Podcasts about healthcare finance

Send us a textDemand for GLP-1 medications has exploded in recent years. What started as a diabetes treatment has quickly become one of the most talked-about forces in healthcare, reshaping how we think about obesity, metabolic disease, access, affordability, and long-term care.But with rapid growth comes confusion: questions about safety, cost, supply constraints, and whether the current system is actually capable of supporting patients for the long haul.Dr. Myra Ahmad, Founder and CEO of Mochi Health joins CareTalk host David E. Williams to discuss what's getting lost in the GLP-1 conversation, why most care models are not built for long-term obesity treatment, and how Mochi is approaching physician-guided metabolic care at scale.

Nobody becomes an icon by staying comfortable. In this special ICONS: Leaders in Finance edition of the FEI Podcast, Heather Cole – Executive Coach and Business Analytics Advisor at Lodestar Solutions – interviews Amber Kinney, Chief Financial Officer of the American College of Emergency Physicians. Amber's career path is anything but traditional. From a background in the performing arts to executive leadership in nonprofit organizations with life-saving missions — including Mothers Against Drunk Driving — Amber shares how conscious career choices, grit, and faith shaped her leadership journey. In this conversation, Amber and Heather dive into: Taking bold career leaps even when you feel “in over your head” Reframing imposter syndrome as a growth signal The power of networking, mentoring, and asking for help Leading with purpose in nonprofit and healthcare organizations Silencing negative voices and protecting your confidence The importance of balance, self-care, and resilience in high-impact roles This episode kicks off a series spotlighting past speakers from Financial Executives International's ICONS: Leaders in Finance event, designed to inspire finance leaders and build momentum toward ICONS 2026, taking place on March 25, 2026 at the Ritz-Carlton in Laguna Niguel, CA and virtually on April 22, 2026. Learn more at www.financialexecutives.org/icons2026.Special Guest: Amber Kinney.

In this episode, host Sandy Vance sits down with Michael Gao, Chief Executive Officer of Smarter Technology, to explore how artificial intelligence is reshaping revenue cycle operations in healthcare. Together, they dig into Smarter Technology's vision and the practical ways AI can help provider organizations better capture the full value of the care they deliver. Michael shares why the revenue cycle is overdue for improvement, how moving from physical to digital workflows can unlock meaningful gains, and what real-world ROI looks like when AI is applied thoughtfully. In this episode, they also talk about:Smarter Technology's vision for using AI in healthcareWhy the revenue cycle needs modernizationMoving from manual and physical processes to digital workflowsWhat ROI looks like when AI is applied to revenue cycle operationsKeeping human oversight where it matters mostCommon documentation and workflow challenges Smarter Technology helps addressAdvice for CFOs considering AI solutionsA Little About Michael:Mike is CEO of Smarter Technologies. He co-founded SmarterDx after discovering that hospitals were leaving significant revenue and quality opportunities on the table while he was leading AI at New York-Presbyterian. Prior to SmarterDx, Mike was an Assistant Professor of Medicine at Weill Cornell and Medical Director for Transformation for New York-Presbyterian. He completed his BS at the University of California, Los Angeles, his MD at the University of Michigan, and his Internal Medicine Residency and Silverman Fellowship for Healthcare Innovation at NewYork-Presbyterian/Weill Cornell.

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

Healthcare finance leaders are operating under unprecedented pressure. Rising costs, staffing shortages, payer complexity, and constant uncertainty. Matthew Ennen, Senior Vice President of Finance and Business Development at Ensemble Health Partners, shares how finance leaders can navigate volatility while staying anchored to their mission, their people and long-term resilience. Drawing on more than 20 years of experience across healthcare and consumer industries, Matthew explains why finance skills are highly transferable, how analytics and scenario planning enable proactive decision-making, and why transparency, empathy and communication are now essential leadership requirements. From balancing cost containment with innovation to keeping teams motivated through periods of transformation, Matthew offers practical insights for finance leaders in any industry facing rapid change. Discussed in This Episode:  Leading finance teams through uncertainty and transformation Why finance skills transfer across industries Balancing cost control with innovation in mission-driven organizations Using analytics to move from reactive to proactive decision-making The role of transparency, empathy and communication in leadershipFor CFO insights, episode show notes and exclusive blog content, visit thecfoshowpodcast.com.

Send us a textIf you don't know where the patient's data is at every moment, you really can't protect it yet. That's the reality many healthcare organizations are facing. Regulations can help but legacy siloed systems keep patients exposed.In this episode of the HealthBiz Podcast, David Williams is joined by Aimee Cardwell, CISO-in-residence at Transcend. Aimee breaks down why compliance doesn't equal security, how legacy architectures and vendor ecosystems create hidden vulnerabilities, and what modern, identity-centric, AI-enabled security should look like.

Send us a textAI assistants like transcription co-pilots and chat-bots are yesterday's news. Now, we're entering the new era of agentic AI. The new tools are powerful but a little unsettling. AI giving advice is one thing, but are we ready for AI to take action on our behalf?In this episode of CareTalk, hosts John Driscoll and David Williams explore the dawn of agentic AI, systems that act autonomously to perform complex tasks, including in healthcare.

Send us a textHealthcare is drowning in messy, inconsistent data, and IMO Health is helping clean it up so organizations can turn information into real clinical insight.In this CareTalk Executive Feature episode, host David E. Williams speaks with John Laursen, Senior Vice President of Commercialization at IMO Health, about how to separate hype from real value in AI healthcare.

Send us a textWhat if rural hospitals could thrive instead of just survive?In this episode of CareTalk Executive Features, WVU Medicine President & CEO Albert L. Wright, Jr. joins host David Williams to share how the health system is redefining rural healthcare, expanding access, advancing innovation, and aligning care delivery through initiatives like Peak Health.

Send us a textVaccines save lives, misinformation spreads fast, and ice cream, believe it or not, might actually be good for you.In this episode of CareTalk, Dr. Zeke Emanuel joins John Driscoll to discuss vaccine myths, public health confusion, and how the healthcare system can communicate science more effectively.

Send us a textWill the $50 billion rural transformation fund save rural hospitals or hasten their demise?  In this episode of CareTalk, hosts David E. Williams and John Driscoll debate whether CMS's plan to reshape rural healthcare can actually work.

In this episode, Alan Condon, Editor-in-Chief at Becker's Healthcare, joins Scott Becker to discuss key leadership changes at CommonSpirit Health, including the appointment of new CFO Michael Browning, and shares insights on the renewed momentum in hospital mergers and acquisitions as health systems pursue growth and resilience heading into 2026.

In this episode, Amanda Eisel, CEO of Zelis, shares insights from new research on how cost pressures, transparency, and technology are reshaping the healthcare financial experience. She highlights where payers, employers, and consumers see opportunities to reduce friction and build trust in a rapidly evolving system.This episode is sponsored by Zelis.

Send us a textThe digital front door to healthcare is jammed, and it's costing patients, providers, and payers alike.In this episode of CareTalk Executive Features, host David Williams talks with Dr. Ashish Mandavia, CEO and cofounder of Sohar Health, about how AI and automation can transform eligibility and benefits verification from a frustrating bottleneck into a seamless, real-time process.

In this first part of a two-part episode, host David Mandell welcomes Dr. Jack Bert, a board-certified orthopedic surgeon and former president of the Arthroscopy Association of North America. Dr. Bert shares his background, including his training at Northwestern, Temple, and the Mayo Clinic, as well as his career—building one of the first outpatient ambulatory surgery centers in Minnesota. He highlights how his practice expanded from a solo effort into a large multi-location group, providing insight into the evolution of orthopedic practice models. Dr. Bert reflects on the influences that led him to orthopedics, including his brother, a spine surgeon, and his time training with John Lachman. He emphasizes the role of innovation in orthopedic surgery, from pioneering arthroscopic procedures to developing surgical tools and implants. His experiences underscore the importance of adapting to insurance reimbursement models and industry dynamics that affect medical practice and physician compensation. Beyond his clinical and entrepreneurial achievements, Dr. Bert discusses his involvement with industry partners and his tenure on the board of the Retired NFL Players Association, where he saw firsthand the long-term toll professional football takes on players. He also stresses the importance of ancillary services and delegation for physicians to achieve financial success, drawing parallels between leveraging physician extenders in medicine and delegating financial management to professionals. Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com. Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

Send us a textMedicaid covers nearly 90 million Americans, but coverage doesn't always equal health.What if the real driver of outcomes isn't the doctor's office or an app, but the communityitself?In this episode of CareTalk Executive Features, WiderCircle co-founder and CEO Darin Buxbaum joins David Williams to share how peer-led circles and community engagement are improving health outcomes, boosting member trust, and delivering value for health plans.

Send us a textEvery 90 minutes, someone in the U.S. is diagnosed with ALS — a devastating disease that has long resisted conventional research and treatment efforts.In this episode of Caretalk, Tris Dyson, Founder and Managing Director of Challenge Works, joins host John Driscoll to discuss how prize-based innovation and crowdsourcing could unlock new breakthroughs. Dyson shares his personal journey, why shifting incentives matters, and how bold new models can spark hope for ALS patients and families worldwide.

Send us a textHealthcare sits on mountains of valuable data, but compliance bottlenecks prevent organizations from unlocking its potential.In this Executive Feature episode of Caretalk, Shubh Sinha, CEO and co-founder of Integral, explains how his company is changing that by treating data infrastructure and compliance as one unified system rather than separate processes.

Send us a textHave you ever had your health plan deny a treatment that your doctor says you need? Well, you're not alone. But there's good news: People who appeal insurance denials often win. In this episode of CareTalk Podcast: Healthcare. Unfiltered., hosts John Driscoll and David E. Williams dig into the history of prior authorization, why denials are so common, and what patients can do to fight back.

Send us a textAccess to healthcare in the U.S. is broken, with millions forced to choose between essential needs and seeing a doctor. Traditional clinics are too costly to scale, and telemedicine has hit adoption limits. In this episode of CareTalk, John Driscoll sits down with Karthik Ganesh, CEO of OnMed, to discuss how OnMed's “clinic in a box” is expanding access to care. Ganesh shares his journey across healthcare, why access has always been his passion, and how OnMed's innovative care stations blend the trust of in-person visits with the scalability of telemedicine to address one of the nation's most pressing healthcare challenges.

Send us a textHealthcare spending continues to surge, with pharmacy costs now representing 30-40% of total healthcare spend.   In this episode of CareTalk Executive Features, David Williams speaks with Dr. Alan Pannier, SVP of Product Strategy at SmithRx, about how legacy PBMs' misaligned incentives drive up costs, the toll on patients, employers, and independent pharmacies, and how a modern PBM model focused on transparency, fair reimbursement, and aligned incentives could finally fix what's broken in pharmacy benefits.

Send us a textForget about the price of eggs. It's healthcare costs that are rising fast. Double digit increases are coming for 2026 and cost sharing is rising for employees. Weight loss drugs like Ozempic are adding billions to the bill and AI is a wild card, which could bring costs down or make them rise even faster.  In this episode, David E. Williams and John Driscoll unpack what's driving the rising cost of healthcare and what it means for the future.

Send us a textClinical trials are the backbone of medical progress, but they've become increasingly complex, costly, and slow. Can technology smooth the process without compromising rigor?Scott Chetham, Founder and CEO of Faro Health and former clinical operations leader at Verily, explains why outdated processes bog down research and how Faro's digital trial platform is making studies faster, more efficient, and more patient-friendly. By transforming static documents into connected, intelligent systems, Faro helps sponsors and regulators streamline design, reduce amendments, and improve trial outcomes.

In this episode, Rodney Adams, SVP of Finance & Reimbursement for the Tennessee Hospital Association, discusses the intersection of healthcare finance.

From Soccer to CFO Strategy with Stanislav Sukhinin of SorsoOn this episode of The Thoughtful Entrepreneur, host Josh Elledge speaks with Stanislav Sukhinin, Founder and CEO of Sorso, a fractional CFO firm helping outpatient healthcare clinics improve financial health, drive growth, and prepare for acquisition. Stanislav blends his background in team sports with deep financial expertise to show how leadership, strategy, and collaboration can transform a clinic's trajectory. This episode delivers practical insights for healthcare founders who want to get out of the weeds and into sustainable, data-driven growth.Why Clinics Need More Than a Bookkeeper to GrowDrawing inspiration from soccer, Stanislav explains how successful clinics operate like high-functioning teams—where every department, from billing to operations, must work together toward a shared goal. He highlights the complex financial challenges clinics face, especially in dealing with delayed insurance reimbursements, unpredictable revenue, and cash flow gaps. These issues often leave owners with an unclear picture of their clinic's true financial health, which can stall growth and undermine decision-making.That's where a fractional CFO comes in. For clinics generating $3M or more in annual revenue, a strategic financial partner can help owners shift from reactive bookkeeping to proactive financial leadership. Stanislav shares how Sorso helps clinics implement systems, optimize revenue cycle management, and prepare for potential acquisition opportunities by standardizing operations and improving margins. He emphasizes that financial leadership is not just about compliance—it's about aligning financial strategy with long-term business and personal goals.Whether you're optimizing reimbursements, opening new locations, or considering a sale in the next 3–5 years, this episode offers actionable advice on building financial systems that scale. From reviewing payer performance to tracking key metrics like gross margin and cash flow, Stanislav outlines how outpatient clinics can make smarter decisions—rooted in both teamwork and data.About Stanislav SukhininStanislav Sukhinin is the Founder and CEO of Sorso, a fractional CFO firm specializing in outpatient healthcare clinics. With a background in finance and a passion for systems thinking, Stanislav helps clinic owners build sustainable businesses through strategic planning, operational insight, and financial clarity.About SorsoSorso provides fractional CFO services tailored to the needs of outpatient healthcare clinics. From revenue cycle optimization to acquisition readiness, Sorso partners with clinic owners to turn complex financial data into clear, growth-focused decisions. The firm serves practices generating $3M+ in annual revenue and looking to scale with confidence.Links Mentioned in this Episode:Sorso WebsiteStanislav Sukhinin on LinkedInEpisode Highlights:How team sports taught Stanislav key lessons for business leadershipThe biggest financial pain points facing outpatient healthcare clinicsWhy bookkeeping alone isn't enough for growth-focused practicesWhen to bring in a fractional CFO—and what criteria to considerActionable steps for improving clinic cash flow and preparing for...

In episode 104, I sit down with David Norris, a seasoned entrepreneur and AI innovator, to explore the transformative potential of artificial intelligence in healthcare. As the CEO of Affineon, David brings a wealth of experience and a passion for solving real-world problems in the medical field.Our conversation delves into the exciting possibilities AI offers for reducing administrative burdens on healthcare providers, particularly in managing clinical inboxes. We discuss how AI can act as a powerful ally, helping clinicians focus more on patient care and less on paperwork.Key insights from our discussion include:The importance of involving healthcare providers in the development of AI solutionsHow AI can triage clinical inboxes, saving hours of administrative work each weekThe role of AI in enhancing patient safety and improving care qualityThe need for responsible AI use in healthcare, including transparency and ethical considerationsDiscover how to:Approach AI adoption in healthcare with optimism and practical considerationsBalance the rapid pace of technological advancement with the need for thoughtful implementationStay informed about AI developments in healthcare through various resourcesMaintain work-life balance as an entrepreneur or healthcare provider in the fast-paced world of medical technologyThis episode offers valuable insights for healthcare professionals curious about AI's potential to alleviate administrative burdens and enhance patient care. It's a must-listen for anyone seeking to understand how AI is reshaping the healthcare landscape and how they can be part of this exciting transformation."I think based on what I've seen, I think it will produce results that will be better for patients, it will be safer and more trustworthy. And that's really, in the end, what you want is you want patients to feel a trust factor, that they're getting help." - David Norris Join us for this thought-provoking conversation that challenges conventional views on AI in healthcare and inspires optimism about the future of medicine. Learn how embracing AI responsibly can lead to more fulfilling careers for healthcare providers and potentially transform patient care for the better.Connect with David Norris and Affineon:Visit ⁠Affineon's website⁠Email David at david.norris@affineon.comLook for Affineon at major healthcare conferences like HIMSS and HLTH—------------------------------------------------------------------------------------------------------------------

Join EisnerAmper's Tony Davis as he dives into the critical issue of technology underinvestment among physician groups and healthcare organizations. With expert guests Becky Munson and Amy Jongerius, this insightful conversation sheds light on how neglecting innovations like outsourced accounting can hinder organizational growth, impact patient care, and create inefficiencies. Packed with practical advice and industry expertise, this episode provides actionable strategies to help healthcare leaders embrace technology and secure their financial health. Tune in to learn how to transform challenges into opportunities for growth and success.

Send us a textHealth coaching is often overlooked in healthcare, but could it be the key to improving behavior change, supporting chronic care, and filling gaps left by clinical shortages? In this episode of CareTalk: Healthcare. Unfiltered., Eugene Borukhovich, COO & Co-Founder of YourCoach, joins John Driscoll to discuss why coaching is gaining traction, how YourCoach is helping scale it, and why embracing health coaches could be critical to building a stronger, more sustainable healthcare system.

Send us a textMedicaid spending is almost certain to get cut significantly under the emerging Congressional reconciliation bill. But what is Medicaid anyway and what will happen if spending drops?

Send us a textChronic pain affects more Americans than cancer, heart disease, and diabetes combined, yet it remains one of the most misunderstood and poorly managed health conditions.In this episode of the CareTalk Podcast, John Driscoll sits down with Jennie Shulkin, Founder of Override Health, to discuss how her personal experience with chronic pain led to building a virtual, team-based care model that can revolutionize pain management as we know it.

In this episode, Alan Condon, Editor-in-Chief at Becker's Healthcare, discusses the latest financial performance of major health systems, the impact of rising costs, and the ongoing challenges with payer reimbursements. Listen in for key insights on the evolving healthcare landscape.

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to outcomesrocket.com The key to improving the patient financial experience lies in personalized, transparent, and empathetic billing practices, moving beyond traditional, impersonal revenue cycle management.  In this episode, Dugan Winkie, Head of Commercial Strategy for Cedar, discusses how his company is revolutionizing the patient financial experience. His company uses a B2B2C model, partnering with providers to interact directly with patients on all billing matters, offering solutions ranging from simple bill payments to complex affordability options. Dugan emphasizes how they differentiate themselves by creating a personalized experience that guides patients through the complexities of healthcare finance. He also explains that Cedar prioritizes data integration to accurately answer complex billing questions and offer a truly integrated patient experience.  Tune in and learn about the future of patient financial engagement and how to create a transparent, personalized, and empathetic experience with the patient billing process! Resources:  Connect and follow Dugan Winkie on LinkedIn. Learn more about Cedar on their LinkedIn and website. Read Cedar's annual report here. Fast Track Your Business Growth: Outcomes Rocket is a full service marketing agency focused on helping healthcare organizations like yours maximize your impact and accelerate growth. Learn more at outcomesrocket.com

In this episode, Laura Dyrda, Vice President and Editor-in-Chief at Becker's Healthcare, discusses financial stability, workforce shortages, and the role of technology in shaping the future of healthcare, offering valuable insights from industry experts and recent reports.

In this episode, Editor-in-Chief Alan Condon joins Laura Dyrda to discuss major healthcare finance developments, including Kaiser Permanente's recent acquisitions, the rapid expansion of urgent care centers, and the shift towards value-based care.

For the first time in history, Texas is home to three female presidents leading Healthcare Financial Management Association (HFMA) chapters, alongside the organization's first female CEO, Ann Jordan. This unprecedented moment is more than symbolic; it highlights a shift toward inclusivity, collaboration, and innovation in healthcare financial management. With Texas chapters spanning diverse regions and communities, these leaders are driving initiatives to energize the next generation, foster meaningful service, and expand HFMA's reach across the state. How are these trailblazing women redefining leadership in healthcare finance, and what does their work mean for the future of healthcare communities?On Highway to Health, host David Kemp sits down with the women in question, namely Rachel Pugliano, Jamie Hill-Walters, and Anna Stevens, to celebrate this historic moment and discuss their vision for HFMA's future.Key Takeaways from the Episode:Inclusive Engagement: Rachel Pugliano emphasizes bridging gaps across South Texas' vast geography, ensuring all members—new and seasoned—feel connected and valued.Empowering the Next Generation: Jamie Hill-Walters highlights initiatives like hands-on volunteer work, education, and certifications to attract and support emerging leaders in healthcare finance.Community in Action: Anna Stevens shares how the Gulf Coast chapter is moving beyond financial support to hands-on service, deepening ties with local organizations.About the Guests:Rachel Pugliano: Rachel Pugliano, Director at Eide Bailly, is a healthcare executive with over 20 years of experience in revenue cycle optimization and process improvement. Leveraging her clinical background, she delivers sustainable solutions and trains teams across all levels of healthcare operations. As President of HFMA's South Texas chapter, Rachel drives initiatives to enhance member engagement and inclusivity.Jamie Hill-Walters, CRCR: Jamie Hill-Walters, CRCR, is a healthcare revenue leader with over 20 years of experience driving financial growth, client engagement, and revenue cycle optimization for major U.S. healthcare systems. Currently Chief Customer Officer at Janus Health, she specializes in implementing strategies that enhance financial outcomes, process efficiency, and client relationships. As President of HFMA's Texas Lone Star Chapter, Jamie champions education, leadership development, and community engagement to advance healthcare financial management.Anna Stevens, CPA, FHFMA: Anna Stevens, CPA, FHFMA, is Partner-in-Charge of Healthcare at Weaver, where she provides assurance, compliance, and financial analysis services to healthcare organizations, including hospitals, clinics, and post-acute care facilities. A Fellow of HFMA and President of the Gulf Coast Chapter, Anna champions initiatives to strengthen healthcare financial management and foster community engagement. With experience as a Corporate Controller for a post-acute healthcare system, she has successfully managed operating budgets, financial reporting, and departmental performance, leveraging over a decade of expertise to drive operational excellence.

Send us a textUnlock the secrets to mastering healthcare finance with our insightful conversation featuring LaTasha Barnes, a trailblazer in transforming healthcare organizations. Imagine gaining the financial acumen that could redefine your leadership journey and elevate your impact in this complex industry. From her early days at Big Four audit firms to navigating the intricacies of healthcare finance, LaTasha shares her unique perspective and expertise. Together, we discuss strategies to bridge the gap between operational roles and financial understanding, offering valuable insights for directors and VPs seeking to enhance their careers and contribute more effectively to their organizations.Explore the intricacies of the healthcare reimbursement landscape and the importance of innovation in care delivery. LaTasha and I dive into the transition from director to vice president roles, shedding light on the nuances of employment contracts and bonus plans. We emphasize the role of mentorship in career growth, highlighting how seasoned guidance can help aspiring leaders navigate common pitfalls. Whether you're grappling with staffing challenges or striving for operational efficiency, our conversation offers actionable strategies and inspirational advice to support your journey in healthcare leadership.Thanks for tuning in to this episode of Follow The Brand! We hope you enjoyed learning about the latest marketing trends and strategies in Personal Branding, Business and Career Development, Financial Empowerment, Technology Innovation, and Executive Presence. To keep up with the latest insights and updates from us, be sure to follow us at 5starbdm.com. See you next time on Follow The Brand!

Prepare to expand your understanding of cybersecurity and IT procurement as we welcome Montae Brockett, the Deputy CIO and Chief Information Security Officer at Washington DC's Department of Healthcare Finance. Montae shares his expert insights on the intricate dance of integrating cybersecurity into IT procurement processes. With the evolving threat landscape in mind, we explore the strategies necessary to synchronize procurement, IT, and cybersecurity teams to meet agency needs and retain top talent, especially during Cybersecurity Month.Our conversation shifts gears as we explore the modernization of procurement offices, focusing on technological and business process advancements. Highlighting the transformative potential of generative AI, we delve into its role in streamlining operations and the complexities of contract terms and legislative landscapes. Montae's insights on these topics underscore the importance of aligning technology with organizational missions and visions, offering listeners valuable knowledge on bridging the gap between open source and commercial products.Click here to view the transcript.Follow & subscribe to stay up-to-date on NASPO!naspo.org | Pulse Blog | LinkedIn | Youtube | Facebook

Blue Cross Blue Shield CEO Sarah Iselin is a great asset for Massachusetts. I admired her work when she ran the Department of Healthcare Finance and Policy and then the BCBS Foundation, and was grateful for her rescue of Massachusetts' implementation of the Affordable Care Act. After a decade-long sojourn to Florida and California she's come back to Massachusetts just in time to address some big challenges. Among the topics we discussed:The Steward Healthcare bankruptcyAccess to care -especially behavioral healthThe health care cost crisisWomen's healthValue based care and the Alternative Quality ContractI also enjoyed learning about how Sarah was inspired by her parents to enter public service and her early dates as an art student.Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.

In this episode, Ken Kaufman, Chair of Kaufman Hall, joins Scott Becker to discuss critical trends in healthcare finance, the impact of COVID-19 on hospital operations, and the challenges of consolidation and staffing in the healthcare industry. Kaufman shares his expert insights on the evolving financial landscape and the future of healthcare delivery.

In this episode, host Dan Karnuta welcomes Nick Hut, senior editor at the Healthcare Financial Management Association. They do a deep dive into the Change Healthcare cyberattack: what happened, who was affected, temporary and long-term fixes, the impact on stakeholders — including patients — and what lessons were learned from a disaster that affected one third of Americans. Professor Karnuta is the director of the Professional Program in Healthcare Management at the Naveen Jindal School of Management at The University of Texas at Dallas. Links: HFMA's Voices in Healthcare Finance podcast

HFMA Policy Director Andrew Donahue's column, “An open letter to Congress on nonprofit hospital finances,” has struck a chord with members. In this episode, he discusses margins, investments and M&A and what measure tells the real story of hospital finance. Also in this episode, Brad talks about the recent HFMA report Curing Payment Confusion. Also mentioned in this episode: Healthcare 2030: Restoring Trust in Healthcare Assessing Reality in Healthcare Financial Information | HFMA

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Welcome to another episode of Passive Income Pilots, where we delve into the burgeoning world of assisted living investments. Join hosts Tate Duryea and Ryan Gibson as they discuss the impact of the demographic shift known as the "Silver Tsunami" with Dwayne Clark, founder of Aegis Living. Dwayne shares his extensive experience in building a premier brand in the senior housing industry and provides insights into the challenges and triumphs of caring for the aging population.Timestamped Show Notes:(00:00) - Introduction by Tate and Ryan, discussing the demographic trends boosting assisted living investments.(01:00) - Tate shares a personal story highlighting the immediate relevance of senior care.(02:00) - Ryan introduces Dwayne Clark, highlighting his accomplishments and the ethos of Aegis Living.(04:00) - Dwayne Clark joins the conversation, detailing his journey from the criminal justice field to senior housing.(05:00) - Discussion on the inception of Aegis Living and the challenges of funding and growing a business in senior housing.(07:00) - Dwayne reflects on the sacrifices made to establish Aegis Living, including personal financial risks.(10:00) - Exploring the demographic changes affecting senior housing and the concept of the "silver tsunami."(13:00) - Insights into the supply constraints in senior housing exacerbated by COVID-19 and its impacts on the market.(15:00) - Dwayne shares his philosophy on integrating community history and elements into the design of Aegis facilities.(17:00) - Detailed explanation of different types of senior living and care options available.(20:00) - Discussion on the investment aspects of senior housing and the importance of choosing the right management.(24:00) - Dwayne addresses how families can finance senior living through home equity and other means.(28:00) - Advice for individuals on how to discuss and plan for aging parents' future care needs.(32:00) - Ryan and Tate reflect on the operational excellence at Aegis Living.(35:00) - Dwayne discusses the role of adversity in shaping his career and approach to senior living.(38:00) - Closing thoughts on the current economic climate and its effect on the real estate and senior living sectors.Resources Mentioned:Aegis Living Website: Visit Aegis LivingDwayne Clark's Personal Website: Explore HereDwayne's upcoming book Where's Your Purse: A Guide for Children with Aging Parents details managing aging parent care.Remember to subscribe for more insights at PassiveIncomePilots.com!Join our growing community on FacebookCheck us out on Instagram @PassiveIncomePilotsFollow us on X @IncomePilotsGet our updates on LinkedInHave questions or want to discuss this episode? Contact us at ask@passiveincomepilots.com See you on the next one!Legal DisclaimerThe content of this podcast is provided solely for educational and informational purposes. The views and opinions expressed are those of the hosts, Tait Duryea and Ryan Gibson, and do not reflect those of any organization they are associated with, including Turbine Capital or Spartan Investment Group. The opinions of our guests are their own and should not be construed as financial advice. This podcast does not offer tax, legal, or investment advice. Listeners are advised to consult with their own legal or financial counsel and to conduct their own due diligence before making any financial decisions. The hosts, Tait Duryea and Ryan Gibson, do not necessarily endorse the views of the guests featured on the podcast, nor have the guests been comprehensively vetted by the hosts. Under no circumstances should any material presented in this podcast be used or considered as an offer to sell, or a solicitation of any offer to buy, an interest in any investment. Any potential offer or solicitation will be made exclusively through a Confidential Private Offering Memorandum related to the specific investment.

In this episode of Minding Memory, Matt & Donovan speak with Dr. Joanne Spetz, the Brenda and Jeffrey L. Kang Presidential Chair in Healthcare Finance and Director of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco (UCSF). Joanne talks with Matt & Donovan about who makes up the professional workforce of people who provide dementia care and how these individuals play a critical role in the delivery of services. Joanne also discusses how different professional roles interact across setting of care. Lastly, Joanne introduces a new study she is working on with Donovan called the National Dementia Workforce Study (NDWS) that will be surveying a large group of clinicians who provide care for people living with dementia. Faculty Bio: https://profiles.ucsf.edu/joanne.spetz Article Referenced in Podcast: Candon M, Bergman A, Rose A, Song H, David G, Spetz J. The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health. J Am Med Dir Assoc. 2023 Nov;24(11):1773-1778.e2. doi: 10.1016/j.jamda.2023.07.023. Epub 2023 Aug 24. PMID: 37634547; PMCID: PMC10735229. Previous Minding Memory Episodes on Dementia & Family Caregiving: S1Ep9: Caregiving for individuals with Dementia (with Amanda Leggett) S1Ep10: What is it like to be a Caregiver for a Person Living with Dementia? (with Peggy Arden) The transcript for this episode can be found here.CAPRA Website: http://capra.med.umich.edu/ You can subscribe to Minding Memory on Apple Podcasts, Spotify, Google Podcasts or wherever you listen to podcasts. Hosted on Acast. See acast.com/privacy for more information.

In this episode, we are joined by Mike Morris, the President and CEO at Xtend Healthcare, Here, we delve into the pressing challenges faced by hospitals and health systems as they navigate the healthcare landscape in 2024. Join us as we explore the critical role of technology in addressing workforce shortages, financial constraints, and revenue cycle inefficiencies.This episode is sponsored by Xtend Healthcare.

AI is going to change everything, today we look at Healthcare Finance.

Navigating the complexities of healthcare finance has become increasingly vital as hospitals and healthcare systems face multifaceted financial challenges. The pressure is mounting from the intricacies of managed care to the nuances of patient billing. Declining revenue and lower-than-average payment recoupment, coupled with increased expenses over the past few years due to the global pandemic, created a perfect storm, leading to a rise in hospital closures.How do healthcare professionals navigate this intricate financial maze?In the latest episode of I Don't Care, host Kevin Stevenson sits down with Dr. Cristian Lieneck, Ph.D., a Professor at Texas State University and an expert in healthcare finance, to unravel the subject's complexities.Key discussion points include:• The challenges of determining true healthcare costs and setting appropriate charges• The impact of pay for performance and the implications of Medicare's strategies on commercial payers• The increasing trend of managed care organizations acquiring physician practices and its implicationsAbout Dr. Cristian Lieneck:Dr. Lieneck is a professor at Texas State University and an award-winning educator and researcher. With over a decade of experience in both graduate and undergraduate programs in health administration, he brings a wealth of knowledge from his time as a practitioner in the field. Dr. Lieneck's journey into health administration began with the army, where he served in various capacities, including running a field evacuation unit and overseeing dental clinics.

Rick Warren, Chief Financial Officer & Chief Operating Officer, Innovation Care Partners, brings lessons from more than 25 years in Healthcare Finance. This includes roles as senior finance and FP&A roles at Ascension (one of the one of the largest private healthcare systems in the United States), Banner Health, one of the largest nonprofit health care systems in the country, and CVS Health, one of the US's largest retail pharmacy store chains. This is a must-listen for anyone who is interested in finance procedures in healthcare and the most important metrics in healthcare for anyone in finance.   This episode covers:  How finance can help transform healthcare equity –  the challenge of getting lower socioeconomic group fair  healthcare coverage Rick Moving from a political science degree to finance and ultimately CFO The importance of Relevance over precision in FP&A The nightmare budget which crashed before it was saved Lessons from Boy Scout leadership positions  Margins for hospitals still struggling post-covid  The fundamental healthcare financial metrics including reducing hospital expenses, admissions per thousand, ER visits vs primary health care physician, SNF nursing home days spent, revenue and expense per member per month  The secrets to effective business partnerships in FP&A Favorite Excel Function FP&A Today is brought to you by Datarails,the AI-powered financial planning and analysis platform.  Keep your own Excel financial models and spreadsheets and benefit from AI for data consolidation, reporting and planning.

Prior authorization. It's a dreaded phrase for patients and providers alike. Now some health plans like Cigna say they're cutting back on the practice, and the feds are contemplating restrictions, too. What is prior authorization in healthcare? And can the US healthcare system live without it?ABOUT CARETALKCareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy.GET IN TOUCHBecome a CareTalk sponsorGuest appearance requestsVisit us on the webSubscribe to the CareTalk NewsletterShop official CareTalk merchFOLLOW CARETALKSpotifyApple PodcastsGoogle PodcastsFollow us on LinkedIn#healthcare #healthinsurance #priorauthorization #healthcarefinance #healthcareeconomics #healthcarepolicy #healthcarebusiness  #digitalhealthCareTalk: Healthcare. Unfiltered. is produced by Grippi Media

The recently signed gun law, S. 2938: Bipartisan Safer Communities Act, contained a surprise dingleberry postponing a regulation designed to save seniors money on their pharmaceutical drugs by prohibiting kickbacks to an industry few have heard of: Pharmacy Benefit Managers (PBMs). This little-known but extremely powerful industry deserves much of the blame for ever rising prescription drugs costs in the United States. In this episode, Jen gives you the scoop on PBMs and how they make their money at the expense of Americans who are most dependent on medications. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via PayPal Support Congressional Dish via Patreon (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank's online bill pay function to mail contributions to: 5753 Hwy 85 North, Number 4576, Crestview, FL 32536. Please make checks payable to Congressional Dish Thank you for supporting truly independent media! View the shownotes on our website at https://congressionaldish.com/cd255-pharmacy-benefit-managers-pbms We're Not Wrong Berlin Meetup Contact Justin at WereNotWrongPod@gmail.com Background Sources Recommended Congressional Dish Episodes CD134: The EpiPen Hearing US Healthcare Landscape Jessi Jezewska Stevens. Apr 23, 2020. “A Brief History of the Great American Healthcare Scam.” Bookforum. Tanza Loudenback. Mar 7, 2019. “The average cost of healthcare in 21 different countries.” Insider. Chuck Grassley and Ron Wyden. 2019. “Insulin: Examining the Factors Driving the Rising Cost of a Century Old Drug [Staff Report].” U.S. Senate Finance Committee. “Health Insurance Coverage of the Total Population.” Kaiser Family Foundation. Sara R. Collins and David C. Radley. Dec 7, 2018. “The Cost of Employer Insurance Is a Growing Burden for Middle-Income Families.” The Commonwealth Fund. PBMs What are PBMs? JC Scott. Jun 30, 2022. “Drug manufacturers are root cause of high drug costs; PBMs drive costs down.” The Hill. Zach Freed. Jun 22, 2022. “The Pharmacy Benefit Mafia: The Secret Health Care Monopolies Jacking Up Drug Prices and Abusing Patients and Pharmacists.” American Economic Liberties Project. Adam J. Fein. Jun 22, 2021. “The Top Pharmacy Benefit Managers of 2020: Vertical Integration Drives Consolidation (rerun).” Drug Channels. “Flash finding: How drug money from sick people really works.” Nov 11, 2021. 46brooklyn. Adam J. Fein. Feb 3, 2019. “Don't Blame Drug Prices on ‘Big Pharma.'” The Wall Street Journal. How PBMs Make Money “DIR Fees.” National Association of Chain Drug Stores. “How PBMs Make Money: PBM Practices & Profits.” RxSafe. True North Political Solutions. Oct 25, 2017. “White Paper: DIR Fees Simply Explained.” Pharmacy Times. ACA “Vertical Integration” Loophole Peter High. Jul 8, 2019. “A View From Inside Cigna's $67 Billion Acquisition Of Express Scripts.” Forbes. Angelica LaVito. Nov 28, 2018. “CVS creates new health-care giant as $69 billion merger with Aetna officially closes.” CNBC. David Dayen. Oct 12, 2018. “Why the Aetna and CVS Merger Is So Dangerous.” The American Prospect. Jeff Byers. April 12, 2018. “Optum a step ahead in vertical integration frenzy.” Healthcare Dive. Graph: Optum opens up wider market for UnitedHealth Group Graph: Optum's pharmacy business contributes the majority of its revenue Susan Morse. May 10, 2017. “Secret weapon: UnitedHealth's Optum business is laying waste to old notions about how payers make money.” Healthcare Finance. Lobbying “Client Profile: Pharmaceutical Care Management Assn.” Open Secrets. The Demise of Independent Pharmacies Christine Blank. Oct 17, 2019. “Independents Prepare to Close Up Shop.” Drug Topics. Paulina Firozi. Aug 23, 2018. “The Health 202: Here's why rural independent pharmacies are closing their doors.” The Washington Post. What Is a Formulary? Ana Gascon Ivey. May 19, 2020. “A Guide to Medication Formularies.” GoodRx. Previous Delays in Rebate Regulation Paige Minemyer. Jan 29, 2021. “In a win for PBMs, Biden administration delays rebate rule.” Fierce Healthcare. Paige Minemyer. Jan 12, 2021. “PCMA sues Trump administration over rebate rule.” Fierce Healthcare. “Incorporating the Effects of the Proposed Rule on Safe Harbors for Pharmaceutical Rebates in CBO's Budget Projections—Supplemental Material for Updated Budget Projections: 2019 to 2029.” May 2019. Congressional Budget Office. The Gun Law Passage Process Office of the Clerk. May 18, 2022. “Roll Call 212 | Bill Number: S. 2938.” U.S. House of Representatives. Tampa Bay Times Editorial Board. May 12, 2022. “Republican lawmakers should be ashamed for failing to honor Justice Joseph Hatchett.” Miami Herald. Annie Karni. Apr 12, 2022. “House G.O.P., Banding Together, Kills Bid to Honor Pioneering Black Judge.” The New York Times. Background on Most Important Provisions Mary Katherine Wildeman. May 26, 2022. “Data show most school shootings carried out by young adults, teens.” CT Insider. Jeffrey Pierre. May 26, 2022. “Experts say we can prevent school shootings. Here's what the research says.” NPR. The Dingleberry Erik Sherman. Jun 30, 2022. “Gun Safety Bill Extends Drug Middlemen Protection From Anti-Kickback Measure.” Forbes. Molly Rutherford. Jun 28, 2022. “Gun legislation provision puts drug supply chain profits over patients.” The Hill. Marty Schladen. Jun 22, 2022. “Deep inside the gun bill: a break for prescription drug middlemen.” Iowa Capital Dispatch. Poland Train Station Taylor Popielarz, Maureen McManus and Justin Tasolides. Mar 25, 2022. “‘The help given is remarkable': Inside the Poland train station that's become a hub for Ukrainian refugees.” Spectrum News NY1. The Law and the Regulation S. 2938: Bipartisan Safer Communities Act Senate Vote: 65-33 (All Nos GOP) House Vote: 234-193 (All Nos GOP) Jen's Highlighted PDF of S. 2938: Bipartisan Safer Communities Act Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees U.S. Health and Human Services Department November 30, 2020 Audio Sources The State of Competition in the Pharmacy Benefits Manager and Pharmacy Marketplaces November 17, 2015 House Committee on the Judiciary Witnesses: Bradley J. Arthur, R.Ph., Owner, Black Rock Pharmacy David Balto, Law Offices of David A. Balto PLLC Amy Bricker, R.Ph. Vice President of Retail Contracting & Strategy, Express Scripts Natalie A. Pons, Senior Vice President and Assistant General Counsel, CVS Health Clips 53:48 Bradley Arthur: The Big Three PBMs control almost 80% of the entire market and these PBMs have the upper hand both in negotiating the contract with the payer, as well as strongly influencing the actual plan design itself. The PBM industry typically states that they can use their economic power to harness enhanced market efficiencies, but for whom? However, the staggering annual revenues that continue to grow each year of the big three suggests that these efficiencies are going directly to their corporations' bottom lines. Small community pharmacies like mine are faced on a daily basis with the impact of the PBMs' disproportionate market power. Community pharmacies routinely must agree to take-it-or-leave-it contracts from the PBMs just to continue to serve our long-standing patients. As if that weren't enough, the PBMs also directly set the reimbursement rates for pharmacies, the very same pharmacies that stand in direct competition of some of these PBM-owned mail-order and specialty pharmacies. Therefore, it comes as no surprise that the PBMs present employer and government payers with carefully tailored suggested plans designs that steer beneficiaries to these PBM-owned entities. Drug Pricing in America: A Prescription for Change, Part I January 29, 2019 Senate Committee on Finance Witnesses: Kathy Sego, Mother of a Child with Insulin-Dependent Diabetes Douglas Holtz-Eakin, Ph.D., President, American Action Forum Mark E. Miller, Ph.D., Vice President of Health Care, Laura and John Arnold Foundation Peter B. Bach, MD, MAPP, Director, Memorial Sloan Kettering Center for Health Policy and Outcomes Clips 1:57:30 Sen. John Cornyn (R - TX): Can anybody on the panel explain to me why we have a general prohibition against kickbacks — they call them rebates — under the Social Security Act, but we nevertheless allow it for prescription drug pricing? What's the sound public policy reason for excluding prescription drug pricing from the anti-kickback rule under federal law? Douglas Holtz-Eakin: I can't explain that and won't pretend to. [laughter] Sen. Cornyn: I thought I was the only one who didn't understand the wisdom of that. Well, it's not a transparent arrangement and it does produce upward pressure on drug prices. And obviously, the negotiations between the PBM and the pharma in terms of what the net cost is, is not transparent, nor is it delivered to the consumer. Is it Dr. Miller? Dr. Bach? Peter Bach: It's delivered to the consumer indirectly through the reduction of the total cost of the benefit, but it is not delivered to the actual consumer using the drug, and that is a disassociation, that is a problem. Because it essentially reverses the structure of insurance. Lowering the total costs are people who use it the least, and raising the costs are people who use it the most, relative to if you allowed the rebate to be used at the point of sale, including all discounts. 1:59:49 Douglas Holtz-Eakin: If we had the negotiation be about the upfront price, so instead of a high list price and a rebate, you just negotiate a lower price, that would be the price that Ms. Sego would pay and insurance companies would look at that and say, okay, she's not paying as much as she used to, we're going to have to make up that money somewhere else and they might raise premiums. That means that people who don't have extreme insulin drug costs would pay a little bit more in a premium every month, and people who have extremely devastating medical conditions and high health care costs would get less costs. That's exactly what insurance is supposed to do. And so the rebate system is more than giving strange incentives on pricing. It's undercutting the purpose of insurance in general. Drug Pricing in America: A Prescription for Change, Part II February 26, 2019 Senate Committee on Finance Witnesses: Richard A. Gonzalez, Chairman and Chief Executive Officer, AbbVie Inc. Pascal Soriot, Executive Director and Chief Executive Officer, AstraZeneca Giovanni Caforio, M.D., Chairman of the Board and Chief Executive Officer, Bristol-Myers Squibb Co. Jennifer Taubert, Executive Vice President, Worldwide Chairman, Janssen Pharmaceuticals, Johnson & Johnson Kenneth C. Frazier, Chairman and Chief Executive Officer, Merck & Co., Inc. Albert Bourla, DVM, Ph.D., Chief Executive Office, Pfizer Olivier Brandicourt, M.D., Former Chief Executive Officer, Sanofi Clips 1:22:03 Albert Bourla: Adverse incentives that favor higher cost biologics are keeping biosimilars from reaching patients. In many cases, insurance companies declined to include lower cost biosimilars in their formularies because they would risk losing the rebates from covering higher cost medicines. I can't think of a more concerning example of a broken system and we need to do something about it. 1:33:35 Sen. Chuck Grassley (R - IA): So many of you have voiced support for the recent rebate rule proposed by the administration. Should the administration finalized this rule, will you commit to lowering your drug prices? Richard Gonzalez [CEO, AbbVie]: Mr. Chairman, we are supportive of the rule. We'd like to see it in its final form, obviously, to make a final decision, but we are supportive of taking the discount to the patient at the point of sale. Sen Grassley: Okay. AstraZeneca? **Pascal Soriot [CEO, AstraZeneca]**The same for us Senator, I would go one step further: if the rebates were removed from the commercial sector as well, we will definitely reduce our list prices. Sen Grassley: Okay. And Bristol? Giovanni Caforio [CEO, Bristol-Myers Squibb]: We have the same positions. Sen Grassley: Okay. Johnson and Johnson? Jennifer Taubert [EVP, J&J]: Yes, we're supportive, and that definitely would be my goal. We would just need to see the final legislation, provided that there aren't additional fees that are added into the system to compensate for the rebates. Sen Grassley: Merck? **Kenneth C. Frazier: I would expect that our prices would go down if we change the system. Again, on the commercial side as well as the Medicare side. Sen Grassley: Okay, Pfizer? Albert Bourla [CEO, Pfizer]: It is a very clear intention that we will not keep a single dollar from these rebates. We will try to move every single penny to the patients and we think if this goes also to the commercial plants that will be even better for more patients. Sen Grassley: Okay. Sanofi? Olivier Brandicourt [Former CEO, Sanofi]: Lowering list price has to be linked to better access and affordability at the counter for the patients. 1:35:20 Sen. Ron Wyden (D - OR): Is it correct that your company, and nobody else, sets the starting price for all drugs sold by Pfizer? Yes or no? Albert Bourla: It is a negotiation with PBMs and they are very powerful. Sen. Wyden: But you still get to set the list price? Albert Bourla: Yes, but we set this price and the rebate limit(?). 1:35:40 Sen. Ron Wyden (D - OR): Is it correct, when a hypothetical patient, let's call her Mrs. Jones, goes to pay for her drug at the pharmacy counter, her coinsurance is based on the price of the drug you set? Albert Bourla: It is correct in many cases. Sen. Wyden: Okay. I just want you all to know that the number one reason consumers are getting hammered, is because these list prices, which you have the last word with respect to where they are, are unaffordable. And the high prices are tied to what the consumer pays at the pharmacy counter. And all this other stuff you talk about, the rebates and the discounts and the coupons, all this other stuff is window dressing, all of that. And the fact is on Part D, 40% of the drugs don't even have a rebate. So I want it understood, particularly because I've asked you, Mr. Borla, I think you and others in the industry are stonewalling on the key issue, which is actually lowering list prices. And reducing those list prices are the easiest way for American consumers to pay less at the pharmacy counter. 2:12:45 Sen. Thomas Carper (D-DE): First is eliminating rebates to PBMs. That's the first one, eliminating rebates to PBMs. The second is value based arrangements. And the third is increasing transparency industry-wide on how you set your prices. 2:13:20 Richard Gonzalez: We clearly support providing the discount at the patient level, eliminating rebates essentially. 2:14:10 Pascal Soriot: If the rebates, as I said earlier, were to be removed from Part D and the commercial sector, we would actually reduce our list prices. 2:15:10 Giovanni Caforio: I would say that not only do we support all three elements that you mentioned, but I do believe those three elements together with the continued effort to develop a generic and biosimilar market would mean significant change, and would clearly alleviate the concerns that patients have today. 2:14:44 Jennifer Taubert: We are very supportive of all three elements that you outlined 2:15:52 Kenneth Frazier: We too support all three. 2:15:55 Albert Bourla: All three elements are transformational for our industry, will disrupt it. However, we do agree that these are the three things that need to be done and also I believe that will have significant meaningful results if we do. 2:16:10 Olivier Brandicourt: We support the three Senator, but we want to keep in mind at the end of the chain the patient has to benefit, so if rebates are removed it has to be to the benefit of patients. Sen. Thomas Carper (D-DE): Good, thanks. 2:18:10 Albert Bourla: 50% of the American people are in commercial plans and these rebate rules apply to Medicare. If the rules apply to all, definitely the list price will go down. 2:18:30 Albert Bourla: The list price is not irrelevant, it's very relevant for a lot of people because they have to pay list price during the deductible period. However if the rebate rule is applied, then they become irrelevant because the patients will not be paying the list price at the purchase point. 2:19:10 Sen. John Thune (R-SD): How would manufacturers respond if the rebate rule were finalized for government programs? I mean, what does that what does that mean for the commercial market? Albert Bourla: Senator, as I said before, all these proposals that they're discussing, [undistinguishable], eliminating the rebate rule, are transformational and will disrupt the way we do business. I don't know exactly how the system will evolve, and I really don't favor a bifurcated system. I would like to have a transparent single system across both parts. So we need to see how the whole thing will evolve. 2:25:26 Johnny Isakson (R-GA): Who sets the discount and who sets the rebate? 2:26:20 Richard Gonzalez: We negotiate with payers, so managed care and PBMs— Sen. Johnny Isakson (R-GA): You're a supplier though, so you have to go negotiate with the PBMs and those people, is that right? Richard Gonzalez: Correct, and they negotiate aggressively. Sen. Isakson: Is that pretty much true with everybody, that they're the major component between the end retail consumer price and the origin of the product? Richard Gonzalez: Yes, Senator. Sen. Isakson: Well, that seems like that's someplace we ought to focus, because that's where the distorted numbers come in. Johnson & Johnson, Janssen, in your testimony, you talked about your average list price of 8.1%, up, but an average net price change of only 4.6%. So while your gross went up 8.6, your net went down 4.6 In the same pricing period. How does that happen? If you're setting the price, how does it not go up on the bottom? Jennifer Taubert: Yeah, and in fact, in 2018, our net price actually declined 8.6%, so even more than that. The intermediaries in the system are very, very effective negotiators— Sen. Isakson: Tell me who the intermediaries are. Jennifer Taubert: Those would be the PBMs and the insurers. Sen. Isakson: …and the insurance companies? Jennifer Taubert: Right, and they set the formularies for patients. Sen. Isakson: And they're not the same. They're two different people? Jennifer Taubert: Yes, correct. 2:40:45 James Lankford (R-OK): All of you have mentioned the rebate issue has been a problem and that insurance companies and PBMs are very effective negotiators. Part of the challenge of this is, health insurance companies pay their PBM based on the quality of their negotiation skills, cutting a price off the list price. And so if a list price is higher and a rebate is higher, that also gives preference to them. So the difficulty is, as you raise list price, and the rebate gets larger, the insurance company gives that preference, making it harder for biosimilars. Am I tracking this correctly? 2:43:00 Albert Bourla: Here in the US, the penetration of biosimilars is much lower than in other places, but it is disproportional to different parts of the US healthcare system. For example, in open systems, systems where the decision maker it is a PBM, the one biosimilar we have has a market share of 5% in the US. In closed systems, in systems like Kaiser, for example, integrated healthcare systems where the one who decides has the whole cost of the healthcare system in its interest, we have 73%. 5% and 73% for the same product. I agree with what Mr. Fraser said that we need to create incentives, but I would add also that we need to break this rebate trap that creates significant disincentives for providers, and the healthcare system, and insurance companies. 3:19:25 Kenneth Frazier: If you went back a few years ago, when we negotiated to get our drugs on formulary, our goal was to have the lowest copay by patients. Today the goal is to pay into the supply chain the biggest rebate, and so that actually puts the patient at a disadvantage since they're the only ones that are paying a portion of the list price. The list price is actually working against the patient. 3:19:50 Sen. Steve Daines (R-MT): Why do we have a system today? Where you all are setting, I'll just say very, very high list prices, which is the starting point for negotiation. Why? Olivier Brandicourt: Senator, we're trying to get formulary position. With those list prices. High list price, high rebates. It's a preferred position. Unfortunately the preferred position doesn't automatically ensure affordability at the end. Kenneth C. Frazier: Senator, If you bring a product to the market with a low list price in this system, you get punished financially and you get no uptake because everyone in the supply chain makes money as a result of a higher list price. Drug Pricing in America: A Prescription for Change, Part III April 9, 2019 Senate Committee on Finance Witnesses: Steve Miller, MD, Former Executive Vice President and Chief Clinical Officer, Cigna Corporation Derica Rice, Former Executive Vice President and President, CVS Health and CVS Caremark William Fleming, Pharm.D., Segment President, Healthcare Services, Humana Inc. John Prince, Chief Executive Officer, OptumRx Mike Kolar, JD, Interim President & CEO, Senior Vice President and General Counsel, Prime Therapeutics LLC Clips Sen. Ron Wyden (D - OR): Pharmaceutical Benefit Managers first showed up decades ago, back when prescription drugs were being utilized more extensively. The PBMs told the insurance companies, “we're the ones who know drug pricing, we will handle the negotiations for you.” But there is little evidence that the pharmaceutical benefit managers have actually held down the prices in a meaningful way. In fact, most of the evidence shows just the opposite. Pharmaceutical Benefit Managers actually make more money when they pick a higher price drug over a lower price drug. Colleagues, let's remember that all the way through this discussion, benefit managers make more money when they pick a higher price drug over a lower price drug. The logic on this isn't exactly complicated, graduate-level economics. PBM profits are based on taking their slice of the prescription-drug pie. More expensive drugs means there's a bigger pie. When there's a bigger pie, [there are] bigger slices for the pharmaceutical benefit managers. 50:24 Mike Kolar: Rebates and the role they play have been key areas of focus in the drug cost debate. In our view, rebates are a powerful tool to offset high prices, which are set by pharmaceutical companies, and pharmaceutical companies alone. The fact that rebates are not offered on many of the highest cost drugs, and that studies show no correlation between prices and rebates underscore that rebates are a key to mitigating rather than causing high drug prices. We pass rebates through fully to our plans, and we believe our plans should be able to choose how to apply these rebates in ways that best serve their members and market needs by balancing premiums and cost sharing. 56:05 Sen. Chuck Grassley (R-IA): I'd like to talk about consolidation, including the recent integration of PBMs with insurance companies. Last year I wrote to the Justice Department on the issues, it reported that the three largest PBMs who are before us today now covers 71% of Medicaid, Medicare Part D enrollees and 86% of standalone Drug Plan enrollees. 57:45 Derica Rice: This is a highly competitive space. In addition to the three that you've pointed out here, CMS has noted there are over 60 PBMs across the US. Therefore, the competition, there's many options for the employers that are out there, government entities, as well as unions to choose from given their specific needs. 1:10:35 Sen. Debbie Stabenow (D-MI): So when we look at Express Scripts has 100 million Americans covered, CVS 90 million, OptumRx 65 million, Prime Therapeutics 27 million, Humana 21 million, and yet Americans still pay the highest prices in the world. Even though you are negotiating for millions of people. The VA has its own pharmacy benefit manager service, they negotiate for 9 million veterans, and they pay, on average, 40% less for the same drugs that the rest of the healthcare system pays for. Despite greater volume, you are unable to secure these kinds of low prices. With all due respect, you guys are pretty bad negotiators. Given the fact that the VA can get 40% less. And so I'd like to know from each of you why that's the case. Dr. Miller? Steve Miller [Former EVP and Chief Clinical Officer, Cigna Corporation]: Yes. Part of the equation is giving patients choice. At the VA, they actually limit their formulary more than any of us at this table do. So oftentimes, they'll have one beta blocker, one ace inhibitor. And so if it's going to get to that level of choice, then we could get better prices also. Sen. Stabenow: Let me jump in, in the interest of time. I know you create nationwide drug formularies, you have pre-authorization, you give preferred status to certain medications. So you don't use any of those tools that the VA is using? Because you do. Steve Miller: We definitely use those tools, but we also give people choice. It's crucial for both physicians and patients to have the choice of the products they want to be able to access. Many of our plans want us to have broad formularies and when you have more products, it means you move less market share. Sen. Stabenow: So basically you're saying a 40% premium gives them more choice. 1:24:30 Sherrod Brown (D-OH): If the administration's rebate rule were finalized as proposed, would you in some way be required to change the way you do business? Mike Kolar: Yes, Senator we would. John Prince: Yes. William Fleming: Yes. Derica Rice: Yes. Steve Miller: Yes. Sen. Brown: Thank you. 1:25:05 Sherrod Brown (D-OH): What percentage of prescriptions that you fill across Part D actually receive a rebate? Roughly what percentage? Mike Kolar: So Senator, approximately 8% of the prescriptions that we cover in Part D are associated with a rebate. Sen. Brown: Okay, Mr. Prince? John Prince: Senator, I don't know the exact number, I know our overall business is about 7%. Sen. Brown: Okay, thank you. William Fleming: About 7-8%. Derica Rice: Senator, I do not know the exact number but we pass through 100% of all rebates and discounts. Sen. Brown: [Grunt] Steve Miller: 90% of the prescriptions will be generic. Of the 10% that are branded, about two-thirds have rebates. So it's about seven-- Sen. Brown: 7-8% like the others. Okay. To recap, PBMs do not set drug prices. Forcing you to change the way you do business -- as the administration's rule would — will not change that fact. And while the rule might impact a small percentage of drugs and Part D that receive a rebate, it does nothing to lower costs, as your answer suggests, for the other 90% of prescriptions you fill. Most importantly, absolutely nothing in the proposed rule would require Secretary Azar's former employer or any other pharma company to lower the price of insulin or any other drug. It's important to establish that, so thank you for that. 1:41:40 Catherine Cortez Masto (D-NV): Let me ask you, Dr. Fleming, in your testimony, you say Humana's analysis of the rebate rule -- and we're talking about the administration's rebate rule now — found that approximately 17% of beneficiaries will see savings at the pharmacy counter as a result of this rule. Can you tell me a little bit more about who these people are? And what kind of conditions do they have? William Fleming: Senator, there will be a number of members who are taking brand drugs for which we get rebates and so it could vary all the way from the common chronic conditions, things like diabetes or hypertension or high cholesterol, all the way over to occasionally, not usually, but occasionally on the specialty drug side. When you think of some medications like treatments for rheumatoid arthritis, multiple sclerosis, places where there's competition. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)