advocates for protecting childcare services and workers. “My child’s last day living in the… The post Podcast: ‘A Day Without Childcare' and the real cost of care gaps first appeared on Maine Beacon.

Long Island lawmakers denounce a law moving elections to even years. A Connecticut bill would give state control to town-run summer camps. New York homeland security officials warn parents about a dangerous new TikTok trend. Plus, WSHU heard from you about your climate concerns.

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

- Overview of the Medical & Indirect Costs of Treatment - What to Do When Cancer Treatment Seems Unaffordable – Self Advocacy - Talking with Your Health Care Team about Your Financial Concerns - The Benefits & Limitations of Your Health Plans, Insurance, Medicare & Medicaid Coverage - Tips on Appealing Your Insurance & Medicare Claims & Provider Denials - Living Wills, Health Care Proxies & Advance Health Care Directives - Accessing Financial, Co-Payment Assistance & Medicaid Programs - Support for the Underinsured & Uninsured, Including the Affordable Care Act (ACA) & Medicaid - Other Resources for Financial Help - Questions for Our Panel of Experts

In the final AMA Update episode of 2024, American Medical Association CXO Todd Unger looks back on another year of stories about the work that physicians are doing across the country and how the AMA is fighting to support them.

Bill Kramer, senior advisor for health policy at the Purchaser Business Group on Health, talks about how the country's largest employers figure out how to keep the cost of health care sustainable for their employees. 

In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable. To Read The Show Notes With All Mentioned Links, Visit the Episode Page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes. This encore is very relevant after the shows with Cora Opsahl (EP452), Claire Brockbank (EP453), and Marilyn Bartlett (EP450). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power. 07:34 How did Rob get to his current role? 09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this. 10:27 Why economic consequences move the needle, and why sometimes they don't. 12:26 Why the best way to address costs isn't to re-shift costs but to address them directly. 13:22 Why compensation that isn't dependent on outcomes is a problem. 16:23 “Strategy's not what people say; it's what they do.” 18:21 How do you operationalize saving money with better outcomes? 26:26 How do employers turn conflict into collaboration? 28:20 What is the win-win-win structure among employers, payers, and providers in Rob's eyes? 30:53 To whom should the task of risk adjustment fall? 34:43 “Better contracts do improve outcomes.”  

Texas hospitals must ask patients starting Friday whether they are in the U.S. legally and track the cost of treating people without legal status.   Please Like, Comment and Follow 'The Ray Appleton Show' on all platforms:   ---    'The Ray Appleton Show' is available on the KMJNOW app, Apple Podcasts, Spotify, YouTube or wherever else you listen to podcasts.    --  'The Ray Appleton Show'   Weekdays 11 AM -2 PM Pacific on News/Talk 580 AM & 105.9 FM KMJ    | Website  | Facebook | Podcast |   -  Everything KMJ   KMJNOW App | Podcasts | Facebook | X | Instagram   See omnystudio.com/listener for privacy information.

In the latest episode of Medicine: The Truth, Dr. Robert Pearl and Jeremy Corr return with timely insights on some of the most pressing issues in healthcare today. From the ... The post MTT #88: Abortion restrictions, PBMs and the rising cost of care appeared first on Fixing Healthcare.

In this Spotlight Episode host Stacey Richter discusses the management of oncology side effects with Dan Nardi, CEO of Reimagine Care. Highlighting the challenges cancer patients face, especially following chemotherapy which often leads to nausea and readmissions, the conversation delves into how Reimagine Care facilitates at-home integrative cancer care.   Their services focus on proactive and reactive support via AI-driven tools like 'Remy' to assist patients outside of clinical environments. This approach aims to reduce emergency visits and improve patient outcomes while easing the workload on healthcare providers. The discussion underscores the role of patient reported outcomes and the integration of technology with human care to improve the quality of oncology treatment pathways.   To Read the Full Article Notes with Mentioned Links, Visit Our Episode Page . If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Note from Stacey Richter: Pulling off a show like this one is not cheap, and my Aventria business partner Dave Dierk and I are happy to fund the vast majority of it. But yeah, breath of fresh air, and thanks much to the team over at Reimagine Care for their sponsorship. My one disclaimer is that I have not personally vetted the solution, but there is a white paper available where you will also find some insights from Reimagine Care's work with Memorial Hermann Health System. 03:38 Why is it really important to keep track of oncology patients and their side effects? 04:27 Why is cancer treatment such a complex care journey? 05:57 Are there outcome and financial issues that compound when an oncology patient is left to navigate their care journey on their own? 08:53 What is difficult in navigating cancer treatment care pathways, and what does Reimagine Care tackle within that? 09:55 EP157 with Ethan Basch, MD. 10:17 How does Reimagine Care proactively check in with oncology patients to help them navigate their care pathways? 12:41 How does Reimagine Care measure their performance, and how did their work affect patient outcomes? 13:28 The Reimagine Care white paper. 14:57 How do providers feel about Reimagine Care services? 17:37 Where can technology really make a difference in cancer care?

Dave Roberts, chief human resources officer for the West Ada School District, talks about the innovative way his district, with help from Regence and moves from the Idaho Legislature, cut the cost of premiums for employees, and what we can all do to ensure we're getting effective, affordable health care. 

Dr. Emily Tincher joins us to discuss the rising costs of veterinary care and how they impact pet families. Dr. Andy Roark and Dr. Tincher dive into her co-authored book chapter on cost, access to care, and payment options, highlighting key factors driving price increases, such as staffing costs, practice economics, and the cost of consumables and drugs. Dr. Tincher also shares insights on effectively communicating with pet owners about these costs and the importance of understanding their preferences. LINKS: Nationwide's Most Common Claims: https://news.nationwide.com/041824-dermatitis-gastroenteritis-most-common-conditions-prompt-vet-visits/ Cost of Care, Access to Care, and Payment Options in Veterinary Practice: https://www.vetsmall.theclinics.com/article/S0195-5616(23)00156-0/abstract Spectrum of Care: www.spectrum-of-care.com Open Door Veterinary Collective: https://opendoorconsults.org/ Pyometra Peer Reviewed Article Referenced: https://avmajournals.avma.org/view/journals/javma/260/S2/javma.20.12.0713.xml ABOUT OUR GUEST Emily M. Tincher, DVM, is Senior Director of Pet Health at Nationwide. A second-generation veterinarian, she is co-author of a chapter in Veterinary Clinics of North America: Small Animal Practice, "Cost of Care, Access to Care, and Payment Options in Veterinary Practice.” Dr. Tincher is a member of the Board of Directors for the Veterinary Leadership Institute and has become a sought-after speaker, most recently on spectrum of care topics, presenting at major veterinary conferences across North America.

To read the full article with show notes, mentioned links and a full transcript, visit relentlesshealthvalue.com In this episode, Abby Burns from Radio Advisory interviews Stacey Richter, host of the Relentless Health Value podcast, during the Raising the Bar Value Summit. They discuss the complexities of defining and creating value in healthcare, focusing on the roles of various stakeholders including patients, providers, and payers. Stacey shares insights on the challenges and tensions in the healthcare system, such as the fragmentation of care, financial toxicity, and the cultural norms that inhibit progress. The conversation also highlights practical examples and potential strategies to drive value and sustain positive changes within the industry. 03:33 Stacey's journey and mission. 04:16 The story of Scott Conard, MD (EP391). 09:28 Why it's important not just to drive change but to sustain it. 12:23 Heart Failure: A Case Study in Value. 14:13 EP438 with John Lee, MD. 15:07 Why patient positive value often fails instead of succeeds. 18:07 How financial toxicity has become clinical toxicity in healthcare. 19:44 How cultural norms have evolved into healthcare challenges. 23:38 The story of Mike Tuggy, MD, in Washington. 25:13 Looking at the four tensions in measuring value as continuums. 25:37 Why timeline is important in creative value in healthcare. 27:52 Finding Allies by Michael Leavitt. 28:34 What are the four ways to measure value in healthcare? 29:27 How do payers and providers collaborate to align on value metrics? 31:26 Why will proven versus experimental treatments become more important in the next few years? 34:54 Stacey's manifesto (EP400) and values for personal integrity in healthcare. 38:55 Stacey's parting advice. For more information, go to Radio Advisory or Aventria Health Group.