Podcasts about Health Affairs

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)  

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The Food and Drug Administration or FDA regulates roughly 78% of the US food supply. This includes packaged products, food additives, infant formula, ultra-processed foods, and lots more. However, an analysis by the Environmental Working Group found that 99% of new food ingredients enter our food supply through a legal loophole that skirts FDA oversight and seems, to me at least, to be incredibly risky. Today we're speaking with two authors of a recent legal and policy analysis published in the Journal Health Affairs. They explain what this loophole is and its risks and suggest a new user fee program to both strengthen the FDA's ability to regulate food ingredients and address growing concerns about food safety. Our guests are Jennifer Pomeranz Associate Professor of Public Health Policy and Management at New York University School of Global Public Health and Emily Broad, director of Harvard Law School Center for Health Law and Policy Innovation. Interview Summary So Jennifer, let's start with you, help our listeners understand the current situation with food ingredient oversight. And what is this legal loophole that allows food companies to add new ingredients without safety reviews. Sure. So, Congress passed the Food Additives Amendment in 1958, and the idea was to divide food additives and generally recognized as safe ingredients into two different categories. That's where the GRAS term comes from generally recognized as safe? ‘Generally Recognized As Safe' is GRAS. But it circularly defines food additives as something that's not GRAS. So, there's not actually a definition of these two different types of substances. But the idea was that the food industry would be required to submit a pre-market, that means before it puts the ingredient into the marketplace, a pre-market petition to the FDA to review the safety. And then the FDA promulgates a regulation for safe use of a food additive. GRAS ingredients on the other hand, initially thought of as salt, pepper, vinegar, are things like that would just be allowed to enter the food supply without that pre-market petition. The problem is the food industry is the entity that decides which category to place each ingredient. There's no FDA guidance on which category they're supposed to ascribe to these ingredients. What has happened is that the food industry has now entered into the food supply an enormous amount of ingredients under what we call the GRAS loophole, which is allowing it to just bring it to the market without any FDA oversight or even knowledge of the ingredient. So, in essence, what we're having now is that the food industry polices itself on whether to submit this pre-market petition for a food additive or just include it in its products without any FDA knowledge. When you said ‘enormous number of such things,' are we talking dozens, hundreds, thousands? Nobody knows, but the environmental working group did find that 99% of new ingredients are added through this loophole. And that's the concerning part. Well, you can look at some ultra-processed foods and they can have 30 or 40 ingredients on them. That's just one food. You can imagine that at across the food supply, how many things there are. And there are these chemicals that nobody can pronounce. You don't know what's going on, what they are, what they're all about. So, what you're saying is that the food industry decides to put these things in foods. There's some processing reason for putting them in. It's important that the public be protected against harmful ingredients. But the food industry decides what's okay to put in and what's not. Are they required to do any testing? Are there criteria for that kind of testing? Is there any sense that letting the industry police itself amounts to anything that protects the public good? Well, the criteria are supposed to be the same for GRAS or food additives. They're supposed to be meeting certain scientific criteria. But the problem with this is that for GRAS ingredients, they don't have to use published data and they can hold that scientific data to themselves. And you mentioned food labels, the ingredient list, right? That doesn't necessarily capture these ingredients. They use generic terms, corn oil, color additive, food additive whatever. And so, the actual ingredient itself is not necessarily listed on the ingredient list. There is no way to identify them and it's unknown whether they're actually doing the studies. They can engage in these, what are called GRAS panels, which are supposed to be experts that evaluate the science. But the problem is other studies have found that 100% of the people on these GRAS panels have financial conflicts of interest. Okay, so let me see if I have this right. I'm a food company. I develop a new additive to provide color or flavor or fragrance, or it's an emulsifier or something like that. I develop a chemical concoction that hasn't really been tested for human safety. I declare it safe. And the criteria I use for declaring it set safe is putting together a panel of people that I pay, who then in a hundred percent of cases say things are. That's how it works? I can't say that in a hundred percent of cases they say it's safe, but a hundred percent of the people have financial conflicts of interest. That's one of the major concerns there. Well, one can't imagine they would continue to be paid... Exactly. This sounds like a pretty shaky system to be sure. Emily: I wanted to add a couple other really quick things on the last discussion. You were saying, Kelly, like they're using a panel of experts, which indeed are paid by them. That would be best case in some cases. They're just having their own staff say, we think this is generally recognized as safe. And I think there's some examples we can give where there isn't even evidence that they went to even any outside people, even within industry. I think that the takeaway from all of that is that there's really the ability for companies to call all the shots. Make all the rules. Not tell FDA what they're doing. And then as we talked about, not even have anything on the label because it's not a required ingredient if it's, used as part of a processing agent that's not a substance on there. So I was feeling pretty bad when Jennifer is talking about these panels and the heavy conflict... Even worse. Of interest, now I feel worse because that's the best case. Totally. And one other thing too is just you kind of warmed this up by talking about this loophole. When we put an earlier article out that we wrote that was about just this generally recognized as safe, the feedback we got from FDA was this isn't a loophole. Why are you calling this a loophole? And it's pretty clear that it's a loophole, you know? It's big enough to drive thousands of ingredients through. Yes, totally. Emily, you've written about things like partially hydrogenated vegetable oils, trans fats, and red dye number three in particular. Both of which FDA has now prohibited in food. Can you walk us through those cases? You asked about partially hydrogenated oils or trans-fat, and then red dye three, which are two examples that we talk about a little bit in our piece. Actually, one of those, the partially hydrogenated oils was allowed in food through the generally recognized as safe definition. And the other was not. But they are both really good examples of another real issue that FDA has, which is that not only are they not doing a good job of policing substances going into food on the front end, but they do an even worse job of getting things out of food on the backend, post-market once they know that those substances are really raising red flags. And you raised two of the prime examples we've been talking about. With partially hydrogenated oils these are now banned in foods, but it took an extremely long time. Like the first evidence of harm was in the mid-nineties. By 2005, the Institute of Medicine, which is now the National Academies, said that intake of trans fat, of partially hydrogenated oils, should be as low as possible. And there was data from right around that time that found that 72,000 to 228,000 heart attacks in the US each year were caused by these partially hydrogenated oils. And on FDA's end, they started in early 2000s to require labeling. But it wasn't until 2015 that they passed a final rule saying that these substances were not generally recognized as safe. And then they kept delaying implementation until 2023. It was basically more than 20 years from when there was really clear evidence of harm including from respected national agencies to when FDA actually fully removed them from food. And red dye number three is another good example where there were studies from the 1980s that raised concerns about this red dye. And it was banned from cosmetics in 1990. But they still allowed it to be added to food. And didn't ban it from food until early this year. So early 2025. In large part because one of the other things happening is states are now taking action on some of these substances where they feel like we really need to protect consumers in our states. And FDA has been doing a really poor job. California banned red dye about 18 months before that and really spurred FDA to action. So that 20-year delay with between 72,000 and 228,000 heart attack deaths attributable to the trans fats is the cost of delay and inaction and I don't know, conflicts of interest, and all kinds of other stuff that happened in FDA. So we're not talking about something trivial by any means. These are life and death things are occurring. Yes. Give us another example, if you would, about something that entered the food supply and caused harm but made it through that GRAS loophole. The example that I've talked about both in some of the work we've done together and also in a perspective piece in the New England Journal of Medicine that really focused on why this is an issue. There was this substance added to food called tara flour. It came on the scene in 2022. It was in food prepared by Daily Harvest as like a protein alternative. And they were using it from a manufacturer in South America who said we have deemed this generally recognized as safe. Everything about that is completely legal. They deemed it generally recognized as safe. A company put it into food, and they sold that. Up until that point, that's all legal. What happened was very quickly people started getting really sick from this. And so there were, I think, about 400 people across 39 states got sick. Nearly 200 people ended up in the hospital, some of them with liver failure because of this toxicity of tara flour. And so FDA followed the thread they did help work with the company to do a voluntary recall, but it then took them two years, until May, 2024, to declare tara flour not generally recognized as safe. So I think, in some ways, this is a great example because it shows how it's so immediate, the impact of this substance that, again, was legally added to food with no oversight. In some ways it's a misleading example because I think so many of the substances in food, it's not going to be so clear and so immediate. It's going to be year over year, decade over decade as part of a full diet that these are causing cardiovascular risk, thyroid disease, cancer risk, those kinds of things. I'd love to hear from either of you about this. Why is FDA falling down on the job so badly? Is it that they don't have the money to do the necessary testing? Do they not have the authority? Is there not the political will to do this? Is there complete caving into the food industry? Just let them do what they want and we're going let it go? Jennifer: All of the above? Everything you just said? It's all of the above. Emily: Jen, do you wanna talk about the money side? Because that sort of gets to the genesis of the article we worked on, which was like maybe there's a creative solution to that piece. Yes, I'd love to hear about that because I thought that was a very creative thing that you guys wrote about in your paper. That there would be an industry user fee to help produce this oversight. Tell us what you had in mind with that. And then then convince me that FDA would appropriately use this oversight and do its job. So, the idea in the paper was proposing a comprehensive user fee program for the food branch of the FDA. The FDA currently collects user fees for all of human drugs, animal drugs, medical devices, etc. With Tobacco, it's a hundred percent funded by user fees. But food, it only gets 1% of its funding through user fees. And it's important to note user fees fund processes. They don't fund outcomes. It's not like a bribe. And the idea behind user fees and why industry sometimes supports them is actually to bring predictability to the regulatory state. It brings efficiency to reviews. And then this all allows the industry to anticipate timelines so they can bring products to market and know when they're going be able to do it. In the food context, for example, the FDA is required to respond to those food additives petitions that we talked about within 180 days. But they can't respond in time. And they have a lot of timelines that are required of them in the food context that they can't meet. They can't meet their timelines because they're so underfunded. So, we proposed a comprehensive user fee. But one of the main reasons that we think a user fee is important is to address the pre-market issues that I talked about and the post-market issues that Emily talked about. In order to close that GRAS loophole, first of all, FDA needs to either reevaluate its authorities or Congress needs to change its authorities. But it would need resources to be able to do something pre-market. Some of the ideas we had was that the user fee would fund some type of either pre-market review, pre-market notification, or even just a pre-market system where the FDA determines whether a proposed ingredient should go through the GRAS avenue, or through food additive petition. So at least that there will be some type of pre-market oversight over all the ingredients in the food supply. And then also the FDA is so severely lacking in any type of comprehensive post-market into play, they would have the resources to engage in a more comprehensive post-market review for all the ingredients. Could you see a time, and I bring this up because of lawsuits against the food industry for some of these additives that are going on now. The state attorney's generals are starting to get involved, and as you said, Emily, the some states are taking legislative action to ban certain things in the food supply. Do you think there could come a time when the industry will come to government pleading to have a user fee like this? To provide some standardization across jurisdictions, let's say? So, there's two things. The first is Congress has to pass the user fee, and historically, actually, industry has done exactly what you said. They have gone to Congress and said, you know what? We want user fees because we want a streamlined system, and we want to be able to know when we're bringing products to market. The problem in the context of food for the issues we're talking about is that right now they can use the GRAS loophole. So, they have very little incentive to ask for user fees if they can bring all their ingredients into the market through the GRAS loophole. There are other areas where a user fee is very relevant, such as the infant formula 90 day pre-market notification, or for different claims like health claims. They might want user fees to speed those things up, but in terms of the ingredients, unless we close the GRAS loophole, they'd have little incentive to actually come to the table. But wouldn't legal liability change that? Let's say that some of these lawsuits are successful and they start having to pay large settlements or have the State Attorneys General, for example, come down on them for these kinds of things. If they're legally liable for harm, they're causing, they need cover. And wouldn't this be worth the user fee to provide them cover for what they put in the food supply? Yes, it's great to have the flexibility to have all these things get through the loophole, but it'd be great as well to have some cover so you wouldn't have so much legal exposure. But you guys are the lawyers, so I'm not sure it makes sense. I think you're right that there are forces combining out in the world that are pushing for change here. And I think it's hard to disentangle how much is it that industry's pushing for user fees versus right now I think more willing to consider federal regulatory changes by either FDA or by Congress. At the state level this is huge. There's now becoming a patchwork across states, and I think that is really difficult for industry. We were tracking this year 93 bills in 35 states that either banned an additive in the general public, banned it in schools. Banned ultra-processed foods, which most of the states, interestingly, have all defined differently. But where they have had a definition, it's been tied to various different combinations of additives. So that's going on. And then I think you're right, that the legal cases moving along will push industry to really want clear and better standards. I think there's a good question right now around like how successful will some of these efforts be? But  what we are seeing is real movement, both in FDA and in Congress, in taking action on this. So interestingly, the Health Affairs piece that we worked on was out this spring. But we had this other piece that came out last fall and felt like we were screaming into the void about this is a problem generally recognized as safe as a really big issue. And suddenly that has really changed. And so, you know, in March FDA said they were directed by RFK (Robert F. Kennedy), by HHS (Health and Human Services) to really look into changing their rule on generally recognized as safe. So, I know that's underway. And then in Congress, multiple bills have been introduced. And I know there are several in the works that would address additives and specifically, generally recognized as safe. There's this one piece going on, which is there's forces coalescing around some better method of regulation. I think the question's really going to also be like, will Congress give adequate resources? Because there is also another scenario that I'm worried about that even if FDA said we're going now require at least notification for every substance that's generally recognized as safe. It's a flood of substances. And they just, without more resources, without more staff devoted to this, there's no way that they're going to be able to wade through that. So, I think that either the resources need to come from user fees, or at least partially from user fees, from more appropriations and I think, In my opinion, they are able to do that on their own. Even given where current administrative law stands. Because I think it's very clear that the gist of the statute is that FDA should be overseeing additives. And I think a court would say this is allowing everything to instead go through this alternative pathway. But I really think FDA's going to need resources to manage this. And perhaps more of a push from Congress to make sure that they really do it to the best of their ability. I was going to say there's also an alternative world where we don't end up spending any of these resources, and they require the industry just to disclose all the ingredients they've added to food and put it on a database. This is like low hanging fruit, not very expensive, doesn't require funding. And then the NGOs, I hope, would go to work and say, look at this. There is no safety data for these ingredients. You know, because right now we just can't rely on FDA to do anything unless they get more funding to do something. So, if FDA doesn't get funding, then maybe this database where houses every ingredient that's in the food supply as a requirement could be a low resource solution. Jennifer, I'll come back to you in a minute because I'd like to ask how worried should we be about all this stuff that's going into food. But Emily, let me ask you first, does FDA have the authority to do what it needs to do? Let's say all of a sudden that your wish was granted and there were user fees would it then be able to do what needs to be done? I think certainly to be able to charge these user fees in almost all areas, it right now doesn't have that authority, and Congress would need to act. There's one small area which is within the Food Safety Modernization Act for certain types of like repeat inspections or recalls or there's a couple other. FDA isn't charging fees right now because they haven't taken this one step that they need to take. But they do have the authority if they just take those steps. But for everything else, Congress has to act. I think the real question to me is because we now know so many of these substances are going through this GRAS pathway, the question is really can they do everything they need to do on their own to close that loophole? And again, my opinion is Congress could make it clear and if Congress were to act, it would be better. Like they could redefine it in a way that was much more clear that we are drawing a real line. And most things actually should be on the additive side of the line rather than the generally recognized as safe side of the line. But even with their current authority, with the current definition, I think FDA could at least require notification because they're still drawing a line between what's required for additives, which is a very lengthy pre-market process with, you know, a notice and comment procedure and all of these things. My take is FDA do what you can do now. Let's get the show on the road. Let's take steps here to close up the loophole. And then Congress takes time. But they definitely can even strengthen this and give a little more, I think, directives to FDA as to how to make sure that this loophole doesn't recur down the line. In talks that I've given recently, I've shown an ingredient list from a food that people will recognize. And I ask people to try to guess what that food is from its ingredient list. This particular food has 35 ingredients. You know, a bunch of them that are very hard to pronounce. Very few people would even have any idea at all what those ingredients do. There's no sense at all about how ingredient number 17 would interact with ingredient 31, etc. And it just seems like it's complete chaos. And I don't want to take you guys outside your comfort zone because your backgrounds are law. But Jennifer, let me ask you this. You have a background in public health as well. There are all kinds of reasons to be worried about this, aren't there? There are the concerns about the safety of these things, but then there's a concern about what these ultra-processed ingredients do to your metabolism, your ability to control your weight, to regulate your hunger and things like that. It sounds this is a really important thing. And it's affecting almost everybody in the country. The percentage of calories that are now coming from ultra-processed foods is over 50% in both children and adults. So it sounds like there's really reason to worry. Would you agree? Yes. And also, the FDA is supposed to be overseeing the cumulative effects of the ingredients and it doesn't actually enforce that regulation. Its own regulation that it's supposed to evaluate the cumulative effects. It doesn't actually enforce this. So by cumulative effects do you mean the chronic effects of long term use? And, having these ingredients across multiple products within one person's consumption. Also, the FDA doesn't look at things like the effect on the gut microbiome, neurotoxicity, even cancer risk, even though they're supposed to, they say that if something is GRAS, they don't need to look at it because cancer risk is relegated only to food additives. So here we're at a real issue, right? Because if everything's entering through the GRAS loophole, then they're not looking at carcinogen effects. So, I think there is a big risk and as Emily had said earlier, that these are sometimes long-term risks versus that acute example of tara flour that we don't know. And we do know from the science, both older and emerging science, that ultra-processed food has definite impact on not only consumption, increased consumption, but also on diet related diseases and other health effects. And by definition what we're talking about here are ultra-processed foods. These ingredients are only found in ultra-processed foods. So, we do know that there is cause for concern. It's interesting that you mentioned the microbiome because we've recorded a cluster of podcasts on the microbiome and another cluster of podcasts on artificial sweeteners. Those two universes overlap a good bit because the impact of the artificial sweeteners on some of them, at least on the microbiome, is really pretty negative. And that's just one thing that goes into these foods. It really is pretty important. By the way, that food with 35 ingredients that I mentioned is a strawberry poptart. Jennifer: I know that answer! Emily: How do you know that? Jennifer: Because I've seen Kelly give a million talks. Yes, she has. Emily: I was wondering, I was like, are we never going to find out? So the suspense is lifted. Let me end with this. This has been highly instructive, and I really appreciate you both weighing in on this. So let me ask each of you, is there reason to be optimistic that things could improve. Emily, I'll start with you. So, I've been giving this talk the past few months that's called basically like Chronic Disease, Food Additives and MAHA, like What Could Go Right and What Could Go Wrong. And so, I'm going give you a very lawyerly answer, which is, I feel optimistic because there's attention on the issue. I think states are taking action and there's more attention to this across the political spectrum, which both means things are happening and means that the narrative changing, like people are getting more aware and calling for change in a way that we weren't seeing. On the flip side, I think there's a lot that could go wrong. You know, I think some of the state bills are great and some of them are maybe not so great. And then I think this administration, you have an HHS and FDA saying, they're going to take action on this in the midst of an administration that's otherwise very deregulatory. In particular, they're not supposed to put out new regulations if they can get rid of 10 existing ones. There are some things you can do through guidance and signaling, but I don't think you can really fix these issues without like real durable legislative change. So, I'm sorry to be one of the lawyers here. I think the signals are going in the right direction, but jury is out a little bit on how well we'll actually do. And I hope we can do well given the momentum. What do you think, Jennifer? I agree that the national attention is very promising to these issues. The states are passing laws that are shocking to me. That Texas passing a warning label law, I would never have thought in the history of the world, that Texas would be the one to pass a warning label law. They're doing great things and I actually have hope that something can come of this. But I am concerned at the federal level of the focus on deregulation may make it impossible. User fees is an example of where they won't have to regulate, but they could provide funding to the FDA to actually act in areas that it has the authority to act. That is one solution that could actually work under this administration if they were amenable to it. But I also think in some ways the states could save us. I worry, you know, Emily brought up the patchwork, which is the key term the industry uses to try to get preemption. I do worry about federal preemption of state actions. But the states right now are the ones saving us. California is the first to save the whole nation. The food industry isn't going to create new food supply for California and then the rest of the country. And then it's the same with other states. So, the states might be the ones that actually can make some real meaningful changes and get some of the most unsafe ingredients out of the food supply, which some of the states have now successfully done. Bios Emily Broad Leib is a Clinical Professor of Law, Director of Harvard Law School Center for Health Law and Policy Innovation, and Founding Director of the Harvard Law School Food Law and Policy Clinic, the nation's first law school clinic devoted to providing legal and policy solutions to the health, economic, and environmental challenges facing our food system. Working directly with clients and communities, Broad Leib champions community-led food system change, reduction in food waste, food access and food is medicine interventions, and equity and sustainability in food production. Her scholarly work has been published in the California Law Review, Wisconsin Law Review, Harvard Law & Policy Review, Food & Drug Law Journal, and Journal of Food Law & Policy, among others. Professor Jennifer Pomeranz is a public health lawyer who researches policy and legal options to address the food environment, obesity, products that cause public harm, and social injustice that lead to health disparities. Prior to joining the NYU faculty, Professor Pomeranz was an Assistant Professor at the School of Public Health at Temple University and in the Center for Obesity Research and Education at Temple. She was previously the Director of Legal Initiatives at the Rudd Center for Food Policy and Obesity at Yale University. She has also authored numerous peer-reviewed and law review journal articles and a book, Food Law for Public Health, published by Oxford University Press in 2016. Professor Pomeranz leads the Public Health Policy Research Lab and regularly teaches Public Health Law and Food Policy for Public Health.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Senior Editor Kathleen Haddad back to the pod to take a look at recent news that HHS terminated 22 mRNA projects. The two explore the agency's reasoning, political and Wall Street reactions, and what it could mean for health care innovation.Join us for these upcoming events:8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)9/3: Theme Issue Briefing: Insights About The Opioid Crisis (FREE TO ALL)9/17: Lunch & Learn: The Current Opioids Policy Landscape & What's Ahead (FREE TO ALL)9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)Become an Insider today to get access to exclusive events like the ones highlighted above.Related Articles:HHS abandons mRNA vaccine research (BioPharma Dive)1 big thing: RFK Jr.'s anti-vaccine revolution (Axios)Moderna Stock Jumps as NIH Chief Tempers Administration's Attack on mRNA (Barron's)750 HHS employees send signed letter to RFK Jr. asking him to stop spreading misinformation (ABC News)Industry frets Kennedy's mRNA decision will curb cancer breakthroughs (Politico Pro) Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Cal Chengqi Fang of the University of Chicago about his recent paper that explores how pay gaps grew between nonprofit hospital CEOs and employees from 2009–23. Order the August 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Send us a textWhy are U.S. health care costs so high—and what does that mean for you and your family? In this episode, I dive into the real reasons behind America's staggering health care bills.We start with a story that hits close to home—a $189,000 outpatient cancer surgery bill followed by $12,000-a-month immunotherapy—and I unpack how even with Medicare coverage, the pricing dynamics can feel shocking. Using my experience as a physician and health policy researcher, I explain why these massive charges happen and where the system is breaking down.At the national level, we now spend over $5 trillion a year on health care—roughly 18% of our GDP—and this number is growing far faster than inflation. This growth threatens the solvency of key programs like Medicare, which is projected to run out of funds by 2033 (Health Affairs). Employers are also feeling the pinch, with average family coverage costs now topping $25,500 annually (WSJ). Individuals, especially those using ACA exchanges, face rising premiums—some increasing by 20–30% next year (Axios)—and deductibles between $3,000 and $5,000 are now typical.Despite all this spending, our health outcomes are among the worst in the developed world. The U.S. ranks 33rd in infant mortality and 32nd in life expectancy out of 38 OECD countries, even though we spend about $12,000 per person annually—nearly three times the OECD average (America's Health Rankings).So, what drives these costs? It boils down to three factors: high prices, high utilization, and high administrative overhead. Prices for common procedures are far above international norms—a CT scan in the U.S. costs around $900 compared to $279 in the Netherlands and just $97 in Canada (Health Imaging). U.S. physicians, nurses, and hospital executives also earn significantly more, contributing to overall spending (Medscape; JAMA).On the utilization front, studies estimate that around 25% of all care may be unnecessary, driven by defensive medicine, patient expectations, and incentive structures that reward more procedures—not necessarily better outcomes (PGPF; Choosing Wisely).Even administrative overhead plays a massive role: nearly 25% of U.S. health care spending goes to bureaucracy—four times what's typical in simpler, single-payer systems (Health System Tracker; Health Affairs%20of%20US%20GDP)).If you're wondering why your doctor spends just 17 minutes with you or why your premiums feel like a second mortgage, this episode offers the context—and data—to help you understand what's really going on.Takeaways: Start asking about cash prices—especially if you're still in your deductible phase. Preventive steps like regular exercise may offer the highest return on investment when compared to costly downstream care. And above all, consider your plan carefully during open enrollment.For deeper insights, links to all the studies mentioned, and access to my newslet

Firearm-related suicides are a hidden public health emergency driven by social despair and systemic inequities.In this episode of Straight Out of Health IT, WellLink's Brian Lane, President and CEO, and Dr. Kim Byas, Vice President of Community Engagement and Impact, share how the Center for Health Affairs in Cleveland partnered with AWS to launch a groundbreaking Social Determinants of Health Innovation Hub. Using clean, harmonized data and predictive modeling, their team has uncovered powerful correlations between firearm suicides and factors like unemployment, housing insecurity, and lack of transportation. This data-driven approach is transforming suicide prevention efforts from reactive to proactive.They discuss how this work has led to targeted interventions, such as deploying trained social workers instead of law enforcement to crisis calls, and inspired replication of the model in other states and internationally. With over 250 organizations collaborating across sectors, the initiative is creating scalable solutions that address both behavioral health crises and their root causes.Brian and Dr. Byas also reveal how AI and large language models are being used to test interventions, improve care pathways, and reduce healthcare costs, all while strengthening community resilience. Their work proves that solving complex health challenges requires both advanced technology and deep community partnerships.Tune in to hear how data, collaboration, and innovation are reshaping the future of suicide prevention!

Subscribe to UnitedHealthcare's Community & State newsletter.In the wake of Medicare and Medicaid's 60th anniversary, Health Affairs' Jeff Byers welcomes Jamila Michener of Cornell University to the pod to discuss her recent Forefront article on organized power and its impact on the future of Medicaid.Also, join us for these upcoming events:8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)9/3: Theme Issue Briefing: Insights About The Opioid Crisis (FREE TO ALL)9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)Become an Insider today to get access to exclusive events like the ones highlighted above.Related Articles:Order Fragmented Democracy: Medicaid, Federalism, and Unequal Politics (Cambridge University Press)Medicare and Medicaid at 60 Forefront Series Subscribe to UnitedHealthcare's Community & State newsletter.

    Dr. Stephen Ferrara, a distinguished retired Navy Captain and the Acting Assistant Secretary of Defense for Health Affairs, joins us on WarDocs to share his inspiring journey through military medicine. Dr. Ferrara opens up about his motivations, which are deeply rooted in family ties and pivotal global events, such as the Gulf War, that led him to pursue a career as a vascular and interventional radiologist. His insights reveal the profound responsibilities of advising the Secretary of Defense on military healthcare policies, managing vast budgets, and advocating for the welfare of military healthcare professionals. Dr. Ferrara's narrative is a testament to the dedication and teamwork that mark the Military Health System, underscoring its essential role in national security.     The episode offers a window into the unique challenges and deeply rewarding experiences of serving as a military medical professional. Dr. Ferrara recounts his swift deployment aboard the USNS Mercy following the devastating 2004 tsunami and his subsequent support of Army operations in Afghanistan. These experiences highlight the adaptability and commitment required in military medicine, where providing care in disaster zones and combat situations becomes a way of life. The personal side of his story unfolds as well, sharing the dynamics of balancing a dual military family life, managing deployments, and instilling values of public service in the next generation.     Dr. Ferrara delves into the complexities of maintaining readiness and supporting healthcare initiatives amid budget constraints. He discusses leveraging partnerships with organizations like the VA and Medicare to enhance medical skills and generate revenue, ensuring the system's commitment to outperforming the private sector in patient outcomes. With congressional support and a focus on efficient governance, Dr. Ferrara's perspective sheds light on the resilience and innovation driving military healthcare forward.     Chapters: (00:04) Military Medicine Leadership and Career Insights (12:13) Military Service (18:51) Military Health System Excellence and Leadership (27:10) Strategic Partnerships for Military Health (40:43) Military Health Leadership and Service   Chapter Summaries: (00:04) Military Medicine Leadership and Career Insights Dr. Stephen Ferrara's extensive career as a retired Navy Captain and current Acting Assistant Secretary of Defense for Health Affairs, overseeing the military health system and advocating for military healthcare professionals.   (12:13) Military Service Military medical professionals serve in disaster zones, combat, and global health missions, while balancing family life and instilling values of public service.   (18:51) Military Health System Excellence and Leadership Transitioning from military physician to health policy and national security roles, emphasizing readiness and supporting warfighters.   (27:10) Strategic Partnerships for Military Health The military health system faces budget constraints but strives to outperform the private sector through efficiency, good governance, and partnerships.   (40:43) Military Health Leadership and Service Dr. Steve Ferreira shares insights on health affairs in the defense sector, highlighting his career and significant experiences.   Take Home Messages: Leadership in Military Medicine: The episode highlights the significant leadership roles within the military health system, emphasizing the importance of advising top defense officials on healthcare policies, managing large budgets, and advocating for military healthcare professionals. The leadership insights shared underline the critical role of maintaining readiness and strategic planning in military medicine. Unique Challenges and Rewards: Serving in military medicine involves unique challenges, such as providing care in disaster zones and combat situations. The episode explores the adaptability and commitment required in these environments, illustrating the profound sense of duty and fulfillment derived from serving both the nation and its service members. Balancing Personal and Professional Life: The narrative also delves into the personal aspects of a military medical career, including the dynamics of balancing a dual military family life, managing deployments, and instilling values of public service in the next generation. This balance is a critical component of a successful military medical career. Strategic Partnerships and Innovation: The episode discusses the importance of strategic partnerships with organizations like the VA and Medicare to enhance medical skills, generate revenue, and maintain the military health system's commitment to excellence. These collaborations are vital for bridging budget gaps and ensuring the system's sustainability. Excellence and Resilience in Military Healthcare: The episode sheds light on the resilience and innovation driving military healthcare forward, focusing on efficient governance and the system's mission to outperform the private sector in patient outcomes. It highlights the dedication of military health professionals and the importance of congressional support in providing the necessary resources for continued excellence. Episode Keywords: Military Medicine, Dr. Stephen Ferrara, Navy Captain, War Docs Podcast, healthcare leadership, vascular radiology, military healthcare challenges, Gulf War, Afghanistan, USNS Mercy, military medical career, defense health system, resilience in healthcare, military health professionals, military medical deployments, strategic partnerships, VA and Medicare, military health budget, military family life, military healthcare excellence   Hashtags: #MilitaryMedicine #WarDocsPodcast #HealthcareLeadership #NavyMedicine #VascularRadiology #MilitaryHealthcare #MedicalReadiness #StrategicPartnerships #HealthcareInnovation #NationalSecurity   Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield,demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast  

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Steven M. Lieberman of the University of Southern California, Los Angeles on his recent paper that explores how Medicare Advantage has seen significant enrollment growth and what reform efforts can be attempted to rebalance traditional Medicare and MA.Order the August 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Senior Editor Leslie Erdelack back to the pod to discuss the proposed rule change to the Medicare Physician Fee Schedule for 2026, which includes payment conversion factors for doctors, alternative payment models, add-on codes for Advanced Primary Care Management services, a new mandatory value-based payment model, and more.Order the August 2025 issue of Health Affairs.Join us for a live taping of A Health Podyssey on Tuesday August 12 where Rob Lott will discuss recent findings about changes in clinician's participation across Medicare value-based payment models with Kenton Johnston.Upcoming Events include:8/20: 340B w/ Sayeh Nikpay (INSIDER EXCLUSIVE)8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)View all Upcoming Events.Become an Insider today to get access to exclusive events like the ones highlighted above.Related Articles:PRESS RELEASE: Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1832-P)CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,' MACRA (Healthcare Dive)CMS proposes 3.6% pay bump for docs, takes aim at chronic conditions in physician fee schedule (Fierce Healthcare)Physicians will see Medicare payments rise in 2026 (AMA)Medicare proposes ‘efficiency' pay cuts that would hit highly paid specialists the most (STAT News) Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Jonathan Perlin of The Joint Commission about the origins of this commission, the impacts made on health care through quality improvement and patient safety, the role of accreditation, the public policy levers that drive change, and more. Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Dr. Aaron Carroll, President and CEO of AcademyHealth, to the pod to discuss his recent Forefront article that takes a closer look at the disappearance of public health information and how this could have an impact on infrastructures that scientists, clinicians, health policy makers, and community leaders rely on daily. Become an Insider today to get access to our trend reports, events, and exclusive newsletters.Related Links:AcademyHealth Situation ReportsPRESS RELEASE: AcademyHealth Joins Lawsuit to Restore Public Health Data Removed from Federal WebsitesBecome an AcademyHealth Member Subscribe to UnitedHealthcare's Community & State newsletter.

Health Affairs' Rob Lott interviews Margaret Sieger of the University of Kansas Medical Center about her recent paper that reviews how Connecticut's novel prenatal substance exposure policy was associated with declining Child Protective Services reports and foster placements. Order the July 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law and Deputy Editor Chris Fleming to the pod to discuss Trump administration's One Big Beautiful Bill and how this will affect Medicaid, Medicare, health savings accounts, rural hospitals, and more. Become an Insider today to get access to our trend reports, events, and exclusive newsletters.Related Links:The 'One Big Beautiful Bill,' Now Law, Does Not Protect Rural Hospitals (Health Affairs Forefront)Rural Health Transformation Program Won't Shield Hospitals And Other Rural Providers From OBBBA's Fallout (Health Affairs Forefront)With Budget Reconciliation Bill Enacted, Health Care Changes Loom (Health Affairs Forefront)Congress Should Remove The Rare Disease Carve-Out From Medicare Drug Price Negotiation, Not Expand It (Health Affairs Forefront)Recent Experience Shows National Medicaid Work Requirements Would Create Enormous Administrative Inefficiencies (Health Affairs Forefront)

Health Affairs' Rob Lott interviews J. Wyatt Koma of Harvard University about his recent paper that explores enrollment trends and characteristics of low-income beneficiaries within Medicare Savings Programs.Order the July 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Health Affairs' Jeff Byers welcomes Ryan Golden, Senior Reporter at HR Dive, to the pod to discuss workforce trends within the health care space pertaining to artificial intelligence, recruitment, overtime eligibility requirements, pay transparency, noncompete agreements, remote work, RTO policies, and more.This week, Health Affairs released their second Insider trend report focusing on the health care workforce, titled "The Health Care Workforce: A Challenge In Sustainability."Become an Insider today to get access to our trend reports, events, and exclusive newsletters. Related Links:What HR pros need to know about AI in the workplace (HR Dive)

Health Affairs' Rob Lott interviews Bohan Li of Harvard University about her recent paper that explores substantial shifts in market landscape and acquisitions in Medicaid managed care.Order the July 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Kristin Raab, Director of the Minnesota Climate and Health Program at the Minnesota Department of Health, shares how the state's “Stay Cool Minnesota” campaign is working to protect Minnesotans against the negative health effects of extreme heat; ASTHO Alum, Dr. Matthew Christiansen, Chief Medical Officer and Vice President of Health Affairs at Valley Health Systems, discusses ASTHO's recent Executive Leadership Forum and the value of public health; ASTHO's new data dashboard to help states use data to guide health improvement; and an ASTHO training on legal maps will take place on July 30th.  Minnesota Department of Health News Release: Health officials launch campaign to encourage Minnesotans to ‘Stay Cool' during extreme heat ASTHO Brief: How States Can Leverage Data to Guide Health Improvement ASTHO Webinar: State and Territorial Infrastructure for Suicide Prevention: Exploring New Legal Maps  

Drs. Durga Borkar and Yashaswini Singh join host Dr. Jay Sridhar to discuss their recent publication regarding private equity (PE) acquisition and access to retinal detachment surgery. According to the study, physicians in PE-acquired practices decreased their number of retinal detachment repairs by nearly 20% after acquisition, potentially negatively impacting access to care and patient outcomes. Discussed in today's podcast: Singh Y, Cardenas GB, Torabzadeh H, Whaley CM, Borkar D. Private Equity-Owned Physician Practices Decreased Access To Retinal Detachment Surgery, 2014-22. Health Affairs. 2025 May;44(5):589-596. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Rebecca Wolfe is a postdoctoral research fellow at Harvard University. Graduating with a PhD in Sociology from the University of California, San Francisco (UCSF) in 2024, Rebecca's research agenda focuses on the areas of gender, sexuality, the body, and mental health, particularly in the context of religion. Rebecca's dissertation work examined bodily experiences of disordered eating and sexual dysfunction among people raised as women in purity culture, a Protestant evangelical movement. Rebecca has been published in academic journals including Health Affairs, Social Science and Medicine - Population Health, and Theology and Sexuality, and created public facing work on podcasts such as EDGES and Anthrodish, and through the Sage Knowledge video series. Visit Sacred Writes: https://www.sacred-writes.org/2025-carpenter-cohorts-spring-semester  

Health Affairs' Rob Lott interviews Paula Chatterjee of the University of Pennsylvania about her recent paper that explores whether or not rural hospitals saw financial improvements from participation in the Pennsylvania Rural Health Model.Order the July 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Health Affairs' Rob Lott interviews Uché Blackstock, CEO and Founder of Advancing Health Equity (AHE), on her experiences founding AHE in 2019, the mission statement of the organization to pursue health equity in health care, and her generational memoir, LEGACY: A Black Physician Reckons with Racism in Medicine. Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

While many of us don't have advanced medical degrees, we all have an impact on the emotional and spiritual well-being of those around us. However, it is fascinating to hear from someone who helps people to heal physically, on how that intersects with the way we heal mentally and spiritually. Join us as Dr. David Lakey, Vice Chancellor of Health Affairs and Chief Medical Officer at the University of Texas System, explains what it is like to live out your faith in the field of medicine. 

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to discuss the recently released National Health Expenditures Projections for 2024–33 from the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS).Related Articles:National Health Expenditure Projections, 2024–33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDPCMS National Health Expenditure Data Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Robert Burke of the University of Pennsylvania about his recent paper which evaluates outcomes for skilled nursing facilities value-based purchasing programs. Order the June 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews MacKenzie Hughes of NORC at the University of Chicago about her recent paper reviewing how transitional care management was associated with healthier days at home and lower spending after hospital discharges for patients.Order the June 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Senior Editor Kathleen Haddad to the pod to discuss the Forefront series, Supplemental Benefits In Medicare Advantage, and how articles from the series elaborated on issues such as challenges in understanding and accessing benefits, CMS requirements to collect encounter data, the intersection of MA supplemental benefits with Medicaid long-term services and supports, and more. Become an Insider today to get access to exclusive events, our recent trend report on AI in health care, and monthly newsletters from authors such as Stacie Dusetzina, David Simon, Brent Fulton, and others.Upcoming Insider Exclusive Events include:6/17: Risk Adjustment Trends & Reform with J. Michael McWilliams7/9: Supreme Court Wrap-Up with moderator Sara Rosenbaum joined by panelists William Sage, Barak Richman, and Renee LandersView all Upcoming Events.Related Articles:The People SayFlex Cards In Medicare Advantage: A Closer Look At Impact and Challenges (Health Affairs Forefront)Medicare Advantage And Supplemental Long-Term Services And Supports: A Small Step In The Right Direction (Health Affairs Forefront)Time To Reexamine The Role Of Supplemental Benefits In Medicare Advantage (Health Affairs Forefront)Medicare Advantage Supplemental Benefits: Origins, Evolution, And Issues For Policy Making (Health Affairs Forefront) Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Keith Drake of Greylock McKinnon Associates about his recent paper that explores trends in authorized generic drug launches and the effects observed on competition in pharmaceutical markets in the US. Order the June 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law back to the pod to discuss the House Republican budget reconciliation legislation and what impacts this legislation could have on the Affordable Care Act market, Medicaid beneficiaries, health savings accounts, Medicare, and more.Become an Insider today to get access to exclusive events, our recent trend report on AI in health care, and monthly newsletters from authors such as Stacie Dusetzina, David Simon, Laura Tollen, and others.Related Articles:The House Republican Budget Reconciliation Legislation: Unpacking The ICHRA And HSA Changes (Health Affairs Forefront)Health Policy At A CrossroadsTrump tax bill will add $2.4 trillion to the deficit and leave 10.9 million more uninsured, CBO says (AP News)Expansions to Health Savings Accounts in House Budget Reconciliation: Unpacking the Provisions and Costs to Taxpayers (KFF) Subscribe to UnitedHealthcare's Community & State newsletter.

Stacey Richter has a second take on the original episode 433 since it is so relevant right now. Stacey engages in a compelling conversation with Justin Leader, CEO of BenefitsDNA, about the opaque practices of third-party administrators (TPAs) and their impact on healthcare costs.  They discuss the hidden fees tucked into weekly claims wires, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, and TPA adjudication fees.  The episode emphasizes the need for transparency, understanding hidden costs, and ensuring fiduciary responsibility for self-funded employers. Additionally, Leader shares insights from a Health Affairs article and mentions ongoing legal cases that highlight the financial discrepancies in TPA practices. === LINKS ===

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Thomas Dobbs of the University of Mississippi Medical Center to offer observations on the current state of public health funding, current career potential in the public health field, and reflections from being the namesake on the Dobbs v. Jackson Women's Health Organization Supreme Court Case.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Senior Editor Michael Gerber back to the program to discuss the Food and Drug Administration's recent announcement to scale a generative artificial intelligence across its center in the future.Health Affairs released their first Insider trend report. The report focuses on AI in health care and you can get full access to this report by becoming an Insider. Insiders also will receive access to our June 17 event on risk adjustment trends and our July 7 event featuring a wrap-up of the recent Supreme Court session.Related Links:FDA's plan to roll out AI agencywide raises questions (Axios)PRESS RELEASE: FDA Announces Completion of First AI-Assisted Scientific Review Pilot and Aggressive Agency-Wide AI Rollout Timeline Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.On May 13, A Health Podyssey's Rob Lott chatted with Andrew Ryan of Brown University about his paper in the May 2025 edition of Health Affairs that explores how Rhode Island's affordability standards impacted hospital prices and insurance premiums. Order the May 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.On May 13, A Health Podyssey's Rob Lott chatted with Andrew Ryan of Brown University about his paper in the May 2025 edition of Health Affairs that explores how Rhode Island's affordability standards impacted hospital prices and insurance premiums. Order the May 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Jeff Byers welcomes Christina Farr, advisor, investor, editor-in-chief of Second Opinion Media, to the pod to discuss recent moves by Omada Health and Hinge Health to take the companies public, how the IPOs could impact the digital health market, and what gains her attention when companies make their investment pitches.Health Affairs released their first trend report, which is exclusive for Health Affairs Insiders. The first report focuses on AI in health care and you can get full access to this report by becoming an Insider. Insiders also will receive access to our June 17 event on risk adjustment trends.Related Links:Pre-order Christina Farr's upcoming book, The Storyteller's Advantage: How Powerful Narratives Make Businesses ThriveSign up for Second Opinion Media's newsletters

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Christina Farr, advisor, investor, editor-in-chief of Second Opinion Media, to the pod to discuss recent moves by Omada Health and Hinge Health to take the companies public, how the IPOs could impact the digital health market, and what gains her attention when companies make their investment pitches. Health Affairs released their first trend report, which is exclusive for Health Affairs Insiders. The first report focuses on AI in health care and you can get full access to this report by becoming an Insider. Insiders also will receive access to our June 17 event on risk adjustment trends.Related Links:Pre-order Christina Farr's upcoming book, The Storyteller's Advantage: How Powerful Narratives Make Businesses ThriveSign up for Second Opinion Media's newsletters Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Thomas Buchmueller of the University of Michigan to discuss his recent paper that explores how during the Medicaid 'Unwinding' of 2023, the reduction in Medicaid-paid prescriptions was offset by increased commercial coverage.Order the May 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Rob Lott interviews Thomas Buchmueller of the University of Michigan to discuss his recent paper that explores how during the Medicaid 'Unwinding' of 2023, the reduction in Medicaid-paid prescriptions was offset by increased commercial coverage.Order the May 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law back to the pod to discuss President Trump's potential changes to the rulemaking process, how that may impact rulemaking at HHS, and break down the house Republican budget reconciliation bill and the impacts it could have on Medicaid and more.Become an Insider today to get access to our May 29 event on the FDA under the second Trump Administration as well as our upcoming premiere trend report on AI in health care.Also, join us on May 27 for a free virtual event featuring a conversation between Clifford Ko and Katherine Ornstein on how the new Age-Friendly Hospital Measure aims to improve the quality and experience of inpatient care for older Americans.Related Articles:The House Republican Budget Reconciliation Legislation: Unpacking The Coverage Provisions (Health Affairs Forefront)New Trump Directive To Further Erode Notice And Comment Rulemaking (Health Affairs Forefront)Tracking The Trump Administration's Early Deregulation Agenda (Health Affairs Forefront)The House Republican Budget Reconciliation LegislationRFK Jr. kills policy on public comment for health regulations (Axios)

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law back to the pod to discuss President Trump's potential changes to the rulemaking process, how that may impact rulemaking at HHS, and break down the house Republican budget reconciliation bill and the impacts it could have on Medicaid and more.Become an Insider today to get access to our May 29 event on the FDA under the second Trump Administration as well as our upcoming premiere trend report on AI in health care.Also, join us on May 27 for a free virtual event featuring a conversation between Clifford Ko and Katherine Ornstein on how the new Age-Friendly Hospital Measure aims to improve the quality and experience of inpatient care for older Americans.Related Articles:The House Republican Budget Reconciliation Legislation: Unpacking The Coverage Provisions (Health Affairs Forefront)New Trump Directive To Further Erode Notice And Comment Rulemaking (Health Affairs Forefront)Tracking The Trump Administration's Early Deregulation Agenda (Health Affairs Forefront)The House Republican Budget Reconciliation LegislationRFK Jr. kills policy on public comment for health regulations (Axios) Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Caitlin Carroll of the University of Minnesota to discuss her recent paper that explores how rural hospital closures led to an increase in prices for nearby remaining hospitals.Order the May 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Senior Deputy Editor Rob Lott interviews Caitlin Carroll of the University of Minnesota to discuss her recent paper that explores how rural hospital closures led to an increase in prices for nearby remaining hospitals.Order the May 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Jeff Byers welcomes Farzad Mostashari, founder & CEO of Aledade and the former National Coordinator for Health IT, to the pod to break down insights in the latest MedPAC report, quality measurement reform, and areas of opportunity for value-based care.Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.Related Links:Crossing the Chasm: How to Expand Adoption of Value-Based Care (The New England Journal of Medicine)2025 MedPAC Report

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Jeff Byers welcomes Farzad Mostashari, founder & CEO of Aledade and the former National Coordinator for Health IT, to the pod to break down insights in the latest MedPAC report, quality measurement reform, and areas of opportunity for value-based care.Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.Related Links:Crossing the Chasm: How to Expand Adoption of Value-Based Care (The New England Journal of Medicine)2025 MedPAC Report Subscribe to UnitedHealthcare's Community & State newsletter.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Eric Topol, Executive Vice President of Scripps Research, on his new book, Super Agers, which provides an evidence-based approach on extending healthy lifespans.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Senior Deputy Editor Rob Lott interviews Eric Topol, Executive Vice President of Scripps Research, on his new book, Super Agers, which provides an evidence-based approach on extending healthy lifespans.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

Let us know what you think about Health Affairs podcasts at communications@healthaffairs.org. If you have 30 minutes to spare, let us know and we'll set up a 30-minute chat for the first 20 listeners that reach out. Coffee will be on us.Health Affairs' Jeff Byers welcomes Senior Editor Akilah Wish to the program to discuss the impacts of preserving the Behavioral Risk Factor Surveillance System, the effects of physical exercise on health, and how this type of data helps inform policy making.We are hosting another live podcast recording of A Health Podyssey featuring host Rob Lott and guest Andrew Ryan where they will discuss his paper in the May 2025 edition of Health Affairs and take questions from a live audience. Sign up today.Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.Related Links:CDC's Population Health Office Is Gone (MedPage Today)Adult Physical Inactivity Outside of Work (CDC)Adult Activity: An Overview (CDC)How Exercise Helps You Age Well (NCOA)Establishing The President's Make America Healthy Again Commission (The White House)

In Episode 474 of 'Relentless Health Value', host Stacey Richter interviews Dr. Yashaswini Singh, an economist and assistant professor at Brown University, about the growing influence of private equity (PE) in healthcare.  The conversation delves into the corporate transformation of medicine, highlighting the potential misalignment between business interests and patient care. Dr. Singh discusses the diverse strategies PE firms use to drive profitability, such as increasing negotiated prices, consolidating market share, employing real estate leasebacks, and emphasizing performance metrics that may not align with patient benefits.  The episode also examines the significant impacts these strategies have on physicians, including increased turnover and changes in practice patterns, as well as the broader implications for patients and communities. Dr. Singh stresses the importance of informed leadership, education, policy enforcement, and transparency to ensure that private investments ultimately benefit healthcare systems without compromising patient care. === LINKS ===

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Senior Deputy Editor Rob Lott interviews Mary Kathryn Poole of Harvard University to discuss her recent paper that breaks down and compares economic assistance models on food security and diet quality. Order the April 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.