Podcasts about hras

Joining the Project Purple Podcast is Andrew Waters, PhD, Assistant Professor of Medical Surgical Oncology at the University of Cincinnati. Dr. Waters joins host Dino Verrelli to discuss his lab's recent research recovery grant from Project Purple and his journey into pancreatic cancer research. Dr. Waters discusses the critical role of KRAS mutations that are found in about 93-94% of pancreatic cancer cases. KRAS and RAS-targeted therapies have evolved from being considered “undruggable” to becoming one of the most exciting and progressive areas in cancer treatment. Recent clinical breakthroughs include promising results from RevMed's investigational drug Daraxonrasib, which targets multiple KRAS mutations and has demonstrated early trial outcomes. We learn about the challenges that remain in pancreatic cancer research, including complex FDA approvals and access to use. Dr. Waters highlights his lab's research into how pancreatic cancer cells develop resistance to KRAS inhibitors by leveraging related proteins such as HRAS. NRAS and MRAS. Understanding these mechanisms could help researchers develop therapies and improve treatment durability and patient outcomes. Subscribe to the Project Purple Podcast for more stories from the pancreatic cancer community! You can learn more about Waters lab at https://med.uc.edu/depart/cancer-biology/labs/waters-laboratory. To learn more or donate to Project Purple's mission of a world without pancreatic cancer, visit projectpurple.org.

n this Bright Spots in Healthcare episode, host Eric Glazer brings together Medicare Advantage and operational leaders to explore a growing challenge facing health plans: why identifying risk is no longer enough to improve outcomes. As organizations invest heavily in HRAs, predictive analytics, and member insight platforms, many still struggle to convert those insights into timely, coordinated action. This discussion focuses on where execution is breaking down between identification and intervention, and what leading plans are doing differently to reduce friction, align teams, and engage members while the opportunity to act still exists. This is a candid discussion for executives navigating increasing pressure around Stars, affordability, member engagement, and operational efficiency, while trying to turn insight into measurable performance improvement. Our guests include: Vanita Pindolia, PharmD, MBA, Vice President, Stars Program, Blue Cross Blue Shield of Michigan Chuck Palermo, Vice President, Operations, Health Alliance Plan Linda Isham, Former Vice President, Operations & Clinical Support, Humana Cory Busse, Vice President, Strategic Solutions, Icario  Together, they explore: Why insight without operational coordination often fails to improve outcomes How leading plans are identifying the small populations that disproportionately impact performance What changes when organizations shift from retrospective reporting to real time intervention How plans are reducing friction by coordinating Stars, quality, operations, and engagement efforts around a shared action plan Why understanding behavioral, social, and operational barriers is becoming critical to improving adherence, experience, and quality outcomes How organizations are designing outreach and engagement strategies that reflect real member behavior, not just clinical gaps This episode offers a practical look at how leading organizations are closing the gap between insight and action, and what it takes to operationalize engagement in a way that consistently improves quality, cost, and member experience.   Panelist Bios: https://www.brightspotsinhealthcare.com/events/closing-the-gap-between-insight-and-action-data-informed-tech-enabled-strategies-for-health-plans/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/Final_May7_Episode_Guide.pdf Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/May_7_2026_KIS.docx.pdf Resources:  Report: Health Plan Playbook for 2027, Part 1: From HRA Completion to Real Action This first report in Icario's Health Plan Playbook for 2027 series examines why Medicare Advantage plans need to rethink the HRA as more than a requirement or data collection exercise. The issue is not that plans lack information. It is that the handoff between what members report and what happens next is often too slow, fragmented, or manual to drive meaningful action. The report focuses on a core shift facing plans heading into 2027: completing an HRA is no longer the goal. Acting on it is. When a member is engaged, self reporting, and open, plans have a short window to intervene. If nothing happens in real time, that moment is lost. Drawing on practical examples, the report shows how real time intervention, automatic enrollment into barrier removal programs, and proactive identification of risk patterns can help plans reduce delays, support care teams, and close the gap between insight and action. Inside, you'll find insights on: Why HRAs should be treated as a moment of influence, not just a compliance requirement Where plans lose momentum between member reported needs and follow up action How automatic enrollment can reduce manual handoffs and connect members to support faster Why delayed intervention creates hidden costs across ED utilization, inpatient stays, Stars performance, and unresolved care gaps How plans can act on SDoH, ADL, and behavioral signals while members are still engaged What changes when real time decisioning is embedded directly into the member experience The broader lesson is operational: plans that improve performance are not just collecting better data. They are reducing the time between signal and action, removing broken handoffs, and helping members get to the right support while the opportunity still exists. To request your copy of the report, please contact show producer Nicole Roberts at nroberts@brightspotsventures.com. Thank You to Our Episode Partner, Icario: Icario is a healthcare engagement platform designed to help health plans move beyond disconnected outreach and fragmented member experiences toward more coordinated, action oriented engagement. By combining behavioral science, real time data, and personalized engagement strategies, Icario helps plans identify where members are most likely to disengage, what barriers may prevent action, and how to intervene at the right moment to drive meaningful outcomes. Rather than simply increasing touchpoints, the focus is on reducing friction, improving coordination across teams and programs, and helping members take the next best step. The result is stronger performance across quality, adherence, cost, and member experience. Schedule a Meeting with a Senior Leader at Icario: To explore how Icario is helping health plans improve engagement, reduce friction, and drive more coordinated action across the member journey, reach out to show producer Nicole Roberts at nroberts@brightspotsventures.com to schedule a conversation with a member of the Icario leadership team. 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.

Dr. Nabil Saba shares the first evidence-based guideline on thyroid cancer from ASCO. He highlights recommendations on first- and subsequent-line systemic treatment – including multikinase inhibitors (MKIs), genomically targeted therapies, immunotherapy, and cytotoxic chemotherapy across four subtypes of thyroid cancer: well-differentiated, differentiated high-grade or poorly differentiated, anaplastic, and medullary thyroid cancer. He dives into the evidence supporting each recommendation and explains the importance of shared decision-making on the risks and benefits of each treatment option. Dr. Saba also touches on outstanding questions including sequencing of agents, addressing resistance, emerging biomarker targets, and management of toxicities. Read the full guideline, "Systemic Treatment of Thyroid Cancer: ASCO Guideline." TRANSCRIPT This guideline, clinical tools and resources are available at https://ascopubs.org/topics/asco-guidelines/head-neck-cancer. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology. Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Nabil Saba from Emory University, lead author on "Systemic Treatment of Thyroid Cancer: ASCO Guideline." Thank you for being here today, Dr. Saba. Dr. Nabil Saba: Pleasure to be here. Brittany Harvey: And then just before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Saba, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into what we're here today to talk about, Dr. Saba, could you start us off by providing a general overview of the scope and purpose of this first ASCO guideline for thyroid cancer? Dr. Nabil Saba: So thyroid cancer is a complex disease, and the complexity has been added with the advent of multiple systemic therapeutic agents that have recently come on as part of the standard of care for treating this disease. The guidelines have lagged behind, I believe, in terms of being able to clearly delineate how to use these agents and what clinical settings to use them. And so this guideline, I think, is a much-needed and much-awaited guideline for clinicians to allow them to understand better the use of systemic agents in the treatment of thyroid cancer. And when we talk about systemic agents, what we want to specify is this applies mostly for patients with recurrent metastatic disease, patients who have failed the standard initial treatment, which continues to be surgical resection for these patients if surgery is possible, in addition to radioiodine therapy for the right clinical setting. Brittany Harvey: Absolutely. It's a good point that this patient population for this guideline focuses mainly on recurrent disease and patients who have already received surgery and radioactive iodine therapy. So then this guideline covers four subtypes of thyroid cancer, including well-differentiated, differentiated high-grade or poorly differentiated, anaplastic, and medullary thyroid cancer. As you mentioned, you address clinical questions on systemic therapies, including multikinase inhibitors, genomically targeted therapies, immunotherapy, and cytotoxic chemotherapy in both the first-line and subsequent lines for each of these subtypes. So I'd like to review the key recommendations by subtype. So first, what are the key points for systemic therapy for well-differentiated thyroid cancer? Dr. Nabil Saba: It's important to also stress the point that we have these different subtypes of thyroid cancer. So when we talk about radioiodine refractory, those are for patients who are candidates for radioiodine therapy, of course. This usually encompasses the well-differentiated thyroid cancer. So for this group of patients, the guideline focuses on whether the use of multikinase inhibitors compared to placebo or observation impacts the survival in the first-line setting, whether the use of targeted therapies compared to placebo impacts also the survival in the first-line setting, all in the radioiodine refractory setting, of course. And then we tackle the issue of immunotherapy because this also is a topic that has entered the realm, if you like, of thyroid cancer and is being used in some subtypes of thyroid cancer. So we thought it would be important to raise the question of the role of immunotherapy compared to targeted agents or multikinase inhibitors, in addition to the role of cytotoxic therapy or chemotherapy, as we say, in this patient population. So the guideline goes through all of these questions and then makes specific recommendations as to the use of some of the agents in the first-line setting and second-line setting in case these patients progress after first-line setting. So, for example, it's clear that for patients who are radioiodine refractory and who have well-differentiated thyroid cancer, multikinase inhibitors are centerpiece of the first-line treatment option. And for this patient population, the recommendation essentially is to use lenvatinib or sorafenib, even though lenvatinib is considered to be the first choice in this patient population in the first-line setting. For the subsequent line settings, patients should be offered cabozantinib, which has been also proven in randomized trials. As far as genomically targeted therapy, there is always the contention of whether these agents should be initiated first in case the patient has a genomically altered disease. And so, for example, if the patient has a RET alteration or NTRK alteration, the recommendation here is in favor of using RET-targeted therapies such as selpercatinib or NTRK-targeted therapies such as larotrectinib or entrectinib for these patients as a first-line setting. If they do have the BRAF alteration, which is a commonly seen alteration in these settings, the guideline essentially indicates that this may be offered initially prior to treatment with multikinase inhibitors as well, even though the quality of the evidence here is rather lower, and the strength of the recommendation is conditional. And so it's clear that multikinase inhibitors, in the absence of any of these genomic alterations, is really the first line, and then the question becomes when do we use these genomically targeted approaches in patients who have genomically altered disease? Which basically introduces also the complexity of the question here because we have multiple agents depending on these genomic findings. And then it is sometimes confusing for practitioners which one to use or what do we use first? And so I think the guideline provides clarity in terms of what is acceptable, what is rather not acceptable, what is based on a strong recommendation, what is based on a rather weaker recommendation. I think that's part of the value of such a guideline. And then finally we have the question of radioiodine well-differentiated and the question of immunotherapy as a first line. And here we do not recommend using immunotherapy for this patient population. For patients with subsequent line settings, potentially adding pembrolizumab to a multikinase inhibitor is mentioned, however the evidence is low, and the strength of the recommendation is also conditional here. As far as chemotherapy, this is not recommended in this day and age for this patient population, however it may be considered also in patients who fail or progress on genomically targeted therapy and/or multikinase inhibitors. So this is the summary of the recommendations for well-differentiated thyroid cancer, but certainly, for details, I would refer you to the actual guideline since there are many nuances that cannot be covered during just this discussion. Brittany Harvey: Certainly. The full guideline will be available for listeners in our show notes, and there are many recommendation tables and figures that can help folks as they think through these recommendations. A lot of those key points are really important as clinicians think through which systemic therapies to offer and sequencing of these agents, as you mentioned. Following those recommendations for well-differentiated thyroid cancer, what are the recommendation highlights for systemic therapy for differentiated high-grade or poorly differentiated thyroid carcinoma? Dr. Nabil Saba: This entity is rather a rare entity. It's important to stress the fact that this entity has not really been very well represented in clinical trials, and so when we talk about differentiated high-grade or poorly differentiated, the information here is limited. However, the guideline infers on the recommendations to this subtype of thyroid cancer based on what we know for other subtypes. And I think because of the strength of evidence we have in the well-differentiated and the anaplastic thyroid cancer, this guideline for this subgroup of patients draws from these two guidelines and sort of makes recommendations based on this. So in the first-line setting, of course, if patients don't have a genomically altered disease, we certainly would recommend lenvatinib or sorafenib like we do in the well-differentiated disease. For patients with genomically altered diseases, we follow sort of the same guideline as we have followed for the well-differentiated setting, with the caveat that the quality is rather lower here and the strength of the recommendation is rather conditional for this subtype of patients. And so I think the take-home message is we do have these recommendations similar to the well-differentiated, but the strength of these recommendations for this particular subgroup of thyroid cancer patients is not as strong, given the under-representation in clinical trials. And that's basically the summary of this disease. Same applies to immunotherapy as well as chemotherapy here. Brittany Harvey: Absolutely. I think it's important to recognize where the evidence is not as strong, it's really important that the guideline panel has still offered up some recommendations to help clinicians in their daily practice as well. The next subtype the guideline panel addressed, what does the expert panel recommend regarding systemic therapy for anaplastic thyroid cancer? Dr. Nabil Saba: So it's important to remind the audience that this is a disease with dismal outcome, and this is rather a very, very rare type of thyroid cancer. So the challenge with anaplastic is we've had very little traditionally in terms of options for patients. However, this guideline highlights the advances that have happened in this disease over a relatively short period of time and stresses the important role of systemic agents. And so, for example, for non-genomically mutant anaplastic thyroid cancer in the first-line setting, the guideline does recommend lenvatinib with or without pembrolizumab. Even though the evidence of the quality is low and the strength of the recommendation is conditional, there is enough data that this recommendation could be made. The added complexity for anaplastic thyroid cancer is that this is a disease where multimodal approaches initially are really encouraged as well, including surgical resection primarily, but also potentially thinking about other modalities such as radiation therapy, as these patients have usually very aggressive disease. And so as far as genomically targeted approaches, the story of targeting BRAF I believe has been a successful story in this disease. And again, for patients with BRAF V600E mutated anaplastic thyroid cancer in the first-line setting, the guideline is clear in saying that we should offer BRAF/MEK inhibitor targeted therapy, namely dabrafenib and trametinib based on published data; the quality is moderate, though the strength of the recommendation is strong, essentially because of the compelling data in these rather small studies. In the first-line setting, again, we may offer also BRAF/MEK inhibition with or without pembrolizumab as well, and the strength here is low, with the recommendation being conditional as well. So you can see here that unlike the other types, immunotherapy may play a bigger role here in this type of cancer compared to the well-differentiated carcinoma because of the nature of the disease, and this has been also stressed in other guidelines. For patients who progress on genomically targeted therapy, there are not too many options, even though people can revert back to lenvatinib or lenvatinib and pembro. We do recommend participation in clinical trials for these patients because we really don't have any clear-cut options since the strength of these recommendations is conditional for these patients. As far as the question of immunotherapy per se, we talked about lenvatinib with pembrolizumab. There is also data on ipilimumab and nivolumab. So we include that also as an option for the first-line setting, and we also include, obviously, the dabrafenib and trametinib in combination with pembrolizumab. And even though all these recommendations are conditional, the size of these clinical trials are single-arm phase II studies. In terms of chemotherapy, again, no recommendation in the first-line setting. However, for patients who fail MKI or fail immunotherapy, clinicians may offer cytotoxic chemotherapy. So you can see that in this rare disease, the recommendations already in 2026 indicate a complex tree of decision-making for a number of these cases. And I think this is where these guidelines offer value to many of the practitioners out there. Certainly, they don't claim to answer any or every possible clinical scenario for these patients because anaplastic thyroid cancer, like any thyroid cancer or any malignancy, usually has to rely on careful evaluation on a case-by-case basis, and for this disease in particular, on a multidisciplinary evaluation based on evaluation by surgical team, by medical oncology, by radiation oncology. But hopefully, these guidelines help at least put in the systemic therapy within that context. Brittany Harvey: Absolutely. I think this is also where, in the guideline, the clinical interpretation can really be helpful for readers. And as you mentioned, that multidisciplinary collaboration along with shared decision-making with patients on the risks and benefits of each treatment option is really critical here. So the final subtype that the guideline expert panel addressed, what systemic therapies are recommended for medullary thyroid cancer? Dr. Nabil Saba: Yes, so medullary thyroid cancer is a separate disease in its own merit, and biologically it's different from the other diseases. And even though it's a relatively rare thyroid cancer, there has been quite substantial advances in systemic therapy, and I think the guideline importantly highlights these advances for this type of thyroid cancer, and this subtype adds to the value of the guideline as well. For these cancers, targeted therapy for patients who have RET alteration is really recommended as a first line. So for patients who have RET mutant disease, selpercatinib certainly is the treatment of choice, and this is based on high evidence and the recommendation being very strong here because it's based on randomized phase III data. In the subsequent line settings, however, patients with RET-altered disease who have progressed on selpercatinib, unfortunately, we don't have clear-cut recommendations, however, participation in clinical trials is recommended. If a trial is not available, we recommend that patients be offered vandetanib or cabozantinib in this situation. For patients without the RET alteration, in other words, for patient populations with wild-type disease, the first-line setting should include cabozantinib or vandetanib based also on improved progression-free survival in randomized clinical trial, and here the recommendation is quite strong. In terms of the role of immunotherapy here, there is very, very little role, and so we don't recommend using immunotherapy in the first-line setting or subsequent line setting. Similarly, for chemotherapy or cytotoxic chemotherapy, it's not recommended that patients be exposed to cytotoxic chemotherapy outside of a clinical trial, whether this be in the first-line setting or second-line setting. We say that in the second-line setting, if patients have failed genomically targeted therapy, clinicians may offer cytotoxic therapy, however, here the evidence is low, and the strength of the recommendation is conditional. And so clearly that tells you that advances have been substantial in this disease, specifically in the realm of targeted therapies, which is importantly highlighted in this guideline as well. Brittany Harvey: Yes, it's great to see the advances across these different subtypes. So thank you for reviewing all of these recommendations. It's clear you and the panel spent a lot of time reviewing the evidence to craft these recommendations. So you've already touched on this throughout our conversation already, but I'd like to ask, in your view, Dr. Saba, what is the importance of this guideline, and how will it impact both clinicians and patients with thyroid cancer? Dr. Nabil Saba: This is a guideline that's important because of the complexity of management of thyroid cancer, in addition to the fact that there has been quite a few systemic therapeutic agents that have come to the scene in the disease, and those are used in specific situations. We talked about medullary thyroid cancer and the story of RET inhibition, for example, the question of sequencing of these agents is important - what do you choose first in terms of your choice depending on the clinical scenario, I think, is highlighted in this guideline. I think this is going to be extremely helpful to practitioners inside and outside the United States because it is going to offer a guide for them to essentially decide on what would be the standard therapeutic option that should be offered to these patients. I know that many of these agents are not perhaps available in other countries, and I hope this guideline will also raise awareness, since it is coming from ASCO, that these agents need to be explored and considered for a large group of the population that may not have access to them, especially outside the United States and in third-world countries. And so I think from that angle, I think also the guideline is important in that it sets what is the accepted standard in terms of systemic therapy for these patients with these different diseases. Brittany Harvey: Yes, these evidence-based guidelines certainly set a standard and it will be really important to have these in the hands of many different people to inform best practices for care. Additionally, you've also mentioned earlier that several of the recommendations referred patients to clinical trials where there wasn't evidence. So I'd like to ask, what are the outstanding questions and ongoing research you are watching in the thyroid cancer space? Dr. Nabil Saba: This guideline I would like to look at it as a start. This is a much-needed start, however, it also exposes us to the fact that there are so many unanswered questions yet. We still don't know the exact way or best way to sequence these agents. The story of, for example, multikinase inhibitors in well-differentiated thyroid cancers that have BRAF alteration, what is to be started first? Do you start with a multikinase inhibitor, or do you start with a BRAF inhibition? This is a topic of a cooperative group trial currently answering these questions in terms of what is the best sequencing because, you know, you do have the approved cabozantinib in the second line, for example, but you also have the approved BRAF inhibition, which could be done in the first or second line. And so sometimes that is confusing to clinicians for a good reason because no studies have really examined the question of the appropriate sequencing of these agents. And so I think the more we get these agents as available options for treating patients, the more pressing the question would be of what would be the best sequencing. So I think that's a major question to tackle, and hopefully clinical trials will tackle that. I think the question of resistance to some of these agents, we don't talk too much about that in the guideline, but certainly these agents have limitations. Not every patient who gets a genomically targeted approach is to benefit from that. We've seen many patients who progress on these, and so the question is, how to overcome resistance? Even for the strong data that we have, for example, on RET alteration or NTRK, resistance mechanisms do happen, and we've seen patients who fail larotrectinib and then they need to go on other therapeutic options. And so I think clinical trials are crucial in answering all these questions, in addition to targeting other subtypes of thyroid cancers that have not really been very common. We know that RAS is also seen in some thyroid cancers, HRAS. There have been some studies along that line. ROS is another potential target. And so the question of resistance, I think the question of sequencing, in addition to the question of toxicity. Because, you know, how best to dose these agents? We talked about this a little in the guideline, but again, the focus on this guideline was not too much the toxicity management. So I think management of toxicities should also be a topic of interest that needs to probably accompany any systemic therapy guideline since we're using agents that people may not be too familiar with when they use it for the first time. Brittany Harvey: Definitely. We'll look forward to the results of these trials that you mentioned to inform sequencing, resistance, new targets, and addressing toxicity and potentially inform updates to this guideline. So I want to thank you so much for your work to develop this first ASCO guideline for thyroid cancer and for your time today, Dr. Saba. Dr. Nabil Saba: It's been my pleasure and it's been a pleasure to actually accomplish this and publish this guideline because I do believe it will be of great benefit to the oncologic community. Brittany Harvey: Absolutely. And finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/head-neck-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Public sector employers are facing growing retiree healthcare liabilities as OPEB obligations approach a trillion dollars nationwide. In this episode of The Via Benefits Exchange, experts explore why rising healthcare costs, longer lifespans, and unfunded retiree benefits are putting pressure on public budgets and financial statements. The conversation examines how shifting from traditional group retiree plans to the individual marketplace can help employers control costs while preserving benefits. Listeners will learn how defined contribution strategies, including HRAs, can reduce exposure to healthcare inflation, support retirees with choice and stability, and deliver sustainable retiree healthcare solutions for municipalities, states, and other public sector organizations.

In this episode, Jack Hooper, CEO and Co-founder of Take Command, explains how individual coverage HRAs are reshaping employer sponsored benefits and why adoption is accelerating. He discusses cost control, employee choice, and what early success stories signal for the future of health insurance.

In this episode, Jack Hooper, CEO and Co-founder of Take Command, explains how individual coverage HRAs are reshaping employer sponsored benefits and why adoption is accelerating. He discusses cost control, employee choice, and what early success stories signal for the future of health insurance.

Thanks to our partners Promotive and Wicked FileHealth insurance premiums keep climbing — but 2026 could bring the biggest shakeup in years.In this episode of Business by the Numbers, Hunt Demarest, CPA with Paar Melis & Associates, breaks down what's happening in the small-business health insurance landscape after recent ACA subsidy changes — and why a new Republican-backed House bill could change how shop owners buy coverage and support their teams.Hunt explains the economics behind rising premiums, who's actually affected by the loss of ACA subsidies, and why shop owners may see new opportunities if association health plans and expanded health reimbursement accounts (HRAs) become available. Whether you already offer health insurance or you're considering it in 2026, this episode will help you understand what's real, what's political, and what's worth watching.Ideal for shop owners and managers who want clarity on benefits costs, recruiting strategy, and what changes may be coming in the next open enrollment cycle.What you'll discover…(02:00) The current state of small business health insurance — and why premiums keep rising 10–20% a year(05:40) How the ACA reshaped the market (06:30) What the new House bill is, why it's being debated now, and the January 31 deadline looming in the background(08:00) Who the loss of ACA subsidies impacts most — and why many shops may see little direct effect(16:10) Association health plans: how small businesses could join buying groups like big employers (and why that could lower premiums)(19:25) Health Reimbursement Accounts (HRAs): the tax advantage shop owners may finally be able to use more flexibly(23:45) What to do now: when it's smart to wait, when it's not, and why open enrollment timing matters(25:00) The future of health insurance for small businessesThanks to our partner PromotiveIt's time to hire a superstar for your business; what a grind you have in front of you. Introducing Promotive, a full-service staffing solution for your shop. Promotive has over 40 years of recruiting and automotive experience. If you need qualified technicians and service advisors and want to offload the heavy lifting, visit https://gopromotive.com/Thanks to our Partner WickedFileTurn chaos into clarity with WickedFile, the AI for auto repair shops. Transform invoices into insights, protect cash flow, and stop losing parts, cores, or credits to maximize your bottom line. visit https://info.wickedfile.com/Paar Melis and Associates – Accountants Specializing in Automotive RepairVisit us Online: www.paarmelis.comEmail Hunt: podcast@paarmelis.comText Paar Melis @ 301-307-5413Download a Copy of My Books Here:Wrenches to Write-OffsYour Perfect Shop The Automotive Repair Podcast Network:

Send us a textYear-end is the last chance to lock in major tax savings for your business.In this episode, Mike walks through the exact steps business owners need to take now, from S Corp requirements and accountable plans to AGI phaseouts, QBI planning, and the Augusta Rule.You'll also learn how to hire your kids correctly, hit retirement deadlines, use timing strategies as a cash-basis filer, harvest tax losses, and document every move so you enter tax season clean, organized, and ready.

Are you missing out on some of the most powerful year-end tax strategies available to small business owners and entrepreneurs? In this episode of the Main Street Business Podcast, Mark J. Kohler and Mat Sorensen break down 20 actionable moves you can still make before December 31 to save thousands on taxes and set yourself up for long-term financial success. From retroactive S-corp elections to HSAs, Solo 401(k)s, and smart income timing, this episode is your complete year-end playbook.Unlike generic tax tips you'll find online, these strategies are tailored for real entrepreneurs — whether you're running an LLC, managing rentals, or building your side hustle. Mark and Mat explain how to pay your kids the right way, leverage 100% bonus depreciation on vehicles and equipment, and take advantage of HRAs, Roth conversions, self-rental rules, and tax-loss harvesting before the clock runs out. They also share which moves are still possible after year-end and which deadlines you can't afford to miss.Whether you're just getting started or already running a profitable business, this episode will help you keep more of what you earn and make smarter tax decisions for 2025. By the end, you'll know exactly how to finish the year strong — and start the next one with a strategy that builds wealth, not stress.If you're serious about saving money, staying compliant, and maximizing every deduction possible, this is an episode you can't afford to skip!How to implement 20 year-end tax strategies that help business owners, investors, and the self-employed keep more of their moneyHow to use S corporation elections, payroll planning, and paying your children legally to reduce self-employment taxWhy HSAs, HRAs, and Solo 401(k)s are some of the most powerful tools for deductible medical and retirement planningHow to unlock startup deductions with a first sale and maximize write-offs through year-end equipment and vehicle purchasesSmart ways to shift income and expenses between tax years to optimize your tax bracketHow Roth conversions, rental real estate strategies, and the self-rental rule build long-term tax-efficient wealthWhy scheduling a personalized tax review ensures that these strategies are actually implemented before December 31Get a comprehensive tax consultation with one of our Main Street tax lawyers that can build a tax strategy plan with an affordable consultation that will leave you speechless!! Here's the link - https://kkoslawyers.com/services/comprehensive-bus-tax-consult/?utm_source=buzzsprout&utm_medium=description-link&utm_campaign=main-street-business-podcast&utm_content=msbp601-20-year-end-tax-strategies Grab my eBook 30 Unique Strategies Every Business Owner Should Know! You don't want to miss this! Secure your tickets for the #1 Event For Small Business Owners On Main Street America: Main Street 360 Looking to connect with a rock star law firm? KKOS is only a click away! Are you ready to get certified in EVERY strategy I teach? Start your journey with a FREE 15-minute discovery call to explore the Main Street Tax Pro Certification. Check out our YOUTUBE Channel Here: https://www.youtube.com/markjkohler Craving more content? Check out my Instagram!

Healthcare costs keep climbing while employees want plans that actually fit their doctors, budgets, and lives. We tackle that tension head-on with Chad Schneider, head of broker channel at Thatch, and unpack how ICHRAs—individual coverage HRAs—let employers lock in predictable budgets while giving every employee real choice on the individual market.We start by demystifying ICHRAs and why 2024 became the breakout year: broader carrier participation, stronger individual risk pools, and better technology. Chad breaks down the biggest barriers leaders worry about—change management, compliance, billing across multiple carriers and states—and shares how infrastructure-first platforms handle the messy “money movement” behind the scenes. From clean decision support that feels like booking travel to licensed, state-specific experts for complex cases, we show how employees can navigate dozens of plans with clarity and confidence.Then we get tactical. You'll hear how to design contribution strategies that create equity across age and geography, using dynamic benchmarks instead of blunt flat-dollar allowances. We explore the 11 ICHRA classes for smart carve-outs, the role of voluntary and high-impact perks, and how newer carriers are pushing legacy players to improve networks and benefits. On data, we explain what you can measure without claims visibility—engagement, satisfaction, enrollment completion—and how emerging APIs make application tracking and digital ID cards standard rather than speculative.Looking ahead three to five years, Chad forecasts tighter integrations, more transparent pricing, and perks once reserved for large groups becoming available to small employers. The result is a practical blueprint: cap volatility, expand choice, and elevate the broker's role from renewal jockey to program architect. If you're ready to rethink the benefits playbook and give your team plans that fit their lives, this conversation lays out the steps and the pitfalls to avoid.Enjoyed the conversation? Follow the show, share it with a colleague, and leave a quick review to help more leaders discover smarter benefits strategies.This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

Thanks to our partner PromotiveThis week, Hunt Demerast, CPA, dives into three hot-button business questions—each with surprising consequences for your bottom line. From covering weight loss meds for your employees to falling into the payroll HR trap, and even how the IRS is tightening the screws on your gambling losses—this episode breaks it all down, minus the legalese.What You'll Learn:(00:00:00) Introduction(01:02) Can you write off weight loss drugs like Ozempic for your employees—or yourself?(03:19) The truth about MERPs, HRAs, and what ChatGPT got right and wrong(07:09) The real IRS rule that trips up most owners (hint: it's about fairness)(11:28) Gambling tax rule changes that could cost you—even if you lose(16:04) What triggers a W2-G, and how scratch-offs could land you a surprise tax bill(23:30) Why HR modules from payroll companies are often a waste of money(25:50) A real-life story that cost Hunt money—and why handbooks matter(29:52) What every business owner should review in their employee handbookWhy It Matters: If you're a shop owner or small business operator trying to make smart decisions on health benefits, tax deductions, and HR compliance, this episode is a must-listen. Hunt pulls back the curtain on commonly misunderstood write-offs, state labor laws, and how small mistakes can lead to big headaches.Thanks to our partner PromotiveIt's time to hire a superstar for your business; what a grind you have in front of you. Introducing Promotive, a full-service staffing solution for your shop. Promotive has over 40 years of recruiting and automotive experience. If you need qualified technicians and service advisors and want to offload the heavy lifting, visit www.gopromotive.com.Paar Melis and Associates – Accountants Specializing in Automotive RepairVisit us Online: www.paarmelis.comEmail Hunt: podcast@paarmelis.comText Paar Melis @ 301-307-5413Download a Copy of My Books Here:Wrenches to Write-OffsYour Perfect Shop The Aftermarket Radio Network: https://aftermarketradionetwork.com/Remarkable Results Radio Podcast with Carm Capriotto https://remarkableresults.biz/Diagnosing the Aftermarket A to Z with Matt Fanslow https://mattfanslow.captivate.fm/Business by the Numbers with Hunt Demarest

Send us a textPS. Whenever you're ready, here are some ways we can help with reducing your taxes... Ready to slash your tax bill? Schedule your free consultation and let's strategize your tax savings together! Book now at: https://www.prosperlcpa.com/apply Or, if you still need more time, here are some other ways to begin winning the tax game... Take our free Tax Planning Checklist & learn about what tax savings may be available for you in our minicourse at https://taxplanningchecklist.com  Tax planning isn't just for the wealthy—it's a vital strategy for people at all income levels that can accelerate the path to financial freedom through systematic wealth creation.• Tax savings are more valuable than income because they represent pure wealth creation without taxation• The tax code incentivizes certain behaviors regardless of income level, making strategies accessible to everyone• For middle-income earners and new entrepreneurs, tax savings can provide critical capital for growth and investment• Real client examples show how tax planning helped eliminate taxes and generate refunds for reinvestment• Don't let "zero tax" years go to waste—use them for Roth conversions and harvesting capital gains• Strategies like hiring family members, the Augusta rule, and HRAs can save tens of thousands without costing extra money• Solar panels and other energy investments can simultaneously reduce costs and create tax benefits• No fancy software or expensive advisors needed—educational resources make tax planning accessible• Every hour spent learning tax strategy typically yields higher ROI than hours worked at your regular job• Tax planning habits developed early create a powerful compound effect on long-term wealthVisit prosperalcpa.com/taxnavigator to learn about our accessible tax education resources designed to help everyday Americans take control of their tax situation.

In this episode, Alan Silver, President of Centene's ICHRA-focused Ambetter Health Solutions, joins the Jakob Emerson to discuss the rapid evolution of individual coverage HRAs, why large and small employers are embracing the model, and what it takes for insurers to succeed in this growing space.

In this episode, we break down how HRAs and HSAs work, their key advantages, and how they can complement each other to empower smarter employee healthcare decisions.Find us at https://www.bernieportal.com/hr-party-of-one/BerniePortal: The all-in-one HRIS that makes building a business & managing its people easy. http://bit.ly/2NEQ5QbWhat is an HRIS?https://www.bernieportal.com/hris/BernieU: Your free one-stop shop for compelling, convenient, and comprehensive HR training and courses that will keep you up-to-date on all things human resources. Approved for SHRM & HRCI recertification credit hours. Enroll today!https://www.bernieportal.com/bernieu/Join the HR Party of One Community!https://hubs.ly/Q02mNML90▬ Social Media ▬▬▬▬▬▬▬▬▬▬▬► LinkedIn: https://www.linkedin.com/company/bernieportal▬ Podcast▬▬▬▬▬▬▬▬▬▬▬▬► Apple Podcasts: https://podcasts.apple.com/us/podcast/hr-party-of-one/id1495233115► Spotify: https://open.spotify.com/show/5ViQkKdatT40DPLJkY2pgA► Amazon Music: https://music.amazon.com/podcasts/1874beb8-2a68-4310-8816-e704e6850995/HR-Party-of-One► iHeartRadio: https://www.iheart.com/podcast/269-hr-party-of-one-57127074/#► Pocket Casts: https://pca.st/o6e2auqq►RSS: https://feeds.captivate.fm/hrpartyofone/ ► Other: https://hrpartyofone.captivate.fm/listen#HR, #HumanResources, #HRTips, #HumanResourcesTips, #SmallBusiness, #HRPartyOfOne, #hsa, #hra

In this episode, Alan Silver, President of Centene's ICHRA-focused Ambetter Health Solutions, joins the Jakob Emerson to discuss the rapid evolution of individual coverage HRAs, why large and small employers are embracing the model, and what it takes for insurers to succeed in this growing space.

In this episode, Chase Cannon and Suzanne Spradley outline the latest proposed bill from the U.S. House of Representatives, potentially up for a vote in the coming weeks. Chase outlines a key element missing from the proposed bill ‒ caps, cuts, or elimination of the so-called employer tax exclusions for health insurance ‒ and explains why it's important for employer health plan sponsors. Chase and Suzanne spend the rest of the episode describing potential changes to HSAs and HRAs, including flexibility with HSA eligibility, increases on HSA contribution limits, and a new vehicle (called a “CHOICE arrangement”) for reimbursing an employee's individual policy premium.

Send us a textPS. Whenever you're ready, here are some ways we can help with reducing your taxes... Ready to slash your tax bill? Schedule your free consultation and let's strategize your tax savings together! Book now at: https://www.prosperlcpa.com/apply Or, if you still need more time, here are some other ways to begin winning the tax game...  Take our free Tax Planning Checklist & learn about what tax savings may be available for you in our minicourse at https://taxplanningchecklist.com  At the very least, get on our newsletter to gain access to free live events and exclusive insight you won't find anywhere else: https://www.prosperlcpa.com/newsletter-subscription Make the most of the available tax strategies for real estate investors and gain access to reliable guidance, expense templates and workpapers with our Essential Tax Planning for Real Estate Investors CourseWe explore powerful tax strategies involving HSAs and HRAs with Dan Pavic to transform medical expenses into significant tax benefits and wealth-building opportunities.• HSAs offer triple tax advantages: tax deduction for contributions, tax-free growth, and tax-free withdrawals for qualified expenses• Health Savings Accounts allow for investment opportunities and unlimited rollovers, making them effective wealth-building tools• Strategic HSA hack: pay medical expenses out-of-pocket, then reimburse yourself years later after funds have grown tax-free• HRAs provide unlimited reimbursement potential versus HSA's $7,000 annual contribution cap• Hiring your spouse creates a pathway for reimbursing family medical expenses through your business• C-Corporations offer unique advantages for health reimbursements due to owner/entity separation• You can combine HSAs and HRAs to maximize both unlimited deductions and tax-free growth• HRAs can serve as affordable alternatives to traditional health insurance for employees• Proper implementation requires formal documentation, compliant reimbursement procedures, and strategic entity structuringLearn more from Dan at: Dan.Pavek@tasconline.comGo to prosperlcpa.com/apply to explore how these strategies could fit your situation or email mark@prosperal.com for access to our upcoming workshop series on maximizing healthcare tax benefits.

In this episode, Council VP of Health Policy & Strategy Katie King sits down with Dave Kerrigan, founder and CEO of benefits solution aggregator BenefitPitch, to get his take on the trends driving brokers and employers to prioritize solutions that thread the needle on controlling costs and retaining employees. From AI in benefits to the growth of individual coverage HRAs, Kerrigan discusses which solutions are top of mind, which are falling out of favor, and where we might see the most trend growths in 2025.

In this episode of the Main Street Business Podcast, hosts Mark J. Kohler and Mat Sorensen break down the incredible tax advantages of Health Savings Accounts (HSAs). Learn how to save big with tax-deductible contributions, tax-free growth, and withdrawals for medical expenses, plus tips on FSAs, HRAs, and the IRA-to-HSA rollover strategy.Here are some of the highlights:Mark and Mat emphasize the importance of deducting 100% of health insurance premiums for self-employed individuals and S corporations.Reminder to use FSAs before the end of the year, including medical, co-pays, and dental expenses.An in-depth discussion on the ability to invest HSA funds in various assets, such as crypto, real estate, and small businesses.Explanation of the requirements for HSA qualifying plans, including high deductibles and out-of-pocket limits.HSAs do not require earned income for contributions, unlike IRAs and 401(k)s.Introduction to the HRA (Health Reimbursement Account) plan as an alternative for small business owners with high medical expenses.A strategy learned from the community, allowing S corporation owners to reduce FICA liability by having the corporation pay for HSAs. Grab my FREE Ultimate Tax Strategy Guide HERE! Are you ready to get certified in EVERY strategy I teach? Start your journey with a FREE 15-minute demo to explore the Main Street Tax Pro Certification. You don't want to miss this! Secure your tickets for the most significant tax & legal event of the year: Tax and Legal 360 Looking to connect with a rock star law firm? KKOS is only a click away! Check out our YOUTUBE Channel Here: https://www.youtube.com/markjkohler Craving more content? Check out my Instagram!

In this episode of The Move, host Larry Williams chats with Greg Gossett, Vice President of Client Success at Unlock Health, about the importance and impact of Health Risk Assessments (HRAs). Greg shares a personal story about how an HRA saved his father's life by identifying significant heart disease risk factors, which led to early intervention. They discuss how HRAs serve as personalized roadmaps that empower individuals to take control of their health by identifying risks and providing actionable recommendations. Additionally, they explore how HRAs can be effectively integrated into marketing strategies to generate high-quality leads and the importance of following up with participants to ensure seamless healthcare journeys. Greg also emphasizes best practices for data security and privacy, as well as emerging trends in the HRA space, including the role of AI and patient empowerment.

In episode 160, Coffey talks with Matt Morris about various health insurance options and strategies for employers, particularly small to medium-sized businesses. They discuss recent trends in health insurance cost increases; comparing traditional fully-insured plans to alternative funding methods; health savings accounts (HSAs) and health reimbursement arrangements (HRAs); level-funded and self-funded plans; captive insurance arrangements; reference-based pricing; the importance of employee education and communication; and criteria for selecting an insurance broker.Good Morning, HR is brought to you by Imperative—Bulletproof Background Checks. For more information about our commitment to quality and excellent customer service, visit us at https://imperativeinfo.com. If you are an HRCI or SHRM-certified professional, this episode of Good Morning, HR has been pre-approved for half a recertification credit. To obtain the recertification information for this episode, visit https://goodmorninghr.com. About our Guest:Matt is a Fort Worth native graduating from Aledo High School then Hardin-Simmons University where he obtained his BBA in Finance and Leadership, graduating with honors in 2002. He was a two-time NCAA All-American offensive lineman while working through college where he met his wife Sarah.  In 2006 Matt received his MBA from Texas Christian University while helping grow Gus Bates Insurance & Investments serving in operational, consulting, Team Lead and President roles from 2002-2020. In July of 2020 Gus Bates joined HUB in a very strategic move to merge 2 great offices within Fort Worth.  Matt then assumed the role of Area President and now leads the combined teams.  The HUB Fort Worth family is a passionate, energetic team with the guiding principle “Don't tell me how much you know, just show me how much you care.”  Matt leads by example.  He supports and encourages teams pushing themselves to “find the better way,” constantly.  He believes the "pursuit of excellence" is something that should never end!  Matt holds his Texas Life, Accident & Health, Texas Insurance Counselors, and Texas Property & Casualty licenses.  He also holds FINRA Series 7, Series 65, and Series 63 licenses, a Chartered Benefits Consultant Designation, among others.In his spare time, Matt enjoys spending time with his wife Sarah and two daughters, Lillian and Hannah.  As a family they enjoy anything outdoors, traveling, reading, coaching and competing in kids sports which often occupies their weekends.  They are active members of Christ Chapel Bible Church, part owners in the Aledo Volleyball Club, and Matt serves on numerous boards such as First Financial Bank's Advisory Board and Aledo's various Growth Committees, among others.Matt Morris can be reached at https://www.hubinternational.com/About Mike Coffey:Mike Coffey is an entrepreneur, human resources professional, licensed private investigator, and HR consultant.In 1999, he founded Imperative, a background investigations firm helping risk-averse companies make well-informed decisions about the people they involve in their business.Today, Imperative serves hundreds of businesses across the US and, through its PFC Caregiver & Household Screening brand, many more private estates, family offices, and personal service agencies.Mike has been recognized as an Entrepreneur of Excellence and has twice been named HR Professional of the Year. Additionally, Imperative has been named the Texas Association of Business' small business of the year and is accredited by the Professional Background Screening Association. Mike is a member of the Fort Worth chapter of the Entrepreneurs' Organization and volunteers with the SHRM Texas State Council.Mike maintains his certification as a Senior Professional in Human Resources (SPHR) through the HR Certification Institute. He is also a SHRM Senior Certified Professional (SHRM-SCP).Mike lives in Fort Worth with his very patient wife. He practices yoga and maintains a keto diet, about both of which he will gladly tell you way more than you want to know.Learning Objectives:1. Explore alternative funding methods like level-funded plans, self-funded plans, and captive arrangements to potentially reduce healthcare costs and increase flexibility.2. Implement effective employee communication strategies to educate staff about their health insurance options and the true costs of coverage.3. Evaluate insurance brokers based on their technological capabilities, customer service, and ability to provide ongoing education and support, rather than solely on premium rates.

In this episode of the Main Street Business Podcast, hosts Mark J. Kohler and Mat Sorensen unpack the advantages and disadvantages of putting your spouse on the payroll. They shed light on potential pitfalls, discuss savvy alternatives such as board roles and Roth IRAs, and highlight the benefits of Solo 401k contributions and HRAs.Here's what you can look forward to:Mark and Mat break down the common misconceptions about paying spouses.Additional payroll costs including FICA, Medicare, and unemployment taxes.The benefits of using board of directors/advisors roles for spouses.Outline of the advantages, including solo 401k contributions for spouses and maximizing retirement savings through payroll.Scenarios where spouses must be on payroll due to material participation.Ensuring compliance with tax laws and regulations. Are you ready to get certified in EVERY strategy I teach? Start your journey with a FREE 15-minute demo. You don't want to miss this! Secure your tickets for the most significant tax & legal event of the year: Tax and Legal 360 Curious what my new certification is all about? Learn More Looking to connect with a rock star law firm? KKOS is only a click away! Grab my FREE Ultimate Tax Strategy Guide HERE! Check out our YOUTUBE Channel Here: https://www.youtube.com/markjkohler Craving more content? Check out my Instagram!

On this episode of Ask Michelle, Michelle covers several health insurance topics such as PCORI fees, Section 1557 of the Affordable Care Act (ACA) and offers guidance on what to do if your organization's health plan experiences a data breach. Michelle answered questions regarding eligibility for health spending accounts under COBRA continuation, stand-alone HRAs for employees on spouse's plan, and employer reimbursement for individual plans. Curious about a compliance issue? Submit your questions to AskMichelle@imacorp.comand Michelle will answer them on the next episode.

In this episode of the ShiftShapers podcast, David Sloves, CEO of Nonstop Health, discusses the evolution and impact of Medical Expense Reimbursement Plans (MERPs) in the healthcare industry. He explains how MERPs differ from traditional health reimbursement arrangements (HRAs), HSAs, and FSAs by offering first-dollar coverage and customizable financial outcomes for both employers and employees. Sloves outlines the historical context of MERPs, their tax benefits, and how they aim to address the skyrocketing costs of healthcare and improve access to medical services. The conversation also covers the challenges of implementing MERPs, their role in enhancing employee satisfaction, recruitment, and retention, and the broader implications for the healthcare system in the United States. Through anecdotes and data, Sloves makes a case for MERPs as an ethical and effective solution to the current healthcare crisis.We wrap up by celebrating the successes of mission-driven companies in the healthcare industry, specifically how they've introduced advanced healthcare programs to employers. David Slove recounts overcoming initial skepticism and the strategies that led to significant financial benefits for clients, thanks to the MERP model. As we close, we reflect on the cascading impact of such inclusive healthcare initiatives. These efforts aren't just reshaping employee benefits—they're empowering businesses, stimulating the consulting community, and fostering a culture of retention and recruitment excellence from the heart of conservative states to the broader national arena.

Find out how HRAs work, are different from other medical savings options, and how to use one to dramatically cut the cost of healthcare and save more money.Money Girl is hosted by Laura Adams. A transcript is available at Simplecast.Have a money question? Send an email to money@quickanddirtytips.com or leave a voicemail at 302-365-0308.Find Money Girl on Facebook and Twitter, or subscribe to the newsletter for more personal finance tips.Money Girl is a part of Quick and Dirty Tips.Links: https://www.quickanddirtytips.com/https://www.quickanddirtytips.com/money-girl-newsletterhttps://www.facebook.com/MoneyGirlQDThttps://twitter.com/LauraAdamshttps://lauradadams.com/

ShownotesOn The Elephant in the Room podcast it has been my endeavour to spotlight leaders from the global majority. I recently had the privilege to speak with Taisha Nurse, Global Senior Director, Diversity Equity and Inclusion at McDermott. As a senior HR practitioner she has been responsible for building Centre's of Excellence across multiple geographies before moving to her current role in 2020. A role she loves the most and believes that her various experiences have prepared her to navigate the web of challenges and opportunities she faces in the course of her work.The focus of the conversation was on an industry well known for its lack of diversity, and to her her views a female leader on all things DEIB/A. We covered many interesting topics including

How the government, particularly the IRS, looks at exercise and diet versus weight loss drugs and other pharmaceuticals is discussed in this episode with Calley Means and Robert F. Kennedy Jr. Here is part of an official statement from the Internal Revenue Service website: WASHINGTON — Amid concerns about people being misled, the Internal Revenue Service recently reminded taxpayers and heath spending plan administrators that personal expenses for general health and wellness are not considered medical expenses under the tax law. This means personal expenses are not deductible or reimbursable under health flexible spending arrangements, health savings accounts, health reimbursement arrangements or medical savings accounts FSAs, HSAs, HRAs, and MSAs. This reminder is important because some companies are misrepresenting the circumstances under which food and wellness expenses can be paid or reimbursed under FSAs and other health spending plans. Some companies mistakenly claim that notes from doctors based merely on self-reported health information can convert non-medical food, wellness and exercise expenses into medical expenses, but this documentation actually doesn't. Such a note would not establish that an otherwise personal expense satisfies the requirement that it be related to a targeted diagnosis-specific activity or treatment; these types of personal expenses do not qualify as medical expenses. Full statement: https://www.irs.gov/newsroom/irs-alert-beware-of-companies-misrepresenting-nutrition-wellness-and-general-health-expenses-as-medical-care-for-fsas-hsas-hras-and-msas --- Send in a voice message: https://podcasters.spotify.com/pod/show/rfkjr/message

Health Reimbursement Arrangements, or HRAs, are a modern way for employers to provide health benefits to employees. Rather than a one-size-fits-all group plan — or leaving employees to cover all of the costs of the plan on their own — employers can now offer their employees a tax-free allowance to purchase benefits that meet their unique needs. Listen as we cover: [2:16] Balancing high cost & still providing for employees [5:53] A new benefits model & how to take advantage of it [8:18] What HRAs help solve for [10:30] How to know if HRAs are right for your specific situation [12:25] How to get started with an HRA & potential cost savings Copyright © 2023 ADP, Inc. All rights reserved. This content may not be distributed, reproduced, modified, sold or used without the written permission of ADP. The information is provided "as is" without any expressed or implied warranty, is based on generally accepted HR practices and is advisory in nature. This content is provided with the understanding that neither the presenters nor the writers are rendering legal advice or other professional services. Employers are encouraged to consult with legal counsel for advice regarding their organization's compliance with applicable laws. This material is current as of the date of this episode (November 2023).

Health insurance professionals who in the employer market are acutely aware of health reimbursement arrangements, commonly shortened to HRAs, and how they work. However, the world of individual coverage HRAs, or ICHRAs, is a relatively new form coverage that employers and brokers alike are still learning how to utilize effectively. On this week's episode of the Healthcare Happy Hour, sponsored by Remodel Health, NABIP's Dan Parker is joined by Justin Clemets co-founder and chief ICHRA officer, Travis Hall, VP of marketing, and John Staub, director of outreach, to discuss how ALEs can utilize ICHRAs, tailoring ICHRAs for various employee classes, broader potential of ICHRAs for different types of reimbursements, and how the Family Glitch fits into all this. Sponsored by Remodel Health

Dr. Tariq Arshad is the Senior Vice President and Chief Medical Officer at Qualigen Therapeutics, addressing multiple types of RAS-driven cancers. While researchers understand RAS's role in tumorgenesis and have identified which cancers are RAS-driven, RAS has been considered an undruggable target. With a pan-RAS approach inhibiting KRAS, HRAS and NRAS, the three isoforms of RAS, Qualigen is identifying drug candidates showing strong anti-tumor efficacy.    Tariq elaborates, "That was so difficult to do because when you look at the KRAS protein itself, it's a complicated, three-dimensional structure that constantly changes. The opening, or the aperture, where a small molecule can attach and inhibit the G12C moiety or specifically the cysteine amino acid, which is targeted by these inhibitors, it appears for a very, very short period of time. It's nothing short of a miracle of bioengineering, and specifically medicinal chemistry that we've been able to identify these inhibitors that can target that subcomponent, that very small aperture within the overall KRAS protein, without, as you're saying, impacting the function of the overall protein." "The field is moving towards understanding why this lack of durability exists and is trying to understand whether it's due to the emergence of other mutations, whether it's due to the emergence of wild-type RAS, or whether it's due to other factors. One of the theories that is emerging behind the emergence of this KRAS resistance is the fact that there are other RAS isoforms that exist in the same tumor. They allow a mechanism in which the tumorigenesis can bypass KRAS, even though it's inhibited, and signal into the cell to convert it into a cancer cell. It now becomes important for us to understand how we can address that potential mechanism of resistance." #QualigenInc #RAS #KRAS #RASDrivenCancer #Cancer  QualigenInc.com Download the transcript here

Dr. Tariq Arshad is the Senior Vice President and Chief Medical Officer at Qualigen Therapeutics, addressing multiple types of RAS-driven cancers. While researchers understand RAS's role in tumorgenesis and have identified which cancers are RAS-driven, RAS has been considered an undruggable target. With a pan-RAS approach inhibiting KRAS, HRAS and NRAS, the three isoforms of RAS, Qualigen is identifying drug candidates showing strong anti-tumor efficacy.    Tariq elaborates, "That was so difficult to do because when you look at the KRAS protein itself, it's a complicated, three-dimensional structure that constantly changes. The opening, or the aperture, where a small molecule can attach and inhibit the G12C moiety or specifically the cysteine amino acid, which is targeted by these inhibitors, it appears for a very, very short period of time. It's nothing short of a miracle of bioengineering, and specifically medicinal chemistry that we've been able to identify these inhibitors that can target that subcomponent, that very small aperture within the overall KRAS protein, without, as you're saying, impacting the function of the overall protein." "The field is moving towards understanding why this lack of durability exists and is trying to understand whether it's due to the emergence of other mutations, whether it's due to the emergence of wild-type RAS, or whether it's due to other factors. One of the theories that is emerging behind the emergence of this KRAS resistance is the fact that there are other RAS isoforms that exist in the same tumor. They allow a mechanism in which the tumorigenesis can bypass KRAS, even though it's inhibited, and signal into the cell to convert it into a cancer cell. It now becomes important for us to understand how we can address that potential mechanism of resistance." #QualigenInc #RAS #KRAS #RASDrivenCancer #Cancer  QualigenInc.com Listen to the podcast here

ICHRA Explained - Everything You Need to Know About Individual Coverage HRA's with Kyle Estep Self-Funded with Spencer, hosted by Spencer Smith, is a podcast for those looking to strategically navigate the complex landscape of health insurance. In this episode, Spencer speaks with guest Kyle Estep from Take Command Health. Kyle Estep is the VP of Growth for Take Command Health. Kyle spent 8 years of his career early on consulting for Deloitte, one of the top consulting firms in the world. He also spent a year in South Africa for Awethu, focused on identifying, developing, and investing in world-class entrepreneurs. He worked alongside the CEO & COO to launch the incubator in Johannesburg, South Africa. His insurance-specific career began at Oscar Health, which was based in New York, and he was hired to help launch their Texas business unit. Kyle built out the sales and distribution team there, helping them scale across the country. His time at Oscar initially led to meeting Jack Hooper, the CEO and Founder of Take Command Health, which offers HRAs for small business health insurance. Specifically, for this episode, we focused on the value of an ICHRA, also known as an Individual Coverage Health Reimbursement Account. An ICHRA is a way for an employer to give tax-free money to its employees so that they can find the health insurance plan that best suits their needs. ICHRAs allow an off-ramp for employers who no longer want to be tasked with managing the risk of a health plan on behalf of their employees, but who still want to provide them with financial support to purchase their desired plans. It is NOT fit for every situation and sometimes depends on the affordability and diversity of plans being offered on the individual market in that specific geographic location. This is where Take Command comes in, in not only consulting around the employer's goals but also analyzing what individual plans are available to benchmark against group health options the employer is quoting as well. In addition to this analysis, Take Command's special sauce is their service around the seamless transition to an ICHRA so that the members still feel supported by their employer. If you have ever wondered what an ICHRA was, what types of companies it works for, and how an employer goes about switching to this arrangement, then this is the episode for you! #SelfFunded #Deloitte #HealthInsurance #ConsumerProtection #ICHRA #Tax #ACA #IndividualMarket #SmallBusinesses #AffordableCareAct #TakeCommand #PublicPrivatePartnership #AdviserOptions --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

A new research paper was published in Oncotarget's Volume 14 on March 24, 2023, entitled, “Polyisoprenylated cysteinyl amide inhibitors deplete singly polyisoprenylated monomeric G-proteins in lung and breast cancer cell lines.” Finding effective therapies against cancers driven by mutant and/or overexpressed hyperactive G-proteins remains an area of active research. Polyisoprenylated cysteinyl amide inhibitors (PCAIs) are agents that mimic the essential posttranslational modifications of G-proteins. It is hypothesized that PCAIs work as anticancer agents by disrupting polyisoprenylation-dependent functional interactions of the G-Proteins. In their new study, researchers Nada Tawfeeq, Jassy Mary S. Lazarte, Yonghao Jin, Matthew D. Gregory, and Nazarius S. Lamango from Florida A&M University College of Pharmacy Pharmaceutical Sciences and Imam Abdulrahman bin Faisal University tested this hypothesis by determining the effect of the PCAIs on the levels of RAS and related monomeric G-proteins. “To investigate the hypothesized anticancer mechanisms of the PCAIs through disruption of G-protein function, we checked the effects of the PCAIs on the G-protein levels in lung cancer (A549 and NCI-H1299) and breast cancer (MDA-MB-231 and MDA-MB-468) cell lines.” Following 48 hours of exposure, they found significant decreases in the levels of KRAS, RHOA, RAC1, and CDC42 ranging within 20–66% after NSL-YHJ-2-27 (5 μM) treatment in all four cell lines tested, A549, NCI-H1299, MDA-MB-231, and MDA-MB-468. However, no significant difference was observed on the G-protein, RAB5A. Interestingly, 38 and 44% decreases in the levels of the farnesylated and acylated NRAS were observed in the two breast cancer cell lines, MDA-MB-231, and MDA-MB-468, respectively, while HRAS levels showed a 36% decrease only in MDA-MB-468 cells. Moreover, after PCAIs treatment, migration, and invasion of A549 cells were inhibited by 72 and 70%, respectively while the levels of vinculin and fascin dropped by 33 and 43%, respectively. Their results show that PCAIs deplete the protein levels of some significant G-proteins which are known to be involved in the migration and invasion of cells (i.e., metastasis) such as RAC1, RHOA, and CDC42. These findings implicate the potential role of PCAIs as anticancer agents through their direct interaction with monomeric G-proteins. “The initial findings presented here indicate how PCAIs can be used as potent agents in developing new anticancer therapeutics, therefore, more extensive studies need to be done to elucidate on its potency. Although we cannot conclusively explain the exact mechanism of action of PCAIs on how they affect the levels of some G-proteins yet, but we can say that these PCAIs have the ability to affect the progression of cancer.” Research paper: DOI: https://doi.org/10.18632/oncotarget.28390 Correspondence to: Nazarius S. Lamango - nazarius.lamango@famu.edu Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords: PCAIs, G-proteins, KRAS, RHOA, RAC1 About Oncotarget Oncotarget is a primarily oncology-focused, peer-reviewed, open access journal. Papers are published continuously within yearly volumes in their final and complete form, and then quickly released to Pubmed. On September 15, 2022, Oncotarget was accepted again for indexing by MEDLINE. Oncotarget is now indexed by Medline/PubMed and PMC/PubMed. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: SoundCloud - https://soundcloud.com/oncotarget Facebook - https://www.facebook.com/Oncotarget/ Twitter - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Media Contact MEDIA@IMPACTJOURNALS.COM 18009220957

ICHRA Explained - Everything You Need to Know About Individual Coverage HRA's with Kyle Estep Self-Funded with Spencer, hosted by Spencer Smith, is a podcast for those looking to strategically navigate the complex landscape of health insurance. In this episode, Spencer speaks with guest Kyle Estep from Take Command Health. Kyle Estep is the VP of Growth for Take Command Health. Kyle spent 8 years of his career early on consulting for Deloitte, one of the top consulting firms in the world. He also spent a year in South Africa for Awethu, focused on identifying, developing, and investing in world-class entrepreneurs. He worked alongside the CEO & COO to launch the incubator in Johannesburg, South Africa. His insurance-specific career began at Oscar Health, which was based in New York, and he was hired to help launch their Texas business unit. Kyle built out the sales and distribution team there, helping them scale across the country. His time at Oscar initially led to meeting Jack Hooper, the CEO and Founder of Take Command Health, which offers HRAs for small business health insurance. Specifically, for this episode, we focused on the value of an ICHRA, also known as an Individual Coverage Health Reimbursement Account. An ICHRA is a way for an employer to give tax-free money to its employees so that they can find the health insurance plan that best suits their needs. ICHRAs allow an off-ramp for employers who no longer want to be tasked with managing the risk of a health plan on behalf of their employees, but who still want to provide them with financial support to purchase their desired plans. It is NOT fit for every situation and sometimes depends on the affordability and diversity of plans being offered on the individual market in that specific geographic location. This is where Take Command comes in, in not only consulting around the employer's goals but also analyzing what individual plans are available to benchmark against group health options the employer is quoting as well. In addition to this analysis, Take Command's special sauce is their service around the seamless transition to an ICHRA so that the members still feel supported by their employer. If you have ever wondered what an ICHRA was, what types of companies it works for, and how an employer goes about switching to this arrangement, then this is the episode for you! #SelfFunded #Deloitte #HealthInsurance #ConsumerProtection #ICHRA #Tax #ACA #IndividualMarket #SmallBusinesses #AffordableCareAct #TakeCommand #PublicPrivatePartnership #AdviserOptions --- Support this podcast: https://podcasters.spotify.com/pod/show/spencer-harlan-smith/support

What challenges do product managers face in highly regulated industries like healthcare and finance? In this episode of the Product Thinking podcast, Melissa Perri speaks with Colin Anawaty about his journey to co-founding First Dollar and the challenges of navigating a highly regulated industry. Colin shares his insights on Health Savings Accounts (HSAs), the benefits of utilizing them, and why he thinks they should be more widely available to all Americans. He also discusses the importance of personal and career growth within startups, and the value of providing clear career paths to employees. He describes how First Dollar evolved into a platform, and how their focus on addressing healthcare inequities and tying together healthcare and finance can lead to incentivizing better outcomes for all.  Colin Anawaty is the Chief Product Officer of First Dollar, a health wallet platform that provides its services to plan administrators to help consumers utilize their health benefits more easily and effectively. Colin has over six years of experience in healthcare and previously worked in the prepaid industry. Before joining First Dollar, Colin worked at athenahealth, where he and Melissa first met. Colin is a product management expert with a strong focus on healthcare and finance and has a passion for helping people make the most of their healthcare benefits. Here are some ideas you'll hear Colin and Melissa discuss: Health Savings Accounts (HSAs) are a type of account created by the US government to make healthcare more affordable through pre-tax contributions. Unlike other benefits, such as FSAs and HRAs, HSAs can be kept even after leaving employment and can be invested for future use. Colin believes that HSAs should be more widely available to all Americans. The healthcare and finance industries are complex and highly regulated, and it can be challenging for product managers to become subject matter experts in both areas. Colin and his team learned about the industries by using resources such as industry experts and advisory boards, and they also hired people who had a mix of product management experience and expertise in either healthcare or finance. When hiring product managers for a startup, Colin looks for people who have the drive to learn and grow, and who have taken courses in product management. It's important to align product managers with the product lines they oversee and to focus on problem discovery and working with customers. Product managers need to be curious and open to learning about new things, especially when dealing with complexity. Formal training, subject matter experts, and nonprofit organizations can all help product managers get up to speed on regulations and compliance. Embedding security ops and compliance into the culture of a company can make it less scary and more manageable for everyone involved. Creating a consumer advisory board or incorporating customer engagement into terms of service can help companies navigate legal and compliance issues when trying to work directly with end users. Big companies prioritize change management and stability, while startups prioritize velocity and rapid iteration to achieve product-market fit. First Dollar started with a mission to help people shop for care but pivoted to become a platform for HSAs and FSAs. Resources: Colin Anawaty on LinkedIn | Twitter | Instagram  First Dollar

What challenges do product managers face in highly regulated industries like healthcare and finance? In this episode of the Product Thinking podcast, Melissa Perri speaks with Colin Anawaty about his journey to co-founding First Dollar and the challenges of navigating a highly regulated industry. Colin shares his insights on Health Savings Accounts (HSAs), the benefits of utilizing them, and why he thinks they should be more widely available to all Americans. He also discusses the importance of personal and career growth within startups, and the value of providing clear career paths to employees. He describes how First Dollar evolved into a platform, and how their focus on addressing healthcare inequities and tying together healthcare and finance can lead to incentivizing better outcomes for all.  Colin Anawaty is the Chief Product Officer of First Dollar, a health wallet platform that provides its services to plan administrators to help consumers utilize their health benefits more easily and effectively. Colin has over six years of experience in healthcare and previously worked in the prepaid industry. Before joining First Dollar, Colin worked at athenahealth, where he and Melissa first met. Colin is a product management expert with a strong focus on healthcare and finance and has a passion for helping people make the most of their healthcare benefits. Here are some ideas you'll hear Colin and Melissa discuss: Health Savings Accounts (HSAs) are a type of account created by the US government to make healthcare more affordable through pre-tax contributions. Unlike other benefits, such as FSAs and HRAs, HSAs can be kept even after leaving employment and can be invested for future use. Colin believes that HSAs should be more widely available to all Americans. The healthcare and finance industries are complex and highly regulated, and it can be challenging for product managers to become subject matter experts in both areas. Colin and his team learned about the industries by using resources such as industry experts and advisory boards, and they also hired people who had a mix of product management experience and expertise in either healthcare or finance. When hiring product managers for a startup, Colin looks for people who have the drive to learn and grow, and who have taken courses in product management. It's important to align product managers with the product lines they oversee and to focus on problem discovery and working with customers. Product managers need to be curious and open to learning about new things, especially when dealing with complexity. Formal training, subject matter experts, and nonprofit organizations can all help product managers get up to speed on regulations and compliance. Embedding security ops and compliance into the culture of a company can make it less scary and more manageable for everyone involved. Creating a consumer advisory board or incorporating customer engagement into terms of service can help companies navigate legal and compliance issues when trying to work directly with end users. Big companies prioritize change management and stability, while startups prioritize velocity and rapid iteration to achieve product-market fit. First Dollar started with a mission to help people shop for care but pivoted to become a platform for HSAs and FSAs. Resources: Colin Anawaty on LinkedIn | Twitter | Instagram  First Dollar

Listen in to Thomas's story this month, as he shares about being diagnosed with stage 4C medullary thyroid cancer in 2020 after having not been to the doctor in about 6 years. He shares about the difficult process of diagnosis, along with being told that he has metastasis in his spine/hips and that he has the HRAS mutation (which doctors have told him impact the ability for them to treat him). He is honest about continuing to have difficult emotional days, but has also found ways to cope with his diagnosis (he shares about finding others diagnosed with MTC, his support system, and cycling). He has plans to cycle across every US state before he dies, we are cheering for you Thomas!**Please be aware that Thomas shares in this episode about getting a bone biopsy without sedation (minutes 13:34-15:50).Please note: This podcast is unedited and represents the opinions, experiences and views of those speaking. Please consult your own medical doctor(s) or therapist for all matters involving your health and medical care.

Health insurance professionals, particularly those who work on the employer-sponsored end of things, are acutely aware of health reimbursement arrangements, or HRAs. But exactly how many and what types of employers are adopting and utilizing their HRAs? And what about the growth of other types of HRAs, including the relatively new individual coverage HRAs, or ICHRAS? On this week's episode of the Healthcare Happy Hour, we are joined by special guests Mark Mixer and Robin Paoli of the HRA Council to discuss the Council's inaugural report on growth trends for ICHRA and QSEHRA.

Health insurance professionals, particularly those who work on the employer-sponsored end of things, are acutely aware of health reimbursement arrangements, or HRAs. But exactly how many and what types of employers are adopting and utilizing their HRAs? And what about the growth of other types of HRAs, including the relatively new individual coverage HRAs, or ICHRAS? On this week's episode of the Healthcare Happy Hour, we are joined by special guests Mark Mixer and Robin Paoli of the HRA Council to discuss the Council's inaugural report on growth trends for ICHRA and QSEHRA.

Health insurance professionals, particularly those who work on the employer-sponsored end of things, are acutely aware of health reimbursement arrangements, or HRAs. But exactly how many and what types of employers are adopting and utilizing their HRAs? And what about the growth of other types of HRAs, including the relatively new individual coverage HRAs, or ICHRAS? On this week's episode of the Healthcare Happy Hour, we are joined by special guests Mark Mixer and Robin Paoli of the HRA Council to discuss the Council's inaugural report on growth trends for ICHRA and QSEHRA.

Dr. Vamsi Velcheti and Dr. Benjamin Neel, of the NYU Langone Perlmutter Cancer Center, and Dr. John Heymach, of MD Anderson Cancer Center, discuss new therapeutic approaches for KRAS-mutant lung cancers and therapy options for RAS-altered tumors.   TRANSCRIPT Dr. Vamsidhar Velcheti: Hello, I'm Dr. Vamsidhar Velcheti, your guest host for the ASCO Daily News podcast today. I'm the medical director of the Thoracic Oncology Program at Perlmutter Cancer Center at NYU Langone Health. I'm delighted to welcome two internationally renowned physician-scientists, Dr. John Heymach, the chair of Thoracic-Head & Neck Medical Oncology at the MD Anderson Cancer Center, and my colleague, Dr. Benjamin Neel, the director of the Perlmutter Cancer Center at NYU Langone Health, and professor of Medicine at NYU Grossman School of Medicine. So, we'll be discussing new therapeutic approaches today for KRAS-mutant lung cancers, and we will talk about emerging new targeted therapy options for RAS-altered tumors. Our full disclosures are available in the show notes, and the disclosures of all the guests of the podcast can be found on our transcript at: asco.org/podcast. Dr. Heymach and Dr. Neel, it's such a great pleasure to have you here for the podcast today. Dr. John Heymach: My pleasure to be here. Dr. Benjamin Neel: Same here. Dr. Vamsidhar Velcheti: Dr. Neel, let's start off with you. As you know, RAS oncogenes were first discovered nearly four decades ago. Why is RAS such a challenging therapeutic target? Why has it taken so long to develop therapeutic options for these patients? Dr. Benjamin Neel: Well, I think a good analogy is the difference between kinase inhibitors and RAS inhibitors. So, kinase inhibitors basically took advantage of an ATP-binding pocket that's present in all kinases, but is different from kinase to kinase, and can be accessed by small molecule inhibitors. So, the standard approach that one would've thought of taking, would be to go after the GTP-binding pocket. The only problem is that the affinity for binding GTP by KRAS is three to four orders of magnitude higher. So, actually getting inhibitors that are GTP-binding inhibitors is pretty much very difficult. And then, until recently, it was felt that RAS was a very flat molecule and there weren't any surfaces that you could stick a small molecule inhibitor in. So, from a variety of biochemical and medicinal-pharmacological reasons, RAS was thought to be impervious to small molecule development. But as is often the case, a singular and seminal insight from a scientist, Kevan Shokat, really broke the field open, and now there's a whole host of new approaches to trying to drug RAS. Dr. Vamsidhar Velcheti: So, Dr. Neel, can you describe those recent advances in drug design that have enabled these noble new treatments for KRAS-targeted therapies? Dr. Benjamin Neel: So, it starts actually with the recognition that for many years, people were going after the wrong RAS. And by the wrong RAS, the overwhelming majority of the earlier studies on the structure, and for that matter, the function of RAS centered on HRAS or Harvey RAS. We just mutated in some cancers, most prominently, bladder cancer, and head & neck cancer, but not on KRAS, which is the really major player in terms of oncogenes in human cancer. So, first of all, we were studying the wrong RAS. The second thing is that we were sort of thinking that all RAS mutants were the same. And even from the earliest days, back in the late eighties, it was pretty clear that there were different biochemical properties in all different RAS mutants. But this sort of got lost in the cause and in the intervening time, and as a result, people thought all RASes were the same and they were just studying mainly G12V and G12D, which are more difficult to drug. And then, the third and most fundamental insight was the idea of trying to take advantage of a particular mutation in KRAS, which is present in a large fraction of lung cancer patients, which is, KRAS G12C. So, that's a mutation of glycine 12 to cysteine and Kevan's really seminal study was to use a library of covalently adducting drugs, and try to find ways to tether a small molecule in close enough so that it could hit the cysteine. And what was really surprising was when they actually found the earliest hits with this strategy, which was actually based on some early work by Jim Wells at Sunesis in the early part of this century, they found that it was actually occupying the G12C state or the inactive state of RAS. And this actually hearkens back to what I said earlier about all RASes being the same. And in fact, what's been recently re-appreciated is that some RAS mutants, most notably, G12C, although they're impervious to the gap which converts the active form into the inactive form, they still have a certain amount of intrinsic ability to convert from the inactive form. And so, they always cycle into the inactive form at some slow rate, and that allows them to be accessed by these small molecules in the so-called Switch-II Pocket, and that enables them to position a warhead close enough to the cysteine residue to make a covalent adduct and inactivate the protein irreversibly. Scientists at a large number of pharmaceutical companies and also academic labs began to understand how to access various other pockets in RAS, and also even new strategies, taking advantage of presenting molecules to RAS on a chaperone protein. So, there's now a whole host of strategies; you have a sort of an embarrassment of riches from an impoverished environment that we started with prior to 2012. Dr. Vamsidhar Velcheti: Thank you, Dr. Neel. So, Dr. Heymach, lung cancer has been a poster child for personalized therapy, and we've had like a lot of FDA-approved agents for several molecularly-defined subsets of lung cancer. How clinically impactful is a recent approval of Sotoracib for patients with metastatic lung cancer? Dr. John Heymach: Yeah. Well, I don't think it's an exaggeration to say this is the biggest advance for targeted therapies for lung cancer since the initial discovery of EGFR inhibitors. And let me talk about that in a little more detail. You know, the way that lung cancer therapy, like a lot of other cancer therapies, has advanced is by targeting specific driver oncogenes. And as Dr. Neel mentioned before, tyrosine kinases are a large percentage of those oncogenes and we've gotten very good at targeting tyrosine kinases developing inhibitors. They all sort of fit into the same ATP pocket, or at least the vast majority of them now. There are some variations on that idea now like allosteric inhibitors. And so, the field has just got better and better. And so, for lung cancer, the field evolved from EGFR to ALK, to ROS1 RET fusions, MEK, and so forth. What they all have in common is, they're all tyrosine kinases. But the biggest oncogene, and it's about twice as big as EGFR mutation, are KRAS mutations. And as you mentioned, this isn't a tyrosine kinase. We never had an inhibitor. And the first one to show that it's targetable, to have the first drug that does this, is really such an important breakthrough. Because once the big breakthrough and the concept is there, the pharmaceutical companies in the field can be really good at improving and modulating that. And that's exactly what we see. So, from that original insight that led to the design of the first G12C inhibitors, now there's dozens, literally dozens of G12C inhibitors and all these other inhibitors based on similar concepts. So, the first one now to go into the clinic and be FDA-approved is Sotoracib. So, this again, as you've heard, is inhibitor G12C, and it's what we call an irreversible inhibitor. So, it fits into this pocket, and it covalently links with G12C. So, when it's linked, it's linked, it's not coming off. Now, the study that led to its FDA approval was called the CodeBreak 100 study. And this was led in part, by my colleague Ferdinandos Skoulidis, and was published in The New England Journal in the past year. And, you know, there they studied 126 patients, and I'll keep just a brief summary, these were all refractory lung cancer patients. They either had first-line therapy, most had both chemo and immunotherapy. The primary endpoint was objective response rate. And for the study, the objective response rate was 37%, the progression-free survival was 6.8 months, the overall survival was 12.5 months. Now you might say, well, 37%, that's not as good as an EGFR inhibitor or the others. Well, this is a much harder thing to inhibit. And you have to remember in this setting, the standard of care was docetaxel chemotherapy. And docetaxel usually has a response rate of about 10 to 13%, progression-free survival of about 3 months. So, to more than double that with a targeted drug and have a longer PFS really is a major advance. But it's clear, we've got to improve on this and I think combinations are going to be incredibly important now. There's a huge number of combination regimens now in testing. Dr. Vamsidhar Velcheti: Thank you, Dr. Heymach. So, Dr. Neel, just following up on that, unlike other targeted therapies in lung cancer, like EGFR, ALK, ROS, and RET, the G12C inhibitors appear to have somewhat modest, I mean, though, certainly better than docetaxel that Dr. Heymach was just talking about; why is it so hard to have more effective inhibitor of KRAS here? Is it due to the complex nature of RAS-mutant tumors? Or is it our approach for targeting RAS? Is it a drug-related problem, or is it the disease? Dr. Benjamin Neel: Well, the short answer is I think that's a theoretical discussion at this point and there isn't really good data to tell you, but I suspect it's a combination of those things. We'll see with the new RAS(ON) inhibitors, which seem to have deeper responses, even in animal models, if those actually work better in the clinic, then we'll know at least part of it was that we weren't hitting RAS hard enough, at least with the single agents. But I also think that it's highly likely that since KRAS-mutant tumors are enriched in smokers, and smokers have lots of mutations, that they are much more complex tumours, and therefore there's many more ways for them to escape. Dr. Vamsidhar Velcheti: Dr. Heymach, you want to weigh in on that? Dr. John Heymach: Yeah, I think that's right. I guess a couple of different ways to view it is the problem that the current inhibitors are not inhibiting the target well enough, you know, in which case we say we get better and better inhibitors will inhibit it more effectively, or maybe we're inhibiting it, but we're not shutting down all the downstream pathways or the feedback pathways that get turned on in response, in which case the path forward is going to be better combinations. Right now, I think the jury is still out, but I think the data supports that we can do better with better inhibitors, there's room to grow. But it is also going to be really important hitting these compensatory pathways that get turned on. I think it's going to be both, and it seems like KRAS may turn on more compensatory pathways earlier than things like EGFR or ALK2, you know, and I think it's going to be a great scientific question to figure out why that is. Dr. Vamsidhar Velcheti: Right. And just following up on that, Dr. Heymach, so, what do we know so far about primary and acquired resistance to KRAS G12C inhibitors? Dr. John Heymach: Yeah. Well, it's a great question, and we're still very early in understanding this. And here, if we decide to call it primary resistance - meaning you never respond in the first place, and acquired - meaning you respond and then become resistant, we're not sure why some tumors do respond and don't respond initially. Now, it's been known for a long time, tumors differ in what we call their KRAS-dependence. And in cell lines and in mouse models, when you study this in the lab, there are some models where if you block KRAS, those cells will die immediately. They are fully dependent. And there's other ones that become sort of independent and they don't really seem to care if you turn down KRAS, they've sort of moved on to other things they're dependent on. One way this can happen is with undergoing EMT where the cell sort of changes its dependencies. And EMT is probably a reason some of these tumors are resistant, to start with. It may also matter what else is mutated along with KRAS, what we call the co-mutations, the additional mutations that occur along with it. For example, it seems like if this gene KEAP1 is mutated, tumors don't respond as well, to begin with. Now, acquired resistance is something we are gaining some experience with. I can say in the beginning, we all knew there'd be resistance, we were all waiting to see it, and what we were really hoping for was the case like with first-generation inhibitors with EGFR, where there was one dominant mechanism. In the first-generation EGFR, we had one mutation; T790M, that was more than half the resistance. And then we could develop drugs for that. But unfortunately, that's not the case. It looks like the resistance mechanisms are very diverse, and lots of different pathways can get turned on. So, for acquired resistance, you can have additional KRAS mutations, like you can have a KRAS G12D or V, or some other allele, or G13, I didn't even realize were commonly mutated, like H95 or Y96 can get mutated as well. So, we might be able to inhibit with better inhibitors. But the more pressing problem is what we call bypass; when these other pathways get turned on. And for bypass, we know that the tumor can turn on MET with MET amplification, NRAS, BRAF, MAP kinase, and we just see a wide variety. So, it's clear to us there isn't going to be a single easy to target solution like there was for EGFR. This is going to be a long-term problem, and we're going to have to work on a lot of different solutions and get smarter about what we're doing. Dr. Vamsidhar Velcheti: Yeah. Thank you very much, Dr. Heymach. And Dr. Neel, just following up on that, so, what do you think our strategies should be or should look like while targeting KRAS-mutant tumors? Like, do we focus on better ways to inhibit RAS, or do we focus on personalized combination approaches based on various alterations or other biomarkers? Dr. Benjamin Neel: Yeah. Well, I'd like to step back a second and be provocative, and say that we've been doing targeted therapies, so to speak, for a long time, and it's absolutely clear that targeted therapies never cure. And so, I think we should ask the bigger question, "Why is it that targeted therapies never cure?" And I would start to conceive of an answer to that question by asking which therapies do cure. And the therapies that we know do cure are immune therapies, or it's therapies that generate durable immune response against the tumor. And the other therapies that we know that are therapies in some cases against some tumors, and radiation therapy in some cases against some tumors. Probably the only way that those actually converge on the first mechanism I said that cures tumors, which is generating a durable immune response. And so, the only way, in my view, it is to durably cure an evolving disease, like a cancer, is to have an army that can fight an evolving disease. And the only army I know of is the immune system. So, I think ultimately, what we need to do is understand in detail, how all of these different mutations that lead to cancer affect immune response and create targetable lesions in the immune response, and then how the drugs we'd give affect that. So, in the big picture, the 50,000-foot picture, that what we really need to spend more attention on, is understanding how the drugs we give and the mutations that are there in the first place affect immune response against the tumor, and ultimately try to develop strategies that somehow pick up an immune response against the tumor. Now in the short run, I think there's also lots of combination strategies that we can think of, John, you know, alluded to some of them earlier. I mean one way for the G12C inhibitors, getting better occupancy of the drug, and also blocking this so-called phenomenon of adaptive resistance, where you derepress the expression of receptor tyrosine kinases, and their ligands, and therefore bypass through normal RAS or upregulate G12C into the GTP state more, that can be attacked by combining, for example, with the SHIP2 inhibitor or a SOS inhibitor. Again, the issue there will be therapeutic index. Can we achieve that with a reasonable therapeutic index? Also in some cases, like not so much in lung cancer, but in colon cancer, it appears as if a single dominant receptor tyrosine kinase pathway, the EGF receptor pathway, is often the mechanism of adaptive resistance to RAS inhibitors, and so, combining a RAS inhibitor with an EGF receptor inhibitor is a reasonable strategy. And then of course, some of the strategies they're already getting at, what I just mentioned before, which is to try to combine RAS inhibitors with checkpoint inhibitors. I think that's an expected and understandable approach, but I think we need to get a lot more sophisticated about the tumor microenvironment, and how that's affecting the immune response. And it's not just going to be, you know, in most cases combining with a checkpoint inhibitor. I think we ought to stop using the term immunotherapy to refer to checkpoint inhibitors. Checkpoint inhibitors are one type of immunotherapy. We don't refer to antibiotics when we mean penicillin. Dr. Vamsidhar Velcheti: Dr. Heymach, as you know, like, there's a lot of discussion about the role of KRAS G12C inhibitors in the frontline setting. Do you envision these drugs are going to be positioning themselves in the frontline setting as a combination, or like as a single agent? Are there like a subset of patients perhaps where you would consider like a single agent up front? Dr. John Heymach: So, I think there's no question G12C inhibitors are moving to the first-line question. And the question is just how you get there. Now, the simplest and most straightforward approach is to say, “Well, we'll take our standard and one standard might be immunotherapy alone, a PD-1 inhibitor alone, or chemo with the PD-1 inhibitor, and just take the G12C inhibitor and put it right on top.” And that's a classic strategy that's followed. That may not be that simple. It's not obvious that these drugs will always work well together or will be tolerated together. So, I think that's still being worked out. Now, an alternative strategy is you could say, “Well, let's get a foot in a door in the first-line setting by finding where chemotherapy and immunotherapy don't work well, and pick that little subgroup.” There are some studies there using STK11-mutant tumors, and they don't respond well to immunotherapy and chemotherapy and say, “Well, let's pick that first.” And that's another strategy, but that's not to get it for everybody in the first-line setting. That's just to pick a little subgroup. Or we may develop KRAS G12C inhibitor combinations by themselves that are so effective they can beat the standard. So, what I think is going to happen is a couple things; I think they'll first be some little niches where it gets in there first. I think eventually, we'll figure out how to combine them with chemotherapy and immunotherapy so it goes on top. And then I think over time, we'll eventually develop just more effective, targeted combos where we can phase out the chemo, where the chemo goes to the back of the line, and this goes to the front of the line. Dr. Vamsidhar Velcheti: And Dr. Heymach, any thoughts on the perioperative setting and the adjuvant/neoadjuvant setting, do you think there's any role for these inhibitors in the future? Dr. John Heymach: Yeah, this is a really exciting space right now. And so that makes this a really challenging question because of how quickly things are moving. I'll just briefly recap for everybody. Until recently, adjuvant therapy was just chemotherapy after you resected a lung cancer. That was it. And it provided about a 5% benefit in terms of five-year disease-free survival. Well, then we had adjuvant immunotherapy, like atezolizumab, approved, then we had neoadjuvant chemo plus immunotherapy approved; that's a CheckMate 816. And just recently, the AEGEAN study, which I'm involved with, was announced to be a positive study. That's neoadjuvant plus adjuvant chemo plus immunotherapy. So now, if you say, well, how are you going to bring a G12C inhibitor in there? Well, you can envision a few different ways; if you can combine with chemo and immunotherapy, you could bring it up front and bring it afterwards, or you could just tack it in on the back, either with immunotherapy or by itself, if you gave neoadjuvant chemo plus immunotherapy first, what we call the CheckMate 816 regimen. So, it could fit in a variety of ways. I'll just say neoadjuvant is more appealing because you can measure the response and see how well it's working, and we in fact have a neoadjuvant study going. But the long-term benefit may really come from keeping the drug going afterwards to suppress microscopic metastatic disease. And that's what I believe is going to happen. I think you're going to need to stay on these drugs for a long while to keep that microscopic disease down. Dr. Vamsidhar Velcheti: Dr. Neel, any thoughts on novel agents in development beyond KRAS G12C inhibitors? Are there any agents or combinations that you'd be excited about? Dr. Benjamin Neel: Well, I think that the YAP/TAZ pathway inhibitors, the TEAD inhibitors in particular, are potentially promising. I mean, it seems as if the MAP kinase pathway and the GAPT pathway act in parallel. There's been multiple phases which suggest that YAP/TAZ reactivation can be a mechanism of sort of state-switching resistance. And so, I think those inhibitors are different than the standard PI3 kinase pathway inhibitor, PI3 kinase mTOR inhibitor, rapamycin. I also think as we've alluded to a couple of times, the jury's still out in the clinic, of course, but it'll be very exciting to see how this new set of RAS inhibitors works. The sort of Pan-RAS inhibitors, especially the ones that hit the GTP ON state. So, the G12C inhibitors and the initial preclinical G12D inhibitors that have been recorded, they all work by targeting the inactive state of RAS, the RAS-GDP state. And so, they can only work on mutants that cycle, at least somewhat, and they also don't seem to be as potent as targeting the GTP or active state of RAS. And so, at least the Rev meds compounds, which basically use cyclophilin, they basically adapt the mechanism that cyclosporine uses to inhibit calcineurin. They basically use the same kind of a strategy and build new drugs then that bind cyclophilin and present the drug in a way that can inhibit multiple forms of RAS. So, it'll be interesting to see if they are much more efficacious in a clinic as they appear to be in the lab, whether they can be tolerated. So, I think those are things to look out for. Dr. Vamsidhar Velcheti: Dr. Heymach? Dr. John Heymach: Yeah, I agree with that. I'm excited to see that set of compounds coming along. One of the interesting observations is that when you inhibit one KRAS allele like G12C, you get these other KRAS alleles commonly popping up. And it's a little -- I just want to pause for a second to comment on this, because this is a little different than EGFR. If you inhibit a classic mutation, you don't get multiple other separate EGFR alleles popping up. You may get a secondary mutation in cyst on the same protein, but you don't get other alleles. So, this is a little different biology, but I think the frequency that we're seeing all these other KRAS alleles pop up tells us, I think we're going to need some pan-KRAS type strategy as a partner for targeting the primary driver. So for example, a G12C inhibitor plus a pan-KRAS strategy to head off these other alleles that can be popping up. So, I think that's going to be probably a minimum building block that you start putting other things around. And by partnering an allele-specific inhibitor where you might be able to inhibit it a little more potently and irreversibly with a pan-KRAS, you may solve some of these problems at the therapeutic window. You can imagine KRAS is so important for so many different cells in your body that if you potently inhibit all KRAS in your body, bad things are likely to happen somewhere. But if you can potently inhibit the mutant allele and then dampen the other KRAS signaling that's popping up, it's more hopeful. Dr. Benjamin Neel: There is a mouse model study from Mariano Barbacid's lab, which suggests that postnatal, KRAS at least, complete inhibition is doable. So, you could take out KRAS postnatally and the mice are okay. Whether that translates to human of course, is not at all clear. And you still have the other RAS alleles, the HRAS, the NRAS that you'd still have to contend with. Dr. John Heymach: Yeah, it's an interesting lesson. We've shied away from a lot of targets we thought weren't feasible. I did a lot of my training with Judah Folkman who pioneered targeting angiogenesis. And I remember hearing this idea of blocking new blood vessels. I said, "Well, everyone is just going to have a heart attack and die." And it turns out you can do it. You have to do it carefully, and in the right way but you can separate malignant or oncogenic signaling from normal signaling in an adult, pretty reasonably in a lot of cases where you don't think you could. Dr. Vamsidhar Velcheti: All right. So, Dr. Neel, and Dr. Heymach, any final closing comments on the field of RAS-targeted therapies, you know, what can we hope for? What can patients hope for, let's say five years from now, what are we looking at? Dr. John Heymach: Well, I'll give my thoughts I guess first, from a clinical perspective, I think we're already seeing the outlines of an absolute explosion in targeting KRAS over the next five years. And I think there's a really good likelihood that this is going to be the major place where we see progress, at least in lung cancer, over these next five years. It's an example of a problem that just seemed insolvable for so long, and here I really want to acknowledge the sustained support for clinical research and laboratory research focused around RAS. You know, the NCI had specific RAS initiatives and we've had big team grants for KRAS, and it shows you it's worth these large-scale efforts because you never know when that breakthrough is going to happen. But sometimes it just takes, you know, opening that door a little bit and everybody can start rushing through. Well, I think for KRAS, the door has been opened and everybody is rushing through at a frantic rate right now. So, it's really exciting, and stay tuned. I think the landscape of RAS-targeting is going to look completely different five years from now. Dr. Benjamin Neel: So, I agree that the landscape will definitely look different five years from now, because it's reflective of stuff that's been in process for the last five years. And it takes about that long to come through. I want to make two comments; one of which is to slightly disagree with my friend, John, about these big initiatives. And I would point out that this RAS breakthrough did not come from a big initiative, it came from one scientist thinking about a problem uniquely in a different way. We need a basic science breakthrough, it almost always comes from a single lab person, thinking about a problem, often in isolation, in his own group. What big initiatives can help with is engineering problems. Once you've opened the door, and you want to know what the best way is to get around the house, then maybe big initiatives help. But I do think that there's been too much focus on the big team initiative and not enough on the individual scientists who often promote the breakthrough. And then in terms of where I see the field going, what I'd really like to see, and I think in some pharmaceutical companies and biotechs, you're seeing this now, and also in academia, but maybe not enough, is that sort of breaking down of the silos between immunotherapy and targeting therapy. Because I agree with what John said, is that targeted therapy, is just sophisticated debulking. If we want to really make progress-- and on the other hand, immunotherapy people don't seem to, you know, often recognize that these oncogenic mutations in the tumor actually affect the immune system. So, I think what we need is a unification of these two semi-disparate areas of therapeutics in a more fulsome haul and that will advance things much quicker. Dr. Vamsidhar Velcheti: Thank you both, Dr. Neel and Dr. Heymach, for sharing all your valuable insights with us today on the ASCO Daily News podcast. We really appreciate it. Thank you so much. Dr. John Heymach: Thanks for asking us. Dr. Benjamin Neel: It's been great having us. Dr. Vamsidhar Velcheti: And thank you all to our listeners, and thanks for joining us today. If you value our insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review and subscribe. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Vamsi Velcheti @VamsiVelcheti Dr. Benjamin Neel @DrBenNeel Dr. John Heymach Want more related content? Listen to our podcast on novel therapies in lung cancer.    Advances in Lung Cancer at ASCO 2022 Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Vamsi Velcheti: Honoraria: Honoraria Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline Dr. Benjamin Neel: None disclosed Dr. John Heymach: None disclosed    

In this episode, the Huddle Guys talk with Mark J. Kohler , a CPA, attorney, author, and podcast host. Mark is a Senior Partner at Kyler, Kohler, Ostermiller & Sorenson, LLP. He is also Fonder & CFO of Directed IRA, and a Senior Partner for Kohler & Eyre CPAs, LLP. Whew…when does Mark sleep?!? Listen as the Huddle Guys and Mark discuss ways to save on healthcare costs via Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). In many regards, these are resources are underutilized tools; opportunities to save money are missed. They share information that is helpful to both tax preparer and tax payers. They also revisit topics related to the Inflation Reduction Act (IRA) which they believe will not save the average tax payer any money, especially if you are deemed to make too much money. (Checkout Episode 55 for more information about the IRA.) As usual, the Huddle Guys also have lots of fun with their guest, who also believes in the ‘mythical' Big Foot. Another first for this podcast! It's time to Huddle Up!

Medicare Advantage (MA), otherwise known as the “money machine,” is often the most profitable parts of many payers' business lines. Medicare Advantage plans can make a lot of cash if they are good at what they do. Look at any of these large, consolidated carriers' financial statements to get the magnitude of that statement. Also, in 2022, Medicare Advantage plans have enrolled 28 million participants between them, which represents 45% of all Medicare beneficiaries. This marks a three-point improvement in penetration over 2021 and a total program enrollment growth of 9%.   All of this is not a secret. So, what's happening right now is that this administration is looking carefully at Medicare Advantage plans and what they have been up to. We have had an amping up of government oversight, including regulatory actions and program audits. In this healthcare podcast, I am speaking with Betsy Seals, who is CEO and cofounder of Rebellis Group, which is a managed care consulting firm working with Medicare Advantage plans. Betsy says (and this is what we talk about in the interview) that there's three main areas that the government is currently scrutinizing: Sales and marketing. There have been these third parties, it seems, these field marketing organizations who were hired to do marketing and sales for some of the Medicare Advantage plans. And because they were third parties, it seems that many of them felt themselves to be excluded from CMS (Centers for Medicare & Medicaid Services) regulations and able to basically mislead prospective members with sales pitches that were highly suspect. Betsy gives some examples of these, and when you hear them, you will see why CMS is cracking down. Recouping improper payments is another area that CMS is all over. Interestingly, as Betsy Seals says in this interview, this might be one area where the government is actually ahead of private sector plans from a technology and analytic standpoint. CMS seems to have better analytics capabilities and is better at detecting fraud schemes and improper payments than the plans themselves. These plans are not sophisticated enough to notice stuff that CMS detects when it gets ahold of the plan data. But as unusual as this situation is where the government is ahead of the business sector, I can't say I'm shocked. We have had one guest on this show after another talking about just how far in the past some of these health plans are lagging. Dan O'Neill probably said it most eloquently and notably (EP359).   But I digress. So, recouping improper payments has the eye of CMS. This means two things largely. It means finding “outlier” codes that some MA plan paid for but which are clearly errors and should not have been paid. Another improper payment is when plans themselves do a little fancy upcoding so that they make more money than they should in their risk-adjustment payments. This has gotten some major attention lately. Let me quote from an OIG (Office of Inspector General) report:   “Our findings raise concerns about the extent to which certain MA companies may have inappropriately leveraged both chart reviews and HRAs [health risk assessments] to maximize risk-adjusted payments. We found that 20 of the 162 MA companies drove a disproportionate share of the $9.2 billion in payments from diagnoses that were reported only on chart reviews and HRAs, and on no other service records.” The sneaky idea here to get more money than they should from taxpayers is that someone somewhere puts down that a member has major depressive disease because someone somewhere said they did. But the patient clearly doesn't have major depressive disease because they aren't getting any treatment for it and nothing anywhere would indicate that they are suffering from a major depressive disease. So, the plan winds up getting more money from the government to care for a patient who is suffering from major depressive disease, but the patient doesn't require any additional care because they don't have major depressive disease. It's a great way to make some dollars for shareholders that is coming right out of the pockets of taxpayers. In sum, the #2 area of additional oversight is recouping improper payments either from paying claims that should not have been paid for or by wild upcoding. This is just kinda like the general sort of compliance oversight that CMS does, meaning grievances and appeals and formulary administration and models of care for SNP plans (special needs plans), compliance program effectiveness—normal stuff like this—which will be interesting given all of the articles coming out right now about how patients on Medicare Advantage plans are less likely to get more costly diabetes treatments and how often there's denials for cancer care or NCI cancer centers aren't covered, etc. One point of note here that's kind of thought-provoking on a few levels: If you're an MA plan, it is super important for you to get members in for their annual screenings. For one, CMS requires that you document diagnoses each year; and you need to do this to reduce the chances that CMS will question a treatment being paid for because there's no underlying diagnosis to support it—and these diagnoses must be re-upped every year. Recall what I was just talking about re: improper payments and fraud schemes. If a patient isn't diagnosed with something, then why are taxpayers paying for its treatment? Also risk adjustment ... if you wanna upcode, it's not a bad idea to have a diagnosis documented in multiple different ways so that when the OIG/CMS/DOJ comes knocking, you can have your ducks in a row. Getting patients in for their annual screenings is how you can safely upcode. Further, one more reason why getting patients in for annual screenings matters to MA plans, member experience counts for an increasing piece of star ratings. Patients who never see their doctor and never interact with the plan don't usually give the plan they have nothing to do with stellar marks—and besides that, these members are tough to retain. Last big deal for an MA plan to get members in for their annual is this is when the doc gets into screening for care gaps, which is also part of star measures. All this about annual screenings is a bit of a sidebar, but it is kind of interesting to contemplate as we get into the conversation today about government oversight. (For a meme on this topic, check out this Tweet from Rik Renard.) My guest, as I mentioned earlier, is Betsy Seals. Listen to our conversation about how MA plans are in the hot seat right now. Later in the fall, Betsy will be coming back to talk about trends in the Medicare Advantage marketplace. You can learn more at rebellisgroup.com.   Betsy Seals is the CEO and cofounder of Rebellis Group, a consulting firm established to provide advisory and hands-on services to Medicare Advantage Organizations (MAOs) and their subcontractors. Betsy is a nationally recognized leader in the managed care industry with over 20 years of experience. Betsy brings to the table a solid mix of leadership and business acumen, as well as regulatory and strategic knowledge within the managed care landscape. Betsy's expertise is focused in the areas of mergers and acquisitions, compliance, sales and marketing, strategy, supplemental benefit landscape, innovative benefit design that address social determinants of health, and health plan operations. Prior to founding Rebellis Group, Betsy served as the chief consulting officer for Gorman Health Group (GHG). In this role, Betsy managed the Medicare consulting practice, including implementation of strategic initiatives, development of new practice areas, and oversight of day-to-day consulting operations. Prior to her role as chief consulting officer, Betsy served as senior vice president, compliance operations, where she assisted MAOs and Part D sponsors to attain and maintain compliance with the Centers for Medicare & Medicaid Services (CMS) regulations and guidance by conducting risk assessments, preparing organizations for CMS audits, performing mock CMS audits, and creating and implementing internal and delegated entity oversight programs. Before joining GHG, Betsy worked for MAOs, where she served in customer service and compliance with responsibility for creation and implementation of oversight programs, CMS audit preparation, implementation of internal corrective action plans, and the day-to-day management of compliance operations. Betsy has also worked as a CMS subcontractor to conduct CMS Compliance Program audits. 08:15 What's happening with sales and marketing in the healthcare industry? 11:04 What's happening with the focus on recouping improper payments? 13:32 “When you look at the fundamentals of it, these are federal dollars. And what we're talking about is federal dollars that were paid when they should not have been paid.” 15:39 Are improper claim payments an administrative problem, or something more intentional? 16:20 “The health plan has a responsibility to catch those issues.” 20:10 What are specialty pharmacy prescriptions being scrutinized for? 22:12 “If this is where CMS is headed … the health plan should've already been doing this.” 23:58 Why do you see a bigger focus on social determinants of health? 25:54 Do these health plan audits actually have any teeth? 27:01 What is the biggest penalty a health plan can face from an audit? 29:57 “Navigating the Medicare program … was near to impossible. I know the program, and even for me, it was hours and hours and hours and hours on the phone.” You can learn more at rebellisgroup.com.   @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth What's happening with sales and marketing in the healthcare industry? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth What's happening with the focus on recouping improper payments? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth “When you look at the fundamentals of it, these are federal dollars. And what we're talking about is federal dollars that were paid when they should not have been paid.” @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth Are improper claim payments an administrative problem, or something more intentional? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The health plan has a responsibility to catch those issues.” @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth What are specialty pharmacy prescriptions being scrutinized for? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If this is where CMS is headed … the health plan should've already been doing this.” @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why do you see a bigger focus on social determinants of health? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth Do these health plan audits actually have any teeth? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is the biggest penalty a health plan can face from an audit? @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Navigating the Medicare program … was near to impossible. I know the program, and even for me, it was hours and hours and hours and hours on the phone.” @betsyseals of @GroupRebellis discusses #MedicareAdvantage plans on our #healthcarepodcast. #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento  

Little help, please! There is so much to unpack when it comes to deciding if reimbursement benefits are right for you – and which option to choose. Reimbursement benefits offset expenses by setting aside pre-tax funds to pay for account-eligible expenses. FSAs, HSAs, and HRAs have a lot of rules around them that can make a reimbursement account tricky to use. Jolene and Sara are joined by resident-expert Prisilla who helps us figure out what to ask HR or your plan administrator so we can all use our plans better.

Every organization wants to provide quality benefits to their staff, but when it comes to healthcare there are too many options! This week on The Balance, Amy speaks with benefits wizard Chuck Newman about navigating the sea of PEOs and HRAs to make the best choice for you and your team. Further Resources: Amy Karson - Chief Executive Officer, Brand K Partners https://www.brandkpartners.com/ Chuck Newman - President and Managing Partner, Charles Newman Co. https://www.charlesnewman.com/

This week's episode is sponsored by PeopleKeep, who helps businesses offer hassle-free health benefits to their employees. Angela is joined by JD Cleary, VP of Marketing Development at PeopleKeep, to discuss how the company can greatly help out businesses and their employees, how JD got started in his own career, and how he focuses.  Many employers cannot offer traditional group benefits because of their high, unpredictable cost; complexity to manage; and lack of employee choice. HRAs are a simple, cost-efficient way to provide health benefits to employees. Be sure to visit PeopleKeep.com today to get started with them for your own business!

Today's episode of The Broker Link Podcast is about How to use a Health Reimbursement Arrangement to purchase insurance. This is a replay of a webinar Mike Smith of the Brokerage hosted with Kyle Estep with Take Command Health.  They run through how this works.  If you have any questions, you can email Kyle at Kyle@takecommandhealth.com. Or visit www.thebrokerageinc.com to learn more.    

Wise health care strategies when you have an entity formed. This podcast will speak on different health care strategies entrepreneurs utilize with their small business like HSA and HRAs. DreamAgain HSA https://livelyme.pxf.io/DreamAgain https://dreamagain-metaverse.mn.co/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Medicare's annual election period marketing season is now underway as NAHU continues to work closely with CMS officials to resolve the significant challenges of the revised Medicare Plan Finder. On this week's episode, NAHU's Marcy M. Buckner and John Greene discuss the role that NAHU is playing in this process and how NAHU members can join us in working towards a solution. This episode also includes a regulatory roundup of President Trump's latest healthcare executive order, new guidance on the individual coverage and excepted benefit HRAs, and our comments to the hospital transparency proposed rule.

The Trump Administration released its final rule on the expansion of health reimbursement arrangements last week that established new individual-coverage HRAs and excepted-benefit HRAs. This week, NAHU's Marcy Buckner and Chris Hartmann join us to review the nearly-500 page final regulation and key compliance considerations for employers and brokers to keep in mind, along with the remaining concerns NAHU has with the final regulation that we raised in formal comments submitted to the proposed rule. The episode also looks into the possibility of the rule facing legal hurdles that could undermine its full implementation, as well as a recap of the ongoing legal challenges to the association health plan and short-term plan final rules.