Podcasts about health plans

Discount Illusions, Billing Errors, and Site-of-Care Markups: A Carrier Network Primer for Employers with Evan Anderson of Handl Health. Episode 531. Whatever the plan was at the very beginning, the big status quo carrier networks have evolved into what Stacey Richter calls a three-headed monster: the contractual illusion of discounts, payment integrity nobody with skin in the game is allowed to check, and wild site-of-care price swings inside the very same network. Stacey talks with Evan Anderson of Handl Health, where he works on product strategy, general strategy, and operations, about how fee-for-service networks got here and what self-insured employers, brokers, and TPAs can do around the edges right now. Consider it a primer — a survey of the general map of the landscape, with breadcrumbs to many past episodes for anyone ready to take a deep dive. WHAT YOU'LL LEARN ✅ Why a discount off a chargemaster price is "an optical illusion" — including the 2023 Health Affairs finding that at roughly half of hospitals, the discounted cash price is lower than the insurer-negotiated rate ✅ How old mainframe adjudication systems, obtuse contracts, and double-digit billing error rates make payment integrity nearly impossible to verify — because where there's mystery, there's margin ✅ How site-of-care differentials drive runaway spend, from hospital multipliers as high as 13X to $135 vs. $13,560 for the exact same infusion drug — both in-network ✅ Why switching carrier networks, even with your own claims file and transparency data, is a shrinking lever as prices regress toward the mean ✅ Three around-the-edges moves: direct contracting for advanced primary care and Centers of Excellence, steerage and tiering that include site-of-care tiers, and bundled episodes of care aggregated into alternative health plans ✅ How the broker/EBC role is shifting from network shopper to plan orchestrator WHY THIS MATTERS These networks are, lest we forget, built on a fee-for-service model that structurally aligns incentives in ways that are a lot of times misaligned with members and plan sponsors. As Evan puts it, cut one head off and the body grows it back — that body being decades of opacity (gag clauses were only banned by the CAA in 2021) and intermediaries paid in ways indifferent or positively correlated to higher spend. For plan sponsors facing extreme increases, knowing the real price, the quality, and what was actually billed is how you start chipping away at the status quo. MENTIONED IN THIS EPISODE EP505 with Ahilan Sivaganesan, MD: Apple Podcasts | Spotify | Other Apps EP434 with Benjamin Schwartz, MD, MBA: Apple Podcasts | Spotify | Other Apps Website: Handl Health Handl Health on LinkedIn Evan Anderson on LinkedIn Article: Katy Talento, ND, ScM, on a post-network world LinkedIn Post by Mark Cuban LinkedIn Post by Craig Gottwals Study: Health Affairs, hospital cash prices vs. negotiated prices EP482 with Preston Alexander: Apple Podcasts | Spotify | Other Apps EP480 with Kimberly Carleson: Apple Podcasts | Spotify | Other Apps EP521 with Andrew Tsang: Apple Podcasts | Spotify | Other Apps Article: Jim Jusko, JD, on healthcare provider networks (Medical Economics) EP529 with Eric Bricker, MD: Apple Podcasts | Spotify | Other Apps EP501 with Ivana Krajcinovic, PhD: Apple Podcasts | Spotify | Other Apps EP472 with Eric Bricker, MD: Apple Podcasts | Spotify | Other Apps EP398 with Jacob Asher, MD: Apple Podcasts | Spotify | Other Apps LinkedIn Post by Mike Hopkins EP528 with Yashaswini Singh, PhD: Apple Podcasts | Spotify | Other Apps LinkedIn Comment by Lori Smith Guliano LinkedIn Comment by Patrick Nelli EP509 with Patrick Nelli: Apple Podcasts | Spotify | Other Apps EP504 with Ryan Jacobs: Apple Podcasts | Spotify | Other Apps EP530 with Jake Velie and Keith Hartman, RPh: Apple Podcasts | Spotify | Other Apps EP523 with Suhas Gondi, MD, MBA: Apple Podcasts | Spotify | Other Apps EP503 with Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky: Apple Podcasts | Spotify | Other Apps EP294 with Steve Schutzer, MD: Apple Podcasts | Spotify | Other Apps === LINKS ===

NOTE: This episode is intended for informational and entertainment purposes. Neither the host or guest are medical professionals, so this episode should not be construed as health advice. It not intended to treat, diagnose, or cure any health condition. N If you have specific concerns, please consult with your healthcare professional. Coach Bill Hogarty spent most of his life in peak condition, won twelve bodybuilding titles including Mr. California, and assumed he understood health. Then a shoulder injury sidelined him, he gained weight, and he learned what it feels like to be on the other side of the gym floor. That experience gave him something his training never had: empathy. Today he channels it into the Kids Diabetes Foundation, built on a conviction that childhood insulin resistance is preventable and that telling a struggling parent they are failing their kid will never work. In this candid conversation, Bill and Corinna trade notes as two people who have spent decades in health and fitness, and they do not always agree. They dig into why BMI is a poor marker while A1C and body composition tell a truer story, why muscle functions as an endocrine organ that protects us as we age, and why abstinence-based rules tend to backfire while moderation sticks. Corinna pushes back on the language of shame and on the toll that diet culture took on her own generation, and Bill meets her there. Along the way you will pick up practical, low-drama tactics: let your kid pick one thing from the produce aisle and build a meal around it, walk 30 minutes a day with someone you love, and learn one number that most doctors never order. CONNECT & SUPPORT CARE MORE BE BETTERSubstack: https://caremorebebetter.substack.comYouTube: https://www.youtube.com/c/caremorebebetterTikTok: https://www.tiktok.com/@caremorebebetterInstagram: https://www.instagram.com/caremorebebetterFacebook: https://www.facebook.com/CareMoreBeBetterLinkedIn: https://www.linkedin.com/company/care-more-be-betterCAUSE PARTNER: If you value open dialogue, sustainability, and social equity, I invite you to support our new cause partner —Prescott College. To learn more about this effort and to support the show, visit: https://caremorebebetter.com/support/ Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of Employee Benefits and Executive Compensation: Preparing for 2027, Troutman Pepper Locke attorneys Lynne Wakefield and Heather Heath Ryan explore the rapidly evolving health and welfare plan landscape and what plan sponsors and fiduciaries need to consider heading into 2027. The discussion opens with a foundational overview of health and welfare plan governance and fiduciary best practices, including the critical distinction between settlor and fiduciary functions, and explains why robust governance structures are increasingly essential in today's legal and regulatory environment.From there, Heather and Lynne turn to the key developments driving risk and change for plan sponsors, including the surge in breach of fiduciary duty litigation involving prescription benefit managers (PBMs), voluntary benefits, and tobacco surcharges; new CAA 2026 disclosure and reporting requirements for group health plan service providers; proposed DOL regulations expanding PBM fee transparency; recent guidance on fertility benefits; anticipated guidance on mental health parity (MHPAEA) and overfunded VEBAs; and considerations related to GLP-1 coverage. Whether you are evaluating your PBM contracts, reviewing your voluntary benefits offerings, or building out your health and welfare plan committee structure, this episode offers practical insights to help your organization manage risk and prepare for the year ahead.Listeners can find updates on Trump accounts, executive compensation, and retirement plans in other episodes in the series. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

While most health plans have at least begun testing AI tools to improve operational efficiency, a far smaller number have moved beyond pilot stage. The challenge is not merely adopting AI – it is deciding which processes to reimagine and which solutions merit investment; doing the work of embedding solutions in end-to-end workflows; measuring success; and, crucially, establishing the organizational alignment needed to generate value at scale. In this episode, host Rae Woods sits down with Troy Anderson, Vice President of Payer Solutions at Optum.ai, and Sally Kim, Advisory Board health plan expert. They talk about why payment integrity and member experience are rising to the top of health plans' priority list for deploying AI, and how regional plans can learn from larger organizations, focus on proven value, and avoid costly mistakes in the early stages of investment and deployment. We're here to help: Expert Insight | How health plans can tackle rising administrative costs Webinar | How health plans are using AI to deliver a better member experience Webinar | The AI arms race: How health plans are responding in payment integrity Episode | Ep. 313: Inside Sutter Health's playbook for scaling AI Episode | Ep. 228: Avoiding ‘pilot purgatory' in remote patient monitoring Research | AI in healthcare: Evaluating promising use cases Research | Health plan strategy Get in touch | Simplifying healthcare with AI | Optum Playbook | Your playbook for developing an AI governance strategy Ready-to-Use Resource| How to take a problem-first approach to AI Playlist | Explore Radio Advisory's Tech & AI playlist for expert insights on innovation and the future of healthcare A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Most employees never choose the health plan their employer buys for them. Mike Markland believes that model is ready for a rethink.In this episode of the Colorado Business Podcast, Mike shares the personal healthcare experience that pushed him into employee benefits, the numbers that convinced him to leave a traditional brokerage, and why employer-funded individual coverage may give workers more control over how they use their benefits.Mike and the hosts unpack ICHRA, now discussed in the episode as CHOICE Arrangements, the incentives built into group health insurance, direct primary care, the role of consumer choice, and the pressure rising costs place on employers and employees. The conversation also moves into building ATMA PMF, hiring people who default to action, systems over goals, personal responsibility, and the standards Mike learned through sports and family.Specific savings figures and healthcare-system claims discussed in the episode reflect the guest's experience and perspective. Results and plan suitability vary by employer, employee, market, and coverage design.FEATURED GUESTMike Markland  Founder, ATMA PMF  Website: https://atmapmf.com/CHAPTERS00:00 The health plan choice most employees never get  00:52 Colorado Business Podcast intro  01:01 Meet Mike Markland of ATMA PMF  07:19 Climbing Kilimanjaro and pushing through the summit  12:16 The health experience that changed Mike's direction  16:18 How employer-funded individual coverage works  19:02 Diamond sponsor read  22:56 Why Mike left to build ATMA PMF  25:44 Who carries the rising cost of health insurance  32:20 What healthcare can learn from unbundling cable  36:20 Direct primary care and access beyond insurance  40:38 What changes for employers and employees  43:15 Opting out of the traditional group model  45:19 The pressure building across American healthcare  48:14 Why the policy has bipartisan momentum  49:17 Bellwether sponsor read  52:29 Industry pushback and employee responsibility  57:29 Using AI to help employees choose coverage  58:10 Building the company and hiring for action  64:30 Books, mentors, and systems over goals  73:20 Responsibility, agency, and changing yourself first  79:45 What football taught Mike about standards  83:24 Where to find Mike and ATMA PMF  83:54 OutroSPONSORSDiamond sponsor read:  EXCO Advisors: https://excoadvisors.com/  LINE-X of Colorado Springs: https://linexcoloradosprings.com/  RAIN: https://rain.tech/  Savion HQ: https://savionhq.com/  Data Hubz: https://datahubz.com/  Reveal Med Spas: https://revealmedspas.com/  Awesome Home Services: https://awesomeservice.com/  Dream Accounting Solutions: https://dreamaccountingsolutions.com/  Exponential Impact: https://exponentialimpact.com/Standard sponsor read:  Bellwether Homes: https://bellwetherhomes.com/  Pioneer Rodeo: https://pioneerrodeo.com/tickets/  Lightning Glassworks and Screens: https://fastglassrepair.com/  Bright Leaf Energy: https://brightleafenergy.co/  Junk-N-Haul: https://junknhaul.com/  Be Our Guest Getaways: https://beourguestgetaways.com/  Planet Duct: https://planetduct.com/  FASTSIGNS: https://fastsigns.com/  Pinnacle Advanced Primary Care: https://pinnacleapc.com/ABOUT THE COLORADO BUSINESS PODCASTThe Colorado Business Podcast features entrepreneurs, founders, builders, and leaders shaping Colorado's business community.Subscribe on YouTube: https://www.youtube.com/@coloradobusinesspodcast  Explore more episodes: https://coloradobusinesspodcast.com/If your employer gave you a benefits budget instead of one group plan, what would matter most in your choice? Share your answer in the comments.#ColoradoBusinessPodcast #MikeMarkland #EmployeeBenefits

Aging Together: Why Age-Friendly Care Is Everyone's FutureAs the U.S. population ages, healthcare organizations and health plans are facing an increasingly important question: How do we make sure care is designed around what older adults actually need—and what matters most to them?In this episode of Quality Matters, host Daniela Lawton explores the Age-Friendly Health Systems movement and its 4Ms framework: What Matters, Medication, Mentation and Mobility. She is joined by Rani Snyder and Eric Cahow for a conversation about how age-friendly care has evolved, what it looks like in practice and how Medicare Advantage plans can help make it a standard part of care.Rani Snyder discusses the origins of the Age-Friendly Health Systems movement, launched in 2016 through The John A. Hartford Foundation and the Institute for Healthcare Improvement, and its growth to more than 6,900 recognized sites. As the movement enters a new phase, the focus is increasingly on reliable implementation, measurable outcomes and demonstrating the impact of age-friendly practices.Eric Cahow explores what age-friendly care means for Medicare Advantage, including the need to prepare for different generations of older adults, align quality measures and financial incentives and build partnerships across the healthcare system. The panel discusses evidence showing improvements such as reduced readmissions, fewer falls and reductions in inappropriate medication use, while also considering the challenges of scaling these approaches and demonstrating return on investment.The conversation also addresses Reframing Aging, an effort to challenge ageism and change the way society talks about aging.Then, in The Patient Voice, Dave White shares his personal journey with kidney disease and the importance of being heard by his care team. His experience reinforces a central message of age-friendly care: understanding what matters to the person receiving care is essential to making care better.Because when it comes to age-friendly care, every touch matters.Key Quote“Every touch matters. Every member of the medical team is equally important when it comes to patient care. One bad interaction at any point can ruin the experience for people living with serious illnesses.”— Dave WhiteWhat You'll HearHow the Age-Friendly Health Systems movement began and evolvedThe 4Ms framework: What Matters, Medication, Mentation and MobilityWhy age-friendly care is increasingly important as the U.S. population agesHow Medicare Advantage can help scale age-friendly practicesWhy aligned quality measures and financial incentives matterEvidence connecting age-friendly care with outcomes such as fewer readmissions, falls and inappropriate medicationsThe challenges of demonstrating ROI and creating reliable implementation at scaleHow Reframing Aging can help address ageism in healthcare and societyDave White's experience navigating kidney disease and the importance of being heardWhy shared planning and understanding the patient's goals are essential to quality careTime Stamps00:00 — Why Aging Matters01:47 — Meet Rani Snyder and Eric Cahow05:44 — How Age-Friendly Health Systems Began09:51 — Medicare Advantage Readiness11:49 — What Age-Friendly Care Looks Like in Practice14:37 — The Role of Health Plans and Incentives17:24 — Proof Points and Payment Reform20:55 — Scaling Challenges and ROI25:36 — Measuring What Matters28:27 — Reframing Aging and Key Takeaways31:08 — The Patient Voice: Dave White41:30 — Closing Summary and Next StepsLinks & ResourcesThe John A. Hartford Foundation | Improving Care for Older AdultsIndependence Blue CrossNCQA's Person-Centered Outcome Measures National Center to Reframe AgingAge-Friendly Health Systems | Institute for Healthcare ImprovementThe Age-Friendly Health System ImperativeDeveloping an NCQA Age-Friendly Medicare Advantage Health Plan Program to Distinguish High PerformersThe 4Ms of Age-Friendly CarePatient Outcomes Associated With a Composite Measure of 4Ms Care Adherence in the Inpatient Setting - Rosner - Journal of the American Geriatrics Society - Wiley Online LibraryStrengthening the National Research Infrastructure for Age-Friendly Health Systems EvidenceAge-Friendly Health Systems Join the Movement | Institute for Healthcare ImprovementAge-Friendly Health Systems | Center | AHAAHA Age-Friendly Healthcare Impact Award | AHAStay Connected | Subscribe to JAHF E-NewsAbout the GuestsRani Snyder, President of The John A. Hartford Foundation, is part of the leadership behind the Age-Friendly Health Systems movement and its efforts to make evidence-based, age-friendly care more reliable across healthcare organizations. In this conversation, she discusses the movement's origins, its expansion across the country and the next phase of focusing on measurable outcomes.Eric Cahow, Vice President of Government Markets Performance at Independence Blue Cross, brings a Medicare Advantage perspective to the conversation, exploring how health plans can prepare for an aging and increasingly diverse population, align incentives and measures and work with partners across the healthcare system to advance age-friendly care.Dave White is featured in The Patient Voice, sharing his experience navigating kidney disease and the healthcare system. His story highlights the importance of listening to patients, incorporating their priorities into care planning and recognizing that every interaction can shape a patient's experience.Key TakeawaysAge-friendly care starts with What Matters.The 4Ms framework puts the patient's goals and priorities alongside medication, mentation and mobility as core elements of quality care.The movement is shifting from adoption to reliability.With thousands of recognized sites, the focus is increasingly on making age-friendly practices consistent, measurable and sustainable.Health plans have an important role to play.Medicare Advantage plans can help drive adoption through quality measurement, incentives, partnerships and alignment with broader healthcare goals.Outcomes matter.The conversation points to improvements associated with age-friendly approaches, including reductions in readmissions, falls and potentially inappropriate medications.Changing how we talk about aging matters, too.Reframing Aging challenges assumptions and stereotypes about older adults and encourages a more accurate, respectful understanding of aging.The patient's voice belongs at the center.Dave White's story demonstrates why patients need to be heard and involved in decisions about their care. Understanding the person behind the condition can change the care experience–and potentially the care itself.The Patient VoiceAt 31:08, Daniela Lawton speaks with Dave White about his experience living with kidney disease.Dave's story brings the themes of the episode down to the individual level: quality isn't only about measures, programs or systems. It is also about whether a person feels heard, whether their priorities are understood and whether their care team works with them to plan what comes next.His experience offers a powerful reminder that every touch matters. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Hosts recap the convention highlights, a new agreement allowing select Atrium hospitals into the State Health Plan access tier, and concerns about coverage and costs. The episode also features an in-depth interview with the Patients Union Executive Director Jamila Headley and Ron Stephens about the proposed WakeMed–Atrium merger, public records and transparency issues, and calls to action for a Monday rally.

A developing policy approach could help small businesses join association health plans, improve negotiating power, reduce administrative challenges, and gain greater flexibility when selecting employee health coverage. Insurance4Dallas (Dallas) City: Dallas Address: 4516 Lovers Lane Website: https://insurance4dallas.com/health-insurance-companies-in-texas/

In this episode, Mike Sanky, Vice President of Healthcare & Life Sciences GTM, Databricks, discusses how health plans can modernize data and AI capabilities to manage rising costs, improve utilization insights and strengthen governance for scalable AI adoption.This episode is sponsored by Databricks.

Host Adam Russo invites Matt Rhenish, SVP, COO Health Plan Operations, Powering Healthtech to discuss the challenges and complexities of the healthcare industry. Adam and Matt share insights on the lack of education on healthcare costs in business schools, the emotional and personal nature of healthcare decisions, and the difficulty of implementing cost-saving solutions due to the diverse needs of different populations. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

In this episode, Suzanne Spradley and Chase Cannon explore the growing interest in value-based pricing models for health plans, including bundled payments, capitation, and outcome-based arrangements. The two discuss how these models aim to connect payment with quality and cost outcomes, while highlighting the ERISA fiduciary, contracting, PBM transparency, HIPAA, and plan document considerations that sponsors should evaluate before adopting them. Listeners will come away with a practical understanding of both the promise and the compliance challenges of moving beyond traditional fee-for-service arrangements.

On this episode of Williams Mullen's Benefits Companion, host Brydon DeWitt welcomes Brian Marks, founder and president of Employee Benefits of Virginia, to discuss why more small and mid-sized employers are considering self-insured and level-funded health plans. Although these arrangements may provide opportunities for cost savings and increased transparency, they also bring additional responsibilities that many employers may not anticipate. Brydon and Brian break down how these plans work, key compliance and reporting requirements, common mistakes employers make, and what organizations should understand before making the transition from a fully insured plan.

In this episode, Cereasa Horner, Vice President of Payment Integrity and Governance at CERIS, discusses how health plans can adapt to accelerating regulatory changes, strengthen documentation and audit readiness, and improve alignment with providers. She also shares strategies for cross-functional collaboration, transparency and an education-first approach to payment integrity.This episode is sponsored by CERIS.

What if the reason your health plan keeps failing is not a lack of discipline but a strategy never designed for your body? In this episode of Sharkpreneur, Seth Greene interviews Angelo Poli, Founder of MetPro and Author of MetPro: The Science to Transform, who explains why generic diets and standardized fitness advice often fail to deliver sustainable results. He explains how metabolic profiling uses individual data, ongoing feedback, and personalized adjustments to identify which nutrition and fitness strategies will produce the most progress. Angelo also reveals why busy entrepreneurs should rely less on willpower and instead build scientifically informed routines that yield the greatest results with the least wasted time. Key Takeaways:→ Every person responds differently to nutrition and exercise. → Metabolic profiling assesses a person's starting point and identifies the specific adjustments needed to improve body composition, energy, and performance. → A perceived “slow metabolism” may be influenced by how the body has adapted to a person's long-term habits. → Busy entrepreneurs are often derailed when their schedules become overwhelming, making a reliable routine more valuable than temporary motivation.→ The most effective health strategy focuses on actions that deliver the greatest return without unnecessary effort. Angelo Poli is the founder of MetPro and the author of MetPro: The Science to Transform. For more than 20 years, he's helped entrepreneurs, executives, professional athletes, and high performers optimize energy, body composition, performance, and longevity. His work centers on a simple idea: performance isn't just about training harder. It's about understanding how your metabolism adapts to stress, recovery, fueling, and workload over time. That's why strategies that work at one stage of training often stop working at the next. After a serious injury left him walking with a cane for nearly a decade, Angelo became obsessed with understanding what truly drives lasting transformation. That pursuit ultimately led to the creation of MetPro and a methodology that has helped more than 20,000 people achieve sustainable results. Connect With Angelo:Website: https://metpro.co/Facebook: https://www.facebook.com/MetabolicProfiling/Instagram: https://www.instagram.com/metproco/YouTube: https://www.youtube.com/@metabolicprofiling

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In this episode of This Is Ag!, Hilary Craig, Director of Produce Category Management at Misfits Market, joins me to explore the connection between agriculture, sustainability, and the people who eat the food farmers grow. Hilary shares how her work helps connect growers with consumers by finding a market for quality produce that may be overlooked because of cosmetic imperfections. From scarred blueberries to unusually shaped fruits and vegetables, the conversation explores how our expectations of perfect-looking produce contribute to food waste and how education and storytelling can help change that. Together, we discuss the importance of understanding where our food comes from, appreciating the work and relationships behind every piece of produce, and choosing flavor and quality over appearance. We also look ahead at the future of agriculture, where technology can help reduce waste, but the human connection to food, farming, and one another remains irreplaceable. Misfits Market: https://www.misfitsmarket.com Kirti Mutatkar, President and CEO of UnitedAg: Reach me at kmutatkar@unitedag.org, www.linkedin.com/in/kirtimutatkarUnitedAg - www.unitedag.org UnitedAg Health and Wellness Centers - https://www.unitedag.org/health-benefits/united-agricultural-benefit-trust/health-centers/ Episode Contributors - Hilary Craig, Kirti Mutatkar, Dave Visaya, Mickayla Ursini The episode is also sponsored by Brent Eastman Insurance Services Inc. - https://brenteastman.com Blue Shield of California - https://www.blueshieldca.com Elite Medical - https://www.elitecorpmed.com Gallagher - https://www.ajg.com/ SAIN Medical - https://sainmedical.com/ MDI Network - https://www.mdinetworx.com/about-us

A round-up of the main headlines in Sweden on 18th August 2026. You can hear more reports on our homepage www.radiosweden.se, or in the app Sveriges Radio. Presenter/producer: Kris Boswell.

Everyone in this market is optimizing for the wrong thing. Consumers want the most weight loss for the cheapest price, and up to 40% of what they're losing is muscle.My guests this week are Nicholas Syhler, a former cardiologist who left his residency to work upstream of the heart attacks he was treating, and Paul Elsass, an exercise physiologist who spent years in startup land before landing on the one root cause nobody had solved. Their company, Embla, runs a coach-first GLP-1 program out of Copenhagen with peer-reviewed data on almost 5,000 patients showing 55% less medication and the same weight loss outcomes seen in clinical trials.We get into why the drug was never designed to shut off hunger, why members can sit on a quarter milligram of semaglutide for months instead of escalating every 30 days, and the claims data suggesting aggressive dosing is quietly driving up MSK spend. We also cover why they built the model around self-funded employers rather than direct-to-consumer, what one bundled price under $500 a month actually includes, and their plan to move from weight loss into full cardiometabolic care with deprescribing as the goal.If you're evaluating a GLP-1 strategy for 2027, this one reframes the question. Tune in."We were seeing four to six pounds per week. That's way too much. It should be one to two." — Nicholas SyhlerThank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Meet Embla(00:01:30) From Cardiology Residency to Quitting Medicine(00:05:56) Reading the First Line on the Label(00:07:07) Losing Weight Too Fast: The Muscle Problem(00:08:34) Why "Eat Less, Move More" Fails(00:12:43) Coach First, Clinician Second(00:14:19) A Quarter Milligram for Four Months(00:16:52) Semaglutide vs. Tirzepatide(00:19:29) The MSK Claims Nobody Saw Coming(00:22:17) Why Self-Funded Employers, Not Consumers(00:25:09) Where the Name Embla Comes From(00:27:28) One Price, Everything Included(00:30:42) Learning About PBMs the Hard Way(00:34:43) Deprescribing and Cardiometabolic Care(00:42:30) Why America Makes This Harder(00:46:30) The Three Behavioral Levers(00:49:27) How the Program Actually Rolls Out(00:54:14) Diet, Fasting, and Food Quality(00:57:10) The Moonshot(01:00:59) Closing ThoughtsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

Everyone in this market is optimizing for the wrong thing. Consumers want the most weight loss for the cheapest price, and up to 40% of what they're losing is muscle.My guests this week are Nicholas Syhler, a former cardiologist who left his residency to work upstream of the heart attacks he was treating, and Paul Elsass, an exercise physiologist who spent years in startup land before landing on the one root cause nobody had solved. Their company, Embla, runs a coach-first GLP-1 program out of Copenhagen with peer-reviewed data on almost 5,000 patients showing 55% less medication and the same weight loss outcomes seen in clinical trials.We get into why the drug was never designed to shut off hunger, why members can sit on a quarter milligram of semaglutide for months instead of escalating every 30 days, and the claims data suggesting aggressive dosing is quietly driving up MSK spend. We also cover why they built the model around self-funded employers rather than direct-to-consumer, what one bundled price under $500 a month actually includes, and their plan to move from weight loss into full cardiometabolic care with deprescribing as the goal.If you're evaluating a GLP-1 strategy for 2027, this one reframes the question. Tune in."We were seeing four to six pounds per week. That's way too much. It should be one to two." — Nicholas SyhlerThank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Meet Embla(00:01:30) From Cardiology Residency to Quitting Medicine(00:05:56) Reading the First Line on the Label(00:07:07) Losing Weight Too Fast: The Muscle Problem(00:08:34) Why "Eat Less, Move More" Fails(00:12:43) Coach First, Clinician Second(00:14:19) A Quarter Milligram for Four Months(00:16:52) Semaglutide vs. Tirzepatide(00:19:29) The MSK Claims Nobody Saw Coming(00:22:17) Why Self-Funded Employers, Not Consumers(00:25:09) Where the Name Embla Comes From(00:27:28) One Price, Everything Included(00:30:42) Learning About PBMs the Hard Way(00:34:43) Deprescribing and Cardiometabolic Care(00:42:30) Why America Makes This Harder(00:46:30) The Three Behavioral Levers(00:49:27) How the Program Actually Rolls Out(00:54:14) Diet, Fasting, and Food Quality(00:57:10) The Moonshot(01:00:59) Closing ThoughtsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

Premiums are climbing, deductibles feel heavier every year, and most people still can't tell you why health care costs what it costs. From the Mackinac Policy Conference, we talk with Dominick Pallone, CEO of the Michigan Association of Health Plans, to get a clear look at what health plans actually do in Michigan and how state policy decisions ripple straight into employer coverage and family budgets.We start with the basics: MAHP represents nine health insurance companies covering nearly four million Michiganders, and their day-to-day work is advocacy with state lawmakers and regulators. From there, we dig into competition and choice in a market long shaped by a dominant carrier, and why employers and individuals should know they have other network options. The goal, Dom argues, is competing on access, quality outcomes, and real value rather than just headlines.Then we get to the affordability problem everyone feels. Dom explains why insurers often function as pass-through entities for underlying prices, and why pharmacy costs have become the biggest lever right now. We talk about double-digit premium trends, specialty drugs that are clinically remarkable but financially punishing, and the policy tightrope between supporting innovation and keeping coverage usable. We also explore practical fixes: value-based care arrangements, custom high-value networks, and health literacy tools like real-person call centers and apps that help members compare cost and quality for elective care.If you care about Michigan health care, health insurance affordability, pharmacy pricing, and what can actually move the needle, this conversation is for you. Subscribe, share this with a friend or colleague, and leave a review with the biggest cost question you want answered next.Support the showEngage the conversation on Substack at The Common Bridge!

In this Bright Spots in Healthcare episode, host Eric Glazer brings together health plan and specialty care leaders to examine a challenge becoming increasingly important to healthcare organizations: how to make sure the right specialty expertise reaches the right patient at the right moment without simply adding another disconnected program. The discussion explores what happens when organizations rethink specialty care as a pathway rather than an isolated episode. Across health plans and specialty care organizations, the conversation looks at how earlier identification, better triage, care navigation, workflow integration, physician engagement, and technology can help organizations improve access while making better use of limited specialist capacity. This is a practical discussion for health plan and provider leaders navigating rising specialty costs, growing demand, limited specialist capacity, and increasingly complex member needs. Our guests include: Shantanu Agrawal, MD, Chief Health Officer, Elevance Health Lora Council, MD, Chief Medical Officer, Fallon Health Sunil Shivaram, MD, Chief Medical Officer, Elite Health Plan Jessica Landin, CEO, Vori Health Together, they explore: How organizations can improve specialty access by identifying, triaging, and routing patients earlier, rather than simply adding specialist capacity How health plans and specialty organizations are redesigning care pathways to better connect primary care, specialists, behavioral health, navigation, and community resources How AI, predictive analytics, digital screening, and asynchronous care can extend clinical capacity while helping specialists focus on patients who need their expertise most What it takes to build more connected specialty care models that improve access, reduce fragmentation and unnecessary utilization, and deliver better outcomes and experiences for patients This episode offers an inside look at how leading organizations are rethinking specialty care not by adding more disconnected solutions, but by improving how expertise is allocated, coordinated, and delivered across the patient's journey. Panelist Bios here: https://www.brightspotsinhealthcare.com/events/rethinking-specialty-care-new-opportunities-to-improve-outcomes-experience-and-affordability/   Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/07/Episode-Guide-Bright-Spots-in-Health-Care-07-30-26.pdf  Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation.  Thank You to Our Episode Partner, Vori Health Vori Health helps health plans and provider organizations rethink musculoskeletal care through an integrated, physician-led model that brings physicians, physical therapists, health coaches, and technology together around the patient. Rather than treating specialty care as an isolated episode, Vori's approach is designed to provide coordinated, longitudinal support while helping patients access the right care at the right time. The model also reflects a broader shift discussed throughout this episode: using technology to extend the care team, identify patients earlier, support engagement between visits, and connect patients to the resources they need across the healthcare system. Vori's digital and AI-enabled tools can support asynchronous care, provide feedback to clinicians, and help identify patient needs before they escalate into higher-cost settings or worse outcomes. Learn more about Vori Health - http://vorihealth.com.  Schedule a Meeting with Jessica Landin, CEO, Vori Health To explore how Vori Health can help your organization rethink MSK care, improve access, reduce fragmentation, and build a more coordinated specialty care model, reach out to show producer Vekonda Luangaphay at vluangaphay@brightspotsventures.com to schedule a conversation with Jessica Landin, CEO, Vori Health. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.  

For years, regional health plans benefited from powerful tailwinds: Medicare Advantage growth, Medicaid expansion, and a prospering ACA marketplace. But many of those growth engines have stalled, just as new pressures emerged: rising utilization, runaway spend, pricing uncertainty and more scrutiny from patients and policy makers. The result is a dramatically different financial reality for health plans. In 2024, only eight of 33 Blues plans reported positive operating margins. In this episode, host Rae Woods sits down with Jared Landis, Vice President of Advisory Board's Health Plan Research practice, to unpack how regional plans got here and the three-year turnaround strategy regional and Blues plans are now pursuing. Together, they explore the market forces that upended the payer playbook, the operational and pricing changes plans are making to stabilize performance, and how AI-enabled transformation could reshape the future of the insurance business. Stay tuned to the end of the episode for an update on the Rural Health Transformation Program, including a key deadline this fall. We're here to help: Episode | Ep. 257: Paul Markovich on new builds, breakups, and bold healthcare bets Episode | 305: “The work isn't easy, but it's clear”: How healthcare leaders are responding to the market Episode | 302: CMS announced the 2027 MA final rate. What do payers and providers need to know? Playlist | Radio Advisory Provider Strategy and Financial Outlook playlist Expert Insight | Can health plans turn their MA business around this year? Research | Health plan strategy Report | Rural health transformation funds: Where they're really going Ready-to-Use Slides | Health Plan Market Explorer Webinar | Understanding health plan decision-makers Sponsor link: Precision in motion: How digital tools support diabetes care providers A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

UPMC and Birth Root Community Doula describe a 4-year partnership addressing food insecurity, housing, and maternal health disparities in Erie, Pennsylvania.

This episode covers the legislature's return and the 51-page Technical Corrections Bill that restored funding for some departments, extended Dolly Parton's Imagination Library, and included incentives for major sporting events, while the House prepares to take up the bill. We also discuss new election bills that shrink early voting, the escalating state health plan conflict with Atrium over pricing and network access, concerns about hospital and pension practices, Gen Z voting trends, and the podcast's new AI chatbot feature.

In January of 2027, people on Medicaid will need to meet a slate of new requirements mandated by the One Big Beautiful Bill Act, or HR1. Some people on the Oregon Health Plan will need to confirm that they are working, volunteering or attending school every six months. And everyone will need to renew twice a year, rather than once every two years. All this paperwork will be handled by the Oregon Department of Human Services, in collaboration with the Oregon Health Authority. Both departments are working hard to make sure they are ready for the January deadline. Vivian Levy, Interim Medicaid Director for the Oregon Health Authority, and Nate Singer, Director of Eligibility Partnership at the Oregon Department of Human Services, join us to explain how Oregonians will be impacted.

This episode of The SEANC View podcast discussed the new tier system of the State Health Plan, highlighting the controversy surrounding the exclusion of Atrium and WakeMed from preferred provider status. The plan aims to cap hospital reimbursements, which can sometimes reach over 800% of Medicare rates. Without the tier system, approved by the State Health Plan Board of Trustees, members faced premium increases of up to 21%. The discussion also touched on the financial reserves of these hospitals, the impact on rural healthcare, and the need for transparency in hospital pricing.

There are several ways to support the podcast! Join us at The49ersRush.com for all of our All22 film breakdowns and bonus content. This is the best way to support the show.We still have our Patreon as well https://www.patreon.com/49ersRushPodcast49ers Rush Road Trip details at https://www.49ersrushroadtrip.com/For the 49er Rush Hat go to https://hiveandpines.com/products/the-red-gateCheck out BetterHelp: https://www.betterhelp.comCheck out Troll Co Clothing and use my code RUSH25 for a great deal: https://www.trollcoclothing.comCheck out Outdoorsy and use my code 49ERS for a great deal: https://www.outdoorsy.comI am most active on Twitter please follow @JL_Chapman, Instagram: 49ers Rush Podcast, Email: 49ersRushPodcast@gmail.comIf you need help with website design/builds go to https://www.powerbrandsystems.com/crm949620?am_id=john874Get all 49ers gear at homage.sjv.io/MmYXO2#49ers #49ersrushOur Sponsors:* Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com* Check out Outdoorsy and use my code 49ERS for a great deal: https://www.outdoorsy.com* Check out Troll Co Clothing and use my code RUSH25 for a great deal: https://www.trollcoclothing.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

A court-ordered mental health plan for inmates moves forward.The chief of an Oklahoma tribe faces allegations of threats against a tribal representative.Oklahoma City is looking into a new design for its flag.You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment.You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, TikTok and Instagram at KOSU Radio.This is The KOSU Daily, Oklahoma news, every weekday.

State Treasurer Brad Briner and Plan Executive Administrator Thomas Friedman join us this week to recap the State Health Plan Board of Trustees meeting and explain major changes: a premium increase, a new three-tier provider network (preferred, access, non-preferred), and the decision to return Blue Cross Blue Shield of North Carolina as the third-party administrator and pharmacy benefit manager in 2028. They discuss why the changes are needed to control costs, how tiers work for members across urban and rural areas, protections for patients in active treatment, and next steps for implementation and member engagement.

In this explainer episode, we've asked Ella Davyson, Genomics Data Scientist, to explain the meaning of the term genomics. You can also find a series of short videos explaining some of the common terms you might encounter about genomics on our YouTube channel. If you've got any questions, or have any other topics you'd like us to explain, let us know on podcast@genomicsengland.co.uk. You can download the transcript or read it below. [00:00:00] Florence: What is genomics? My name is Florence Cornish, and today I'm joined by Ella Davyson, who is a genomics data scientist here at Genomics England, and she is here to explain the topic in much more detail So, Ella, we obviously both work at Genomics England. This podcast is called Genomics 101, so I guess it's fitting that we have an episode dedicated to explaining the term 'genomics'. [00:00:26] But before we get into that, I think it would be good if you could first explain what we mean by the term 'genome'. [00:00:32] Ella: Thanks, Florence. The genome is, essentially you can think of it like a manual booklet, or instructions that the body uses in how to grow, survive, and function, and this is a manual that's in every single cell within our body, and it tells our cells exactly how to divide, how to survive. [00:00:54] For example, the genome in the pancreas, in pancreatic cells will tell those cells how to produce proteins such as insulin that we need to control our blood sugar. And also, the genome within our eye cells will tell the cells how to generate photoreceptors to enable us to see. So the genome is essentially like the ultimate guide that our body uses to tell it how to create everything that we need to survive going forwards. [00:01:25] Florence: So then, what do we mean by the term 'genomics'? [00:01:30] Ella: So, genomics is essentially the study of the entire human genome. So we study its structure and also how it functions, in terms of how is this instruction manual being read by the body, and how does that result in healthy human beings that we see today. [00:01:48] Florence: So when we're talking about studying DNA, lots of our listeners might have heard the term 'genetics', which kind of also refers to the study of DNA and genes, so it might be a little bit confusing. [00:01:58] So what's the difference between the two? What's the difference between genetics and genomics? [00:02:04] Ella: So genetics is specifically the study of genes in the genome, and genes are part of the instruction manual, that specifically tell the body to produce a certain thing. So, in our insulin example, there is an INS gene, so, which is the gene in the genome or the instruction manual that specifically tells the cells to make insulin and to produce this product. [00:02:30] There are many different genes in our genome, and genetics is the study of all of these. In contrast, genomics is the study of the entire instruction manual altogether, so that includes all of the genes in genetics and also everything else in the manual. So, genetics is limited to the study of these parts of the manual that clearly encode certain proteins or products such as insulin. Genomics is the study of everything all at once, everything under the bathroom sink. So yeah, the confusion I think can arise a lot because historically when we first started looking at DNA and researching genetics, we didn't have the technology to look at the whole genome all at once, and with older sequencing technologies we would focus on particular genes that we knew important for certain diseases. [00:03:19] So in diabetes, for example, they would instead specifically look at the insulin gene and see how does this influence diabetes, rather than looking at the entire instruction manual at once. Nowadays, we do have that technology, and that is what we do here at Genomics England, just use that to look at the entire genome rather than specific subsets of the genome, so specific genes. [00:03:45] We can look at everything in its entirety. So, you can kind of think of genomics as a much broader, more complete study of genetics. [00:03:56] Florence: So speaking of genomic testing, I don't know if you saw, but in the government's 10-year Health Plan that they published last year, they predicted that genomics could play a role in up to 50% of healthcare interactions. [00:04:08] Could you tell me a bit about why genomics is important in healthcare? [00:04:12] Ella: So that's a really exciting point, and I think one that we should be all striving towards. So, genomics can play a role in healthcare in so many different ways. I think before going into each of them, it's kind of maybe important just to illustrate that our genomes between two, two people are 99.9% the same. [00:04:38] So we're both humans. We are both the same species. There is 0.1% difference between two people's genomes, and those differences underlie all the uniqueness that makes a person a unique individual. [00:04:54] So personality, appearance and also risk to different health and disease outcomes. So that is where the role of genomics can come in, is to understand how the differences between people and their genetic makeup can influence maybe their risk for being more predisposed to developing a condition. Conditions such as Cystic Fibrosis or Huntington's disease that are specifically caused by genetic variants or mutations in genes that directly cause the condition. So it's a bit more maybe obvious, if you like, about how studying genetics in those, in those conditions can directly inform on how they arise, potential ways that we can better treat them. [00:05:52] So another way that genomics can be used in healthcare is through screening. So this is being piloted at the moment in the Generation Study by Genomics England which is applying whole genome sequencing to newborn babies to look for a range of conditions which are caused by genetic changes, all of which are treatable. [00:06:13] But importantly, screening will enable clinicians and families to know about these conditions much earlier and start life-changing treatment much, much sooner. So this is kind of already beginning to be, I think it will be showcased with this study in the next couple of years and the power of this in healthcare, I think can't really be overestimated. [00:06:40] Florence: And finally, just to finish off, is there anything coming up in the field of genomics that you're especially excited about? [00:06:48] Ella: There are loads of different things that I'm excited about in the field of genomics. I think probably maybe one that's most kind of relevant to clinical care is the possibility of doing more personalised medicine with treatments. [00:07:05] Often, at the moment, we majority have kind of one treatment for all when treating certain conditions, and sometimes these treatments aren't tolerated well by some people, and also some of these treatments just don't work well in some people as well. Sometimes there's a clear reason for these things, but more often than not, it's not entirely clear why some people might benefit more for some treatments or some people don't respond or don't react well to some treatments as well. [00:07:35] And understanding more, so there's a whole field about how genomics interacts with drugs and medicines, which is called pharmacogenomics, and its aim is to understand which medicine might be most effective or well-tolerated in certain people based on their genetics. And I think that will be kind of life-changing as well for some people, who are suffering from diseases where the medication is either not effective enough or is also affecting their quality of life. [00:08:10] Florence: Mm-hmm. [00:08:10] Ella: Because that is a whole other part of it as well is that sometimes these treatments for certain conditions are really hard to tolerate. [00:08:19] Other things that I'm excited about are just the technologies that are coming out at the moment mean that we can measure and understand a whole lot more about genomics than we used to be. So now we can say this gene is influencing this disease, but sometimes, you know, it's more complicated, and we now have the technology to measure all sorts of different things, so how our environment can influence our genes and how our genes react with each other. [00:08:57] So we're just getting, we're getting able to look at more and more, and I think we'll expand our understanding in a lot of conditions that unfortunately aren't very simple. [00:09:12] Florence: Well, I think we'll finish there. Thank you so much, Ella, for coming on and for taking the time to explain genomics to us. [00:09:18] Ella: Thank you, Florence. Thanks so much for inviting me, and it was a pleasure to be on the podcast today. [00:09:23] Florence: If you want to hear more explainer episodes like this, you can find them on our website at www.genomicsengland.co.uk or wherever you get your podcasts. Thank you for listening.

Major healthcare changes are coming for hundreds of thousands of state employees, retirees and family members. Starting next year, State Health Plan premiums will go up, and a new provider system could change what members pay for care. WRAL State Government Reporter Will Doran explains the changes with WRAL News+ Anchor Elizabeth Holmes.

Sign up for my free newsletter and get 1-page action plans (Dr. Bobby's 1-page PrescriptionsA birthday can sneak up on you and suddenly you're asking a blunt question: what am I actually doing for my health, and am I focused on the right things? As I near 70, I share the health plan I actually follow, not as a template for you to copy, but as a clear way to think about your own evidence-based health plan for longevity, energy, and a life you still want to live.I organize my choices into three practical buckets. First: what I can influence directly, without needing anyone else or a prescription. That includes aerobic exercise (the easiest “yes” because I love endurance work), sleep (the hardest “yes” because it requires protecting bedtime), alcohol (a real tradeoff because it impacts sleep and raises concerns around dementia risk), and simple nutrition habits like maintaining a healthy weight and getting enough protein without obsessing over the perfect diet. I also talk about injury prevention as we age, because staying consistent beats proving you can suffer, plus the value of N-of-1 experiments like testing magnesium for muscle cramps.Second: where I need support from others. Knowing the evidence doesn't guarantee I do the work, and strength training is my best example. I explain why accountability and a trainer can be the bridge between knowing and doing, and I share how getting real help for emotional health, including EMDR, can succeed when decades of solo effort don't.Third: where medication is the right evidence-based tool. I push back hard on the wellness narrative that needing prescriptions means you failed, and I walk through how I think about blood pressure, cholesterol, blood sugar, and long-term mental health treatment.If this helps you rethink your own plan, subscribe, share the episode with a friend, and leave a review on Apple Podcasts or Spotify. What's one part of your health plan you can do today, and what's one part you need help with?Send us Fan MailSupport the show

"The most unused cash in the country right now is the money you're wasting on healthcare... If you save a million dollars a year, that's $20 million in market cap."Is your company treating its healthcare spend like a business strategy, or are you just writing a blank check to the major insurance carriers every year?In this episode, I was (finally) joined by Mark Cuban, Ann Lewandowski, and Matt Miron. After answering how he would approach healthcare for a hypothetical company on Shark Tank, Mark broke down his exact playbook for mid-market employers: why you should fire traditional networks, the massive ROI of hiring an internal "Healthcare CFO" to negotiate single-case agreements, and why "carve-out" is the most important phrase for your benefit strategy this year. Together, we also discussed the dark side of healthcare economics, including the exorbitant spread pricing of PBMs and distributors, how to use AI (like Claude or ChatGPT) to find the hidden "gotchas" in your ASO contracts, and the terrifying legal liabilities CEOs face when their carriers deny life-saving treatments.This one has been in the works for years, and I hope it doesn't disappoint. Tune in!Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Introductions: Mark Cuban, Ann Lewandowski, and Matt Miron (00:01:08) Mark Cuban's Healthcare Playbook for Shark Tank Companies (00:05:54) Single Case Agreements and Hiring an Internal Healthcare CFO (00:10:08) Why the Keyword for 2026 is "Carve Out" (00:14:32) Fiduciary Duty and Waiving Employee Deductibles (00:20:52) Starting with Out-of-Network Negotiations (00:25:09) The No Surprises Act, IDR Arbitration, and Secret Payouts (00:29:12) Why Mark Started Cost Plus Drugs (and Cost Plus Wellness)(00:32:10) How Distributors and PBMs Inflate Drug Prices (00:36:49) Using AI (Claude/ChatGPT) to Audit Your Carrier Contracts (00:37:52) The 340B Scam and Fiduciary Lawsuits (00:44:27) Increasing Enterprise Value: Why Healthcare Savings = Market Cap (00:47:46) CEO Liability for Life-Threatening Claim Denials (00:50:37) The Perverse Economics of Prior Authorizations and Appeals (00:52:59) Final Takeaways: Watch Your Money and Carve OutKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

In this episode, Dr. Brian Miller — hospitalist, policy advisor, and vice chair of the North Carolina State Health Plan Board — explores why health care is so expensive and what can be done about it. We discuss hospital consolidation and the Atrium–WakeMed merger, steering and preferred provider strategies, income‑adjusted premiums, price transparency, drug costs, and practical steps the state health plan is taking to lower costs and protect members.

Your health plan might be robbing you blind. The fun part? You may be paying someone to let it happen. Healthcare benefits are one of the biggest expenses for small business owners, and most employers are stuck playing a game where the rules are hidden, the prices move, and somehow the bill always gets worse. In this episode of The Liquid Lunch Project, hosts Matthew R. Meehan and Luigi Rosabianca sit down with Donovan Ryckis, CEO of Ethos Benefits, to rip the lid off employer-sponsored healthcare. Donovan breaks down why insurance costs keep rising, how brokers can create conflicts of interest, why pharmacy benefit managers deserve a long side-eye, and how small businesses can start asking much better questions before renewal season punches them in the face.  

Best Of 2GG: Jay's Health Plan For Brooke Pt1 by Two Girls and a Guy

Best Of 2GG: Jay's Health Plan For Brooke Pt2 by Two Girls and a Guy

Provider-sponsored health plans have been around for years. Has this "pay-vider" business model fulfilled its promise to lower costs and improve outcomes? David W. Johnson and Julie Murchinson critique their promise and performance on, “Do Hospitals and Health Plans Mix?” the new episode of the 4sight Health Roundup podcast, moderated by David Burda. 

In this episode, Chase Cannon and Suzanne Spradley discuss a recent HHS Office for Civil Rights settlement showing that self-insured employer-sponsored group health plans are not outside the reach of HIPAA enforcement — especially when ransomware, electronic PHI, and incomplete risk analysis are involved.

Dominick Pallone, executive director at the Michigan Association of Health Plans, joins us on today's episode of Rural Health Today. Health plans are an essential component to healthcare affordability and accessibility in the United States, but the cost of premiums continues to climb. Dominick is here to provide insights in healthcare affordability in Michigan. We'll talk about upcoming legislation, payer-hospital negotiations, and of course, what it all has to do with rural health.  Follow Rural Health Today on social media! https://x.com/RuralHealthPod https://www.youtube.com/@ruralhealthtoday7665  Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital/ https://www.twitter.com/hillsdalehosp/ https://www.linkedin.com/company/hillsdale-community-health-center/ https://www.instagram.com/hillsdalehospital/  Follow our guest! https://www.linkedin.com/in/dominick-pallone-200b3269/ https://www.linkedin.com/company/mahp/ https://www.facebook.com/MichiganAssociationofHealthPlans

Heart disease is still the number one killer, and Dr. David Brownstein says the current approach is not working.In this episode of The Natural Heart Doctor Show, Dr.Brownstein joins Dr. Jack Wolfson to discuss food quality, iodine deficiency, thyroid health, fluoride exposure, statins, and why preventing heart attacks and strokes requires looking beyond prescriptions.- - - - - About the Guest:Dr. David Brownstein is a board-certified family physician and the Medical Director of the Center for Holistic Medicine in West Bloomfield, Michigan. A graduate of the University of Michigan and Wayne State University School of Medicine, he is a member of the American Academy of Family Physicians and serves on the board of the International College of Integrative Medicine.Dr. Brownstein is an internationally recognized speaker and the author of 17 books, including Iodine: Why You Need It, Why You Can't Live Without It. His work focuses on holistic medicine, thyroid health, iodine, natural hormones, nutrition, and helping patients address the underlying factors that contribute to chronic illness.Social Handles:Website: https://www.drbrownstein.com/Instagram: https://www.instagram.com/centerforholisticmedicine/- - - - -Jack Wolfson, DO, FACCWebsites: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drjackwolfson.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠; ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://naturalheartdoctor.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/drjackwolfson⁠⁠⁠⁠⁠⁠⁠Ready to move past the confusion and fear of typical heart health approaches? Visit ⁠⁠⁠⁠⁠⁠⁠naturalheartdoctor.com/discovery⁠⁠⁠⁠⁠⁠⁠ to schedule your free discovery call and start your journey toward a 100-year heart with real, evidence-based answers.- - - - -PODCAST Thank you for listening. Please subscribe and share. This podcast is produced by DrTalks.com ⁠⁠⁠⁠⁠⁠⁠https://drtalks.com/podcast-service/

In this episode, Jakob Emerson, Associate News Director, Becker's Healthcare, discusses Cigna's decision to drop GLP-1 weight loss drug coverage for employees, the financial pressures facing health insurers, the challenges of implementing new Medicaid work requirements, and the ongoing retreat of provider-sponsored health plans.

For most employers, the annual health insurance renewal cycle is a source of pure frustration. It's often marked by rising costs, confusing packages, and a total lack of control. In this episode of Healthcare Americana, host Christopher Habig sits down with Niko Caparisos, Program Architect at Community-Owned Health Plans (COHP). Together, they explore how shifting the focus back to local, independent vendors can dramatically reduce costs while improving the patient experience. Niko discusses his mission to educate benefits brokers and empower employers to ditch rigid, one-size-fits-all national plans in favor of grassroots, community-centered solutions.The conversation digs deep into how Direct Primary Care (DPC) and cash-pay consumerism can fix the broken way we pay for healthcare in America. Niko shares actionable strategies for companies looking to reclaim their healthcare data, including how to support a remote workforce and how to implement a phased, multi-year approach to self-funding. If you are tired of repeating the same broken benefit renewal cycle every year, this episode provides a clear, solution-oriented roadmap to building a transparent, high-quality health benefit from the ground up.More on Freedom Healthworks & FreedomDoc HealthSubscribe at https://healthcareamericana.com/More on Niko J. Caparisos & Community-Owned Health PlansFollow Healthcare Americana: Instagram & LinkedIN

In this episode,. Alan Condon, Editor-in-Chief at Becker's Healthcare, breaks down the latest financial performance and strategic shifts among major nonprofit health systems including CommonSpirit, Ascension, and Trinity Health. He also discusses the growing focus on ambulatory surgery centers, Providence's decision to wind down its health plan business, and the mounting pressures facing provider-sponsored insurance plans.

In this episode, Rakesh Mathew, MS, MBA, CPHIMS, Interoperability Leader at Jefferson Health Plans, joins the podcast to discuss the financial pressures facing payers and how sustained losses can reduce competition and lead to market consolidation. He shares perspectives on improving affordability and access, and outlines how organizations can prepare for success in 2027 through stronger interoperability and strategic planning.

Did you know that if you have a high-deductible health plan, some services like immunizations and screenings are free (even if you haven't met your deductible)? Or that you might be able to invest the money in your HSA? This episode, KFF Health News reporter Jackie Fortiér shares tips on getting the most out of your HDHP.Have a question about navigating the health care system? Contact us here and you might be part of an upcoming episode of Health Care Helpline.Follow us on Instagram: @nprlifekitSign up for our newsletter here.Have an episode idea or feedback you want to share? Email us at lifekit@npr.orgSupport the show and listen to it sponsor-free by signing up for Life Kit+ at plus.npr.org/lifekitSee pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

Adjustable-rate mortgages (ARMs) are booming again, but Clark has a major warning: this "oldie but baddy" could be a financial time bomb. Clark breaks down why banks are pushing ARMs, who they actually work for (a narrow group indeed), and the "reset" risk that could cost you your home. Also, health insurance has become insanely expensive. Many Americans are skipping meals just to pay for healthcare. Clark discusses why catastrophic-only plans are a dangerous gamble and identifies the real culprit behind our skyrocketing medical bills.  Danger: Adjustable Rate Mortgages: Segment 1 Ask Clark: Segment 2 High Deductible Health Plans: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Adjustable-Rate Mortgages Are Popular Again – Here's Why You Need To Be Careful NYTimes: A Third of Americans Have Cut Spending or Borrowed Money for Health Care NYTimes: New A.C.A. Plans Could Increase Family Deductibles to $31,000 What Is an HSA Account and How Does It Work? - Clark Howard How to Deal With Medical Debt - Clark Howard Will Mark Cuban's Prescription Company Really Save You Money? 10 Ways To Save on Prescription Drugs - Clark Howard Clark.com resources: Episode transcripts Community.Clark.com  /  Ask Clark Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices. Visit megaphone.fm/adchoices