Podcasts about Managed care

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Larragem Raines, MS, director of research at the Center for Innovation & Value Research, about her organization's open-source value model for major depressive disorder (MDD). She also defines dynamic pricing and explains how it is incorporated into the MDD value model, topics she expands upon in a recent contributor article. Looking ahead, Raines discusses the potential of artificial intelligence (AI) to improve diagnosis, treatment, and access in the MDD space.

On this episode of Managed Care Cast, The American Journal of Managed Care® speaks with Brady Post, PhD, assistant professor at Northeastern University and lead author of a study published in this month's issue. His study, "Impact of Hospital-Physician Integration on Medicare Patient Mix," found no evidence that hospital-employed physicians treated a higher proportion of complex patients, at least among those enrolled in traditional Medicare. During the conversation, Post shares the inspiration behind his research, key findings, and areas for further investigation.

Today we are bringing you a conversation the use of continuous glucose monitoring technology and its transformative potential in diabetes care. Davida Kruger, a certified nurse practitioner at Henry Ford in the division of endocrinology, spoke with Jaime Murillo, MD, senior vice president and chief medical officer, medical affairs, United Health Group; Jeremy Wigginton, MD, chief medical officer at a regional Blue plan; Ian Neeland, MD, director of cardiovascular prevention, University Hospitals Harrington Health and Vascular Institute, and associate professor of medicine, Case Western Reserve University School of Medicine; and Ken Cohen, MD, executive director of translational research, Optum Health. The topics of conversation for today's podcast include how CGM addresses therapeutic inertia, enhances glycemic control, and drives improvements in patient outcomes and health care efficiency, as well as the barriers to adoption, strategies for expanding access, and the cost effectiveness of CGM implementation.

Send us a textWhen you hear "managed care" in audiology, what comes to mind? In this eye-opening conversation between Dr. Douglas Beck and Dr. Noël Crosby, the troubling reality of third-party payment systems in hearing healthcare takes center stage.Dr. Crosby, a three-time president of the Florida Academy of Audiology with decades of clinical experience, pulls back the curtain on how managed care administrators position themselves between patients, insurance companies, and audiologists – often to the detriment of comprehensive patient care. The discussion reveals how Medicare Advantage plans, now covering roughly half of all Medicare recipients, frequently fail to deliver on their marketed hearing benefits.The most concerning revelation? Many third-party payers operate under the false assumption that everyone with hearing difficulties simply needs hearing aids. This fundamentally misunderstands audiology's scope of practice. As Dr. Beck points out, approximately 26 million Americans have perfectly normal hearing thresholds but struggle with speech comprehension in noisy environments – issues that require specialized testing beyond basic screenings.Both experts share compelling insights about the limitations of "free hearing tests," the inadequacy of quick screenings, and the ethical problems with viewing every patient as a potential device sale rather than someone deserving comprehensive care. The conversation turns particularly insightful when discussing tinnitus management, highlighting how third-party payment systems often prevent patients from accessing treatments that could significantly improve their quality of life.For anyone navigating hearing healthcare, whether as a patient, provider, or caregiver, this episode provides crucial perspective on a system that often prioritizes profit over patient outcomes. The Academy of Doctors of Audiology's recent call for major reforms in hearing healthcare coverage underscores the urgency of rethinking how we value and deliver audiological services.Listen now to understand why the future of hearing healthcare depends on recognizing audiologists as healthcare providers first – not simply as hearing aid dispensers. Your hearing deserves more than a quick screening and a sales pitch.While we know all hearing aids amplify sounds to help you hear them, Starkey Genesis AI uses cutting-edge technology designed to help you understand them, too.Click here to find a provider near you and test drive Starkey Genesis AI! Connect with the Hearing Matters Podcast TeamEmail: hearingmatterspodcast@gmail.com Instagram: @hearing_matters_podcast Twitter: @hearing_mattasFacebook: Hearing Matters Podcast

St. Jude Evening of Hope Gala with proceeds going to the St. Jude Research Hospitals will be on May 3rd, 5:30pm at the Omni Hotel in OKC. (See flyer and link below for more information.) I learned so much from the show Saint Judes was originally established in 1962 by Danny Thomas and continues to be ran by his daughter Marlo Thomas, who still is on the board stay tuned to the fantastic show and the Saint Jude evening of Hope gala that you can get involved in through your corporation, your business your services or individually.ClaudiaMy name is Claudia Al-Botros and I am a healthcare administrator for Psychiatric Care Solutions. I am a dedicated mother, and wife as well as an advocate for St. Jude Children's Research Hospital. I currently serve on the St. Jude Committee in Oklahoma City, giving back and making a meaningful impact in the lives of children battling cancer. I am passionate about fundraising and advocacy, ensuring that St. Jude continues its mission of providing lifesaving treatment to children at no cost to their families.Calbotros@aol.com405-924-3231________________DanetteDanette Mondalek has over 27 years of experience in healthcare administration and is the Oklahoma Regional Director of Managed Care at SSM Health, focusing on payer contracting. She excels in strategic negotiations and team building, enhancing healthcare systems' efficiencies. Passionate about quality care for seniors and at-risk populations, she actively supports various community organizations and promotes accessible healthcare for all.dmondalek@hotmail.com405-250-0430

Let us know what you think - send us a textAre you building a medical career… or just working in one? STOP leaving money, autonomy, and fulfillment on the table.In this episode of The Independent Physician's Blueprint, we explore how one physician broke away from the traditional medical grind and transformed a podiatry career into a thriving business—without ever being taught how in medical school. Through an engaging story of two physicians with the same name and a twist of fate, you'll uncover how business savvy, financial clarity, and managed care knowledge can reshape your medical future. You'll learn:How strategic cash flow planning can help physicians regain control and reduce stress.Why mastering the business side of medicine—IPAs, managed care, and niche specialization—can multiply your income.What it really takes to build a sustainable, burnout-resistant medical practice from the ground up.It's time to stop operating like an employee and start thinking like a physician-entrepreneur. Hit play now and learn how to reclaim your practice, your profits, and your purpose. Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans.

While tariffs continue to dominate headlines, our Global Head of Fixed Income Research and Public Policy Strategy Michael Zezas suggests investors should also focus on the sectoral impacts of additional U.S. policy choices.----- Transcript -----Welcome to Thoughts on the Market. I'm Michael Zezas, Morgan Stanley's Global Head of Fixed Income Research and Public Policy Strategy. Today, we'll be talking about U.S. policy impacts on the market that aren't about tariffs.It's Wednesday, March 12th, at 10:30am in New York.If tariffs are dominating your attention, we sympathize. Again this week we heard the U.S. commit to raising tariffs and work out a resolution, this time all within the span of a workday. These twists and turns in the tariff path are likely to continue, but in the meantime it might make sense for investors to take some time to look away – instead focusing on some key sectoral impacts of U.S. policy choices that our Research colleagues have called out. For example, Andrew Percoco, who leads our Clean Energy Equity Research team, calls out that clean Energy stocks may be pricing in too high a probability of an Inflation Reduction Act (IRA) repeal. He cites a letter signed by 18 Republicans urging the speaker of the house to protect some of the energy tax credits in the IRA. That's a good call out, in our view. Republicans' slim majority means only a handful need to oppose a legislative action in order to block its enactment. Another example is around Managed Care companies. Erin Wright, who leads our Healthcare Services Research Effort, analyzed the impact to companies of cuts to the Medicaid program and found the impact to their sector's bottom line to be manageable. So, keeping an in-line view for the sector. We think the sector won't ultimately face this risk, as, like with the IRA, we do not expect there to be sufficient Republican votes to enact the cuts. Finally, Patrick Wood, who leads the Medtech team, caught up with a former FDA director to talk about how staffing cuts might affect the industry. In short, expect delays in approvals of new medical technologies. In particular, it seems the risk is most acute in the most cutting edge technologies, where skilled FDA staff are hard to find. Neurology and brain/computer interfaces stand out as areas of development that might slow in this market sector. All that said, if you just can't turn away from tariffs, we reiterate our guidance here: Tariffs are likely going up, even if the precise path is uncertain. And whether or not you're constructive on the goals the administration is attempting to achieve, the path to achieving them carries costs and execution risk. Our U.S. economics team's recent downgrade of the U.S. growth outlook for this and next year exemplifies this. Thanks for listening. If you enjoy the show, please leave us a review wherever you listen and share Thoughts on the Market with a friend or colleague today.

Managed Care Incentive Payment Program: Data Analytics Manager Chris Magee recaps a new LLA report that evaluates the Louisiana Department of Health's design and oversight of the Medicaid Managed Care Incentive Payment Program, which totaled $2.39 billion from September 2019 through March 2024. | https://LLA.La.gov/go/podcast

Managed Care Incentive Payment Program: Data Analytics Manager Chris Magee recaps a new LLA report that evaluates the Louisiana Department of Health's design and oversight of the Medicaid Managed Care Incentive Payment Program, which totaled $2.39 billion from September 2019 through March 2024. | https://LLA.La.gov/go/podcast

On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.

Every Gen X'er listening to this is gonna be singing that Clash song in your head for the rest of the day. So, let's turn our attention to Medicare Advantage policy. And on the show today, I grill the one and only Betsy Seals to find out which policies she thinks are going to stay and which are going to go. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Obviously, this is very much in the context of a new administration and also just other things that are going on. But today we talk about the following four “stay or go” policy areas. Here's the first policy area we talk about: changes and activities within the Stars program. How will the Medicare Advantage Stars program change or not? Not only with this new administration, but also there are lawsuits and how they will impact the goings-on moving forward. Second policy, will it stay or will it go, that we talk about is risk adjustment and all of the activity in government oversight and focus on recoupment of improper payments as kind of the overarching bucket and what will be the incoming administration's method around risk adjustment. This is certainly on many people's minds. The third “will it stay or will it go” policy that we discuss is the use of AI (artificial intelligence) by Medicare Advantage plans. What does the appropriate oversight of the use in AI look like? Lots of talk about those prior auth AI algorithms and the high levels of denied care. A big topic of everybody's collective mind is looking at how to ensure that oversight is appropriate and that we're using AI for good and that it's not having any adverse impact. So that's the third will it stay or will it go. Fourth, and lastly, the whole agent broker realm—additional CMS and government oversight over misleading or inaccurate information coming from the marketing or the agent broker marketing world. How will that look in 2025 and moving forward? This last one, I'm kind of all over the nuance there after reading posts and comments by Samantha George, and I would recommend following her on LinkedIn would be my suggestion. I am reflecting back on the Ann Kempski episode (EP444), where we talk about the whole, really consider the downstream impact when making any policy changes, because there can be unintended consequences. Now, in a show about carriers—in this case, Medicare Advantage carriers—I'd be pretty tone deaf not to mention the nation's ire at carriers at this exact moment in time, some of it extremely well earned and some of it reflective of an extremely dysfunctional healthcare system. I'd also be tone deaf not to mention the MedPAC (Medicare Payment Advisory Commission) report, which states that Medicare Advantage plans receive payments from CMS that are 122% of spending for similar beneficiaries in traditional Medicare. This translates to an estimated $83 billion in higher spending in 2024. And I would lastly be remiss not to mention how Medicare Advantage plans are most carriers' most profitable service lines, with average earnings of around $1800 per enrollee. All of what I said is not some kind of grand revelation, of course, to most listeners of this show. And it's also not the topic of the conversation today, although some of this did get asked and answered in the earlier shows (EP387, EP375, EP291) with Betsy Seals. One thing I will remind everyone about is that there are regional carriers that are not the big five who may or may not be doing big five types of things. And also, it is actually really difficult to run a Medicare Advantage plan successfully. They call it risk for a reason. One thing I really appreciated about the conversation with Betsy Seals that follows is her advice to contemplate value to the patient and make sure that anybody working on the carrier side, you have enough of a bead on what's actually happening to be able to identify when things are going off the rails, which does not seem to be the case in some instances. This also, by the way, having a bead on what's actually happening on the ground, helps to ensure compliance and that's piece of advice two. Last piece of advice is to learn how to be proactive and not reactive. And this is eminently more possible vis-à-vis data that's available and learning how to use it well. Betsy Seals, my guest today, has had a very busy last couple of years since she was on Relentless Health Value the last time. Betsy is CEO and co-founder of Rebellis Group, a managed care consulting firm focused specifically in Medicare Advantage. Rebellis was actually acquired in February of 2024 and joined as a family of a couple of other consulting firms that now Betsy heads up. So, in short, she's really busy. Also mentioned in this episode are Samantha George; Ann Kempski; Rebellis Group; and Vivian Ho, PhD.   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   Betsy Seals is the CEO of Alerion Advisors, a family of companies dedicated to delivering unparalleled consulting services across the healthcare spectrum. As a parent organization, Alerion Advisors unites three specialized firms—Rebellis Group, Advent Advisory, and Toney Healthcare—to provide health plans and their partners with comprehensive, innovative, and results-driven solutions. With over 25 years of experience in the managed care industry, Betsy is a nationally recognized leader known for her regulatory expertise and strategic insights. 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 (SDoH), and health plan operations.   05:09 Will the Star Ratings program stay in this new administration? 08:08 How will the lawsuits against CMS policies play out with this new administration? 10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive? 16:22 How does AI directly impact beneficiary lives? 21:38 What's going on now with the override payments? 27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward? 31:45 Why is it important to become more technologically savvy in compliance?   You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn.   @betsyseals discusses #medicareadvantage policies on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher    

Howie and Harlan are joined by Sachin Jain, CEO of the nonprofit Scan Health Plan, who argues that the managed care industry must dramatically reorient itself towards patient care. Harlan looks at the long-term health effects of the L.A. wildfires and an effort to replace the widely used body-mass index; Howie reflects on the growing mistrust of doctors and its connection to declining vaccination rates. Links: Wildfires and Health “Los Angeles wildfires: Firefighters face several more critical hours of Wednesday's dangerous winds” “Health Effects Attributed to Wildfire Smoke” “Long-term exposure to wildfire smoke associated with higher risk of death” Redefining Obesity “Definition and diagnostic criteria of clinical obesity” “Move aside BMI: There's a better way to define obesity, commission finds” “New obesity definition sidelines BMI to focus on health” “New Obesity Definition Challenges Current Use of B.M.I.” Toward a More Humane Managed Care Industry Scan Health Plan Sachin Jain: “The Path Forward for the Health Insurance Industry” Sachin H. Jain: “The path forward for the US Health Insurance Industry begins with saying “We Are Sorry” Sachin Jain: “In 2025, I urge you to start seeing things clearly” Sachin Jain: “What It Really Takes to Listen to Patients” “Lyft is driving patients to see their doctors and saving insurers big money” Trust and Vaccinations “Americans' Ratings of U.S. Professions Stay Historically Low” “Childhood Vaccination Rates Were Falling Even Before the Rise of R.F.K. Jr.” “Falling Child Vaccinations” Health & Veritas Episode 95 with Peter Hotez “Meta to end fact-checking, replacing it with community-driven system akin to Elon Musk's X” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Jeff Margolis, founder of TriZetto, joins Julie Yoo, a16z Bio + Health general partner, to share the journey of building an iconic company in healthcare infrastructure. From the early days of managed care to creating a three-pronged platform uniting computing power, software, and data analytics, Jeff reflects on TriZetto's groundbreaking model that reshaped payer-provider transactions and set industry standards. Together, they also delve into the strategic importance of scaling through acquisitions, aligning with industry standards, and crafting innovative pricing models.

The editors in chief of The American Journal of Managed Care® discuss the key managed care research and news from 2024 and look forward to the journal's upcoming 30th anniversary.

Today we are bringing you a conversation on treatment with Bruton tyrosine kinase inhibitors for patients with treatment-naïve chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL). Ryan Haumschild, PharmD, MS, MBA, CPEL, vice president of ambulatory pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with 3 experts: Tara Graff, DO, medical oncologist, Mission Cancer and Blood; Jacqueline Barrientos, MD, MS, chief, Hematologic Malignancies, and director, Oncology Research at Mount Sinai Comprehensive Cancer Center; and Matthew Davids, MD, MMSc, director of Clinical Research, Division of Lymphoma, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School. They covered a wide range of topics including the data on treatment regimens for both CLL and MCL, the cost of treatment, patient-specific considerations during treatment decision making, and the future of treatment.

Send us a textAdministrative hassles and mountains of paperwork remain some of the biggest challenges in healthcare today.Every day, critical time and resources are diverted from doctors, nurses, and other medical staff to navigate inefficient prior authorizations and overwhelming paperwork. Isn't it time we find a better solution?In this episode of CareTalk, David E. Williams and John Driscoll sit down with Anterior Founder and CEO Abdel Mahmoud to explore the burden of administrative tasks on healthcare and how AI can bring clarity and efficiency to the chaos.This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.TOPICS(0:28) Sponsorship(1:40) Dr. Abdel Mahmoud's Military Experience(3:05) The Personal Journey of Dr. Abdel Mahmoud(5:35) Understanding Large Language Models(7:59) The Journey of Anterior(10:49) AI's Role in Managed Care(14:22) How Anterior is Different(15:52) How Anterior Uses Language Learning Models(20:27) The Future of Anterior(22:42) Using AI as Support(24:01) How Anterior Differentiates from the Competition(26:15) The Future of AI in Healthcare

Today we are bringing you insights from 3 separate interviews with experts about the treatment, management, and burdens of idiopathic pulmonary fibrosis (IPF). In this podcast, you'll hear insight from the following individuals: Toby Maher, MD, PhD, professor of clinical medicine, Keck School of Medicine, USC; Martin Kolb, MD, PhD, professor of medicine, McMaster University; and Steven Nathan, MD, FCCP, medical director of the Advanced Lung Disease Program and Lung Transplant Program, Inova Fairfax Hospital, and professor of medicine, University of Virginia. These experts discuss what IPF is, how it impacts patients' quality of life, barriers to care, and treatments in the pipeline.

In this special episode of Managed Care Cast, the executive editor of The American Journal of Managed Care, Mary Caffrey, speaks with Tyler Sandahl, PharmD, of Cleveland Clinic, and Michael Byrne, DO, of Tennessee Oncology, about the use of bispecific antibodies to treat patients with multiple myeloma, the importance of caregivers for this regimen, how the entire staff plays a role, the common adverse events patients need to be looking out for, and more.

In episode 123 of The Business of Healthcare Podcast, attorneys-at-law Lawrence Laddaga and Dale Turner of the law firm Laddaga-Garrett, P.A, join host Dan Karnuta for a discussion about Medicare Advantage plans in Medicare. They discuss its history, its problems and its future. Laddaga is Attorney At Law-Founder-President; and Turner is an associate attorney at Laddaga-Garrett, P.A., a law firm that provides legal services for the healthcare industry. Karnuta is director of the Professional Program in Healthcare Management at The University of Texas at Dallas Naveen Jindal School of Management.

Hormones are essential for our overall health. At Million Marker, we test urine to determine levels of BPA, phthalates, parabens, and other hormone-disrupting chemicals in a person's body. Then, we help people try to limit those exposures in hopes of finding hormonal balance. Over the last few months, we've created a lot of educational content about thyroid health, including an intro to thyroid health with Dr. Paria Vaziri. There is so much information to take in when it comes to hormone health, it's hard to do it all in one IG Live. That's why we're talking about thyroid health a little more in-depth today, with a focus on Hashimoto's. 14 million people have Hashimoto's Disease. That's why we're so glad to be joined by Dr. Autoimmune Girl, Donna Mazzola, with us today! Donna Mazzola is a Clinical Pharmacist with extensive experience in Managed Care and Integrated Delivery Systems. She is also the author of the upcoming book, the Immunity Food Fix, which you can purchase by clicking our Link In Bio and tapping on our post promoting this IG Live. Learn more about Donna's services: https://linktr.ee/drautoimmunegirl Get tested for BPA, phthalates, parabens, and other hormone-disrupting chemicals with Million Marker's Detect & Detox Test Kit: https://www.millionmarker.com/

How Albertsons Is Making Grocery Retail a Health & Wellness Destination (#363) Irina Pelphrey, VP of Health and Managed Care for Albertsons, discusses how grocery retail can become a health and wellness destination. If you thought you knew what grocery retailers were capable of when it comes to health and wellness, you're going to get a lot out of this conversation as Irina connects the dots between food as medicine, prevention, medication adherence, behavior change, and ultimately lifestyle modification.  All that, plus the Flava of the Week about Amazon Pharmacy expanding same-day delivery of medications. What can we learn from their expansion, and how can we double down on simple consumer insights in other areas of health and wellness journeys?  Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

We spend a lot of time griping about the insidious power of corporate health insurance in our healthcare system here. But you would expect that taxpayer funded public programs for our most vulnerable friends and neighbors are free from profiteering right?  Sadly, no. Medicaid - the public program that serves the lowest income Americans, plus some people with disabilities, and a lot of the country's long-term care - has been extensively privatized in most states. Hoping to trim budgets, most states have outsourced Medicaid recipients to “Medicaid Managed Care Organizations,” which are actually private insurance companies. And with private insurance comes the barriers to care we know all too well, like prior authorizations, denial of claims, and narrow networks. These are all part of the private insurance/public programs business model: the more care they avoid paying for, the more money from those capitated payments they get to keep. But today we have a rare ray of sunshine: a state showing there's another way to provide care, not just coverage, to some of their most vulnerable residents. In 2012 Connecticut kicked the private insurance-run Managed Care Organizations out of their Medicaid program. They took on Big Insurance and won. Our guest today will walk us through how it went down. Sheldon Toubman has been a litigation attorney for Disability Rights Connecticut since 2021, and a leader of the efforts to remove Managed Care Organizations from the state's Medicaid program. Before that, he was a staff attorney with New Haven Legal Assistance Association (NHLAA), where he spent 30 years representing and working on behalf of Medicaid enrollees. He engages in a variety of strategies on behalf of people with disabilities, from litigation to legislative advocacy and public education through media, webinars and other means. https://www.youtube.com/watch?v=zM7dRzHkVu0&t=1804s Show Notes Sheldon tells us that before 2012, Connecticut's Medicaid program was bifurcarted: eligible kids, pregnant people, and families were in a capitated Managed Care Organization (MCO) model and people with disabilities were in a fee-for-service program. (Medicaid is funded with federal dollars, but unlike Medicare, states design the programs and make all the decisions about plans.) With a fee-for-service model, the state takes on the risk. With the MCO model, the MCO receives a per-person/per-month fee (a "capitated payment") from the state, and they have to provide the care; if the patient requires less care, the MCO keeps the money, but if the patient requires more care, the MCO has to pay for the amount above the per-person/per-month fee. MCOs had a financial incentive to deny care so they could recoup more money. Beginning in the late 1990s, Medicaid advocates began a campaign of lawsuits and lobbying to remove Managed Care from their Medicaid program. Hartford, Connecticut is known as the insurace capital of the US, so this was a tough fight. Insurance companies fought this campaign because public programs are a major profit center for insurers, often more profitable than private employer-sponsored insurance. The insurance industry claimed they provided excellent care for less money, and coordinated care in a way that's not possible with the fee-for-service model. The insurance industry also ran ads about all the jobs they provide, and legislators were afraid to tangle with them. When the state asked for data about how the MCOs spent public dollars, they refused to provide it. So advocates only had anecdotal information, and it was hard to refute the claims the MCOs made about how well they served patients. One of the anecdotal complaints they heard the most was the lack of access to providers. Advocates convinced the state to check the insurance company provider network lists, so the state instituted a Secret Shopper survey to analyze them. They found that patients could get an appointment with supposed in-netw...

One year ago, on October 30, 2023, President Joe Biden signed an executive order laying the groundwork both for how federal agencies should responsibly incorporate artificial intelligence (AI) within their workflows and how each agency should regulate the use of AI in the industries it oversees. What has happened in the past year, and how might things change in the next? On this episode, Epstein Becker Green attorneys Lynn Shapiro Snyder, Eleanor Chung, and Rachel Snyder Good reflect on what is new in health care AI as a result of the 2023 executive order and discuss what industry stakeholders should be doing to comply and prepare for future federal regulation of AI in health care. Article – HTI-1 final rule: https://www.healthlawadvisor.com/oncs-information-blocking-enhancements-under-the-hti-1-rule-are-in-effect Article – HTI-2 proposed rule: https://www.healthlawadvisor.com/as-the-window-for-comments-closes-on-onc-astps-hti-2-proposed-rule-whats-in-hti-2-and-what-does-it-mean-for-you Webinar – New Final Regulation Prohibiting Algorithmic Discrimination by Health Care Providers and Payers: https://www.ebglaw.com/insights/events/new-final-regulation-prohibiting-algorithmic-discrimination-by-health-care-providers-and-payers Webinar – Demystifying AI Tools in Health Care, An Introduction for Federal Policymakers: https://www.ebglaw.com/insights/events/alliance-for-health-policy-demystifying-ai-tools-in-health-care-an-introduction-for-federal-policymakers Visit our site for related resources and email contact information: https://www.ebglaw.com/dhc83. Subscribe for email notifications: https://www.ebglaw.com/subscribe. Visit: http://diagnosinghealthcare.com. This podcast is presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

Joe Russell, Vice President of Network Management and Contracting at Strategic Healthcare shares his invaluable perspective on how community-based providers can thrive despite the dominance of managed care plans and the ever-present issues of fraud, waste, and abuse.Our conversation uncovers the influence of pivotal regulatory shifts, such as the Affordable Care Act and CMS initiatives, on managed care. We navigate the delicate balance between cost containment and quality care, addressing critical challenges like authorization limits and the impact of timely payments on providers. As we look to the horizon, our dialogue transitions into the evolving dynamics of provider-payer relationships, where data-driven quality metrics take center stage. The burgeoning landscape of managed Medicare Advantage plans demands a new level of collaboration between payers and providers, with an emphasis on trust and innovative cost-containment solutions. We explore the significance of aligning with metrics like star ratings and rehospitalization rates to enhance opportunities and reimbursement. Value-based care in post-acute settings is poised for growth, and providers must lead the charge by understanding their costs and crafting compelling value propositions for managed care plans. Join us as we chart the course for the future of healthcare, where collaboration and strategic partnerships will redefine success.Visit our websiteConnect with us - LinkedIn, Twitter, YouTube, FacebookMake Lives Better

California 2024 ballot propositions - BallotpediaProposition Analysis (ca.gov)2024 California ballot measures: What you need to know (calmatters.org)Ballot Measures - League of Women Voters of California | Education Fund (cavotes.org)

CJ Dietzman welcomes Tara Albin to the Alliant Cyber team and explores her background in the managed care industry, specifically focusing on how cyber risks have impacted the insurance market. They also discuss her prediction for the future of the cyber market and the current threat actors and key controls organizations can implement such as MFA, EDR solutions, email filtering, employee education and incident response plans.

Our US Public Policy Strategist explains the potential impact of the upcoming presidential election on the healthcare sector, including whether the outcome is likely to drive a major policy shift.----- Transcript -----Welcome to Thoughts on the Market. I'm Ariana Salvatore, Morgan Stanley's US Public Policy Strategist. Along with my colleagues bringing you a variety of perspectives, today I'll focus on what the US election means for healthcare. It's Tuesday, September 17th at 10am in New York. Around elections what we tend to see is voters rank healthcare pretty high among their priority list. And for that reason it's not surprising that it generates significant debate as well as investor concern – about everything from drug pricing to potential sweeping reforms. We think that the 2024 election is unlikely to transform the US healthcare system. But there are still policies to watch that could change depending on the outcome. We outlined these in a recent note led by our equity research colleagues Erin Wright and Terence Flynn. To start, we think bipartisan policies should continue uninterrupted, regardless of the election outcome. Certain regulations requiring drug price and procedural transparency, for example, which affect hospitals and health plans, are unlikely to change if there is a shift of power next year. We've seen some regulations from the Trump era kept in place by the Biden administration; and similarly during the former president's term there were attempts at bipartisan legislation to modify the Pharmacy Benefit Management model. There are some healthcare policies that could be changed through the tax code, including the extension of the COVID-era ACA subsidies. In President Biden's fiscal year [20]25 budget request, he called for an extension of those enhanced subsidies; and Vice President Kamala Harris has proposed a similar measure. As we've said before on this podcast, we think tax policy will feature heavily in the next Congress as lawmakers contend with the expiring Tax Cuts and Jobs Act. So many of these policies could come into the fold in negotiations. Aside from these smaller potential policy changes, we think material differences to the healthcare system as we know it right now are a lower probability outcome. That's because the creation of a new system - like Medicare for All or a Public Option - would require unified Democratic control of Congress, as well as party unanimity on these topics. Right now we see a dispersion among Democrats in terms of their views on this topic, and the presence of other more motivating issues for voters; mean[ing] that an overhaul of the current system is probably less likely. Similarly, in a Republican sweep scenario, we don't expect a successful repeal of the Affordable Care Act as was attempted in Trump's first administration. The makeup of Congress certainly is important, but there are some actions that the President can leverage unilaterally to affect policy here. For example, former President Trump issued several executive orders addressing transparency and the PBM model. If we look at some key industries within Healthcare, our equity colleagues think Managed Care is well positioned heading into this relatively more benign election cycle. Businesses and investors are focusing on candidates' approaches to the Medicare Advantage program and the ACA Exchange, which has subsidies set to expire at the end of 2025. Relative to prior elections, Biopharma should see a lower level of uncertainty from a policy perspective given that the Inflation Reduction Act, or the IRA, in 2022 included meaningful drug pricing provisions. We also think a full-scale repeal of the IRA is unlikely, even in a Republican sweep scenario. So, expect some policy continuity there. Within Biotech, the path to rate cuts is likely a more significant driver of near-term Small and Mid-Cap sentiment rather than the 2024 election cycle. Our colleagues think that investors should keep an eye on two election-related factors that could possibly impact Biotech including potential changes to the IRA that may impact the sector and changes at the FTC, or the Federal Trade Commission, that could make the M&A environment more challenging. As always, we will continue to keep you abreast of new developments as the election gets closer. Thanks for listening. If you enjoy the show, please leave us a review wherever you listen to podcasts and share Thoughts on the Market with a friend or colleague today.

We've all heard the rhetoric. The US has the best health care in the world. That's true for some who can afford to pay for it. But on average, that's not true.  On today's show we are going to look at a report published by the Commonwealth Fund a little over a year ago. It was also reported in the American Journal of Managed Care earlier this year.  Now you might wonder why we would focus on this on a real estate podcast. Well, it's because anywhere there are problems, there is a solution waiting to be implemented. Often, any large scale solution has a real estate component to it.  According to the Commonwealth Fund report, United States experiences the worst health outcomes overall of any high-income nation. ------------- **Real Estate Espresso Podcast:** Spotify: [The Real Estate Espresso Podcast](https://open.spotify.com/show/3GvtwRmTq4r3es8cbw8jW0?si=c75ea506a6694ef1)   iTunes: [The Real Estate Espresso Podcast](https://podcasts.apple.com/ca/podcast/the-real-estate-espresso-podcast/id1340482613)   Website: [www.victorjm.com](http://www.victorjm.com)   LinkedIn: [Victor Menasce](http://www.linkedin.com/in/vmenasce)   YouTube: [The Real Estate Espresso Podcast](http://www.youtube.com/@victorjmenasce6734)   Facebook: [www.facebook.com/realestateespresso](http://www.facebook.com/realestateespresso)   Email: [podcast@victorjm.com](mailto:podcast@victorjm.com)  **Y Street Capital:** Website: [www.ystreetcapital.com](http://www.ystreetcapital.com)   Facebook: [www.facebook.com/YStreetCapital](https://www.facebook.com/YStreetCapital)   Instagram: [@ystreetcapital](http://www.instagram.com/ystreetcapital)  

Nikki Price, Director of Managed Care at Albertsons guests on the PQS by Innovaccer Quality Corner Show to talk about partnering with PQS to expand new pharmacy services and improve patient care through performance programs.Quality Corner Host Nick Dorich, PharmD, and Nikki Price talk about working with health plans on new programs and services that create patient impact. Discussion revolves around how to involve the pharmacies while taking in pharmacist considerations. Price also talks about the patient response to these new programs and services.

Beatrice and Jules discuss “managed care,” a seemingly innocuous term for a guiding principle in contemporary US healthcare that structures and incentivizes medical rationing and austerity. We also discuss how the use of managed care in state Medicaid programs leads to widespread denials for trans care. Transcript forthcoming. This episode was originally released for Death Panel patrons on August 21st, 2023. To support the show and help make episodes like this one possible, become a patron at www.patreon.com/deathpanelpod Find our book Health Communism here: www.versobooks.com/books/4081-health-communism Find Jules' new book, A Short History of Trans Misogyny, here: https://www.versobooks.com/products/3054-a-short-history-of-trans-misogyny Death Panel merch here (patrons get a discount code): www.deathpanel.net/merch As always, support Death Panel at www.patreon.com/deathpanelpod

In this episode of American Potential, host Jeff Crank welcomes Darin Selnick, a United States Air Force veteran and senior advisor for Concerned Veterans for America. Selnick shares his extensive background in healthcare and military service, discussing how these experiences shaped his role as a senior advisor to two VA secretaries and as the Veterans Affairs advisor for the president at the Domestic Policy Council during the Trump Administration. Dive into the challenges veterans face with the Department of Veterans Affairs (VA) healthcare system, including long wait times and travel difficulties. Selnick passionately argues for the importance of choice and competition in veterans' healthcare, detailing his efforts to improve electronic health records and community care delivery at the VA. Learn about Senator Marsha Blackburn's Vets Healthcare Freedom Act, aimed at normalizing the Managed Care process in the VA system and providing veterans with more freedom to choose their healthcare providers. Join us for an insightful conversation on the critical need for reform in the VA healthcare system to ensure veterans receive the quality care they deserve.   Check out American Potential here: https://americanpotential.com   Check out our Spanish episodes here: https://www.youtube.com/playlist?list=PL8wSZydeKZ6uOuFlT_1QQ53L7l6AmC83c   Facebook: https://www.facebook.com/AmericanPotentialPodcast    Instagram: https://www.instagram.com/americanpotentialpodcast/   X: https://twitter.com/AMPotentialPod

Knock, knock! If the Drug Enforcement Administration (DEA) is already at your door, it may be too late. Enforcement is on the rise, and the microscope is fixed on controlled substances. What can industry stakeholders do to prevent penalties and protect themselves from DEA scrutiny? On this episode, Epstein Becker Green attorneys Melissa Jampol, David Johnston, and Avery Schumacher discuss recent and pending updates to DEA rules and guidance, outline steps stakeholders can take to prepare for an inspection, and share tips on what to do when the DEA arrives. Visit our site for more information and related resources: https://www.ebglaw.com/dhc80 Subscribe for email notifications: https://www.ebglaw.com/subscribe. Visit: http://diagnosinghealthcare.com. This podcast is presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

In a recent landmark decision, the U.S. Supreme Court overruled the Chevron doctrine in the case of Loper Bright Enterprises v. Raimondo. This ruling has significant implications for employers and other entities in the health care and life sciences industries, as it changes the way courts are likely to interpret and apply regulations issued by federal agencies. On this episode, Epstein Becker Green attorneys George Breen, Stuart Gerson, Rob Wanerman, and Paul DeCamp analyze the fallout of this monumental decision, discuss what it means for entities seeking to challenge ambiguous statutes and regulations, and assess how to proceed from here. Visit our site for more information and related resources: https://www.ebglaw.com/dhc78 Subscribe for email notifications: https://www.ebglaw.com/subscribe. Visit: http://diagnosinghealthcare.com. This podcast is presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

Today we are bringing you a conversation between 3 experts on paroxysmal nocturnal hemoglobinuria (PNH). Ryan Haumschild, PharmD, MS, MBA, vice president of Pharmacy at Emory Healthcare and Winship Cancer Institute, spoke with Jamie Koprivnikar, MD, of John Theurer Cancer Center; David Dingli, MD, PhD, of Mayo Clinic; and Brian P. Mulherin, MD, of American Oncology Network. The topics of conversation for today's podcast include the pathophysiology of PNH, complement inhibitors, treatment strategies, and the challenges of managing this rare, life-threatening disorder.

Virginia Medicaid's managed care failing to connect patients with prenatal care; Dominion Energy is looking to expand its offshore wind operations; Chesterfield County Public Schools Superintendent to retire; and other stories

If you need a transplant and want to have a say in your surgical team plus your recovery facility, you had better avoid a "Managed Care" plan like Medicare advantage! .Find out how much a house call cost my father-in-law (and my parents) back in the last millennium. A chart purporting to show the average cost of a day in a hospital in each state actually shows three: for profit, non-profit and government owned. The rates are all over the place! Finally, how does Medicare cover your podiatry needs? Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)   Inspired by: "MEDICARE FOR THE LAZY MAN 2024; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

On this episode of Managed Care Cast, we're talking with the University of Southern California's Erin Duffy, PhD, MPH, an author of a study published in the June 2024 issue of The American Journal of Managed Care®. Her study, "Deductible Double Jeopardy: Patients May Pay More Out of Pocket When Pregnancy Crosses 2 Years" discusses how annual high-deductible insurance plans may increase maternity care costs when pregnancies cross 2 calendar years, causing patients to hit their cost-sharing limits twice.

This time on Code WACK! How did a single mom in Kentucky, in the 1970s, become a physician, then a health insurance medical reviewer and eventually a whistleblower? To find out, we recently interviewed Dr. Linda Peeno, a physician and ethicist who has spent nearly four decades working to protect patients from harm and death by corporate healthcare systems.  Dr. Peeno was played by actor Laura Dern in the 2002 docudrama “Damaged Care,” and she was also featured in Michael Moore's 2007 documentary “Sicko.” She has assisted in more than 150 legal cases to expose for-profit systems that have corrupted medicine and health care. Check out the Show Notes and Transcript for more!  

June 6, 2024: Dr. Eric Lee, the Medical Director of Clinical Informatics at AltaMed, engages in a deep dive into the integration of technology and healthcare services at one of the nation's largest federally qualified health centers. They explore how AltaMed leverages its position to manage care for a vast and diverse patient base across L.A. and Orange Counties. How does the implementation of technological innovations like EPIC's Chronicles claims loader and digital tools address quality measures and improve patient outcomes? What strategies does AltaMed employ to navigate the challenges of Medi-Cal expansions and the integration of clinical informatics? These questions are explored, shedding light on the practical implications of digital transformation in a healthcare setting focused on underserved communities.Key Points:Digital Transformation JourneyManaged Care ChallengesClinical Informatics IntegrationServing Impoverished CommunitiesAdapting EHR SystemsSubscribe: This Week HealthTwitter: This Week HealthLinkedIn: Week HealthDonate: Alex's Lemonade Stand: Foundation for Childhood Cancer

This time on Code WACK! How do Managed Care health insurance plans hurt patients? Why is it legal for commercial health insurers to use Denial-of-Care as a business model? And what is one organization doing to call attention to such issues? To find out, we spoke to Kimberly J. Soenen, founder of “SOME PEOPLE,” a Chicago-based not-for-profit organization and multiverse channel dedicated to removing barriers to healthcare access. Soenen is also the COO of AMPERS Radio Association in Minnesota, but the views she expressed in this podcast are solely her own. This is the second episode in a two-part series with Kimberly Soenen.

This time on Code WACK!   How do Managed Care health insurance plans hurt patients? Why is it legal for commercial health insurers to use Denial-of-Care as a business model? And what is one organization doing to call attention to such issues?  To find out, we spoke to Kimberly J. Soenen, founder of “SOME PEOPLE,” a Chicago-based not-for-profit organization and multiverse channel dedicated to removing barriers to healthcare access.  Soenen is also the COO of AMPERS Radio Association in Minnesota, but the views she expressed in this podcast are solely her own. This is the second episode in a two-part series with Kimberly Soenen.   Check out the Transcript and Show Notes for more!  

Matt Grissinger, RPh, FISMP, FASCP is the Director of Education at the Institute for Safe Medication Practices (also known as ISMP).  During our conversation, we talk about ISMP's Targeted Medication Safety Best Practices for Community Pharmacy first.  Then, we talk about how to report an error, CPE available from past ISMP webinars, adding education on operations to the pharmacy school curriculum, and more.  This is a great episode for any pharmacist, pharmacy student, pharmacy technician, or pharmacy owner.  Medication Safety is important.     Thank you for listening to episode 280 of The Pharmacist's Voice ® Podcast!   To read the FULL show notes, visit https://www.thepharmacistsvoice.com/podcast.  Select episode 280.   Subscribe to or follow The Pharmacist's Voice ® Podcast to get each new episode delivered to your podcast player and YouTube every time a new one comes out!     Apple Podcasts   https://apple.co/42yqXOG  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt   Bio (May 2024) Matthew Grissinger, RPh, FISMP, FASCP is the Director of Education at the Institute for Safe Medication Practices (ISMP). He first joined ISMP in 2000 as an ISMP Safe Medication Management Fellow. Prior to joining ISMP, he served as a home care and long-term care pharmacy surveyor for the Joint Commission. He was project leader for the Hospital and Healthsystem Association of Pennsylvania (HAP) Hospital Improvement Innovation Network's (HIIN) Adverse Drug Event (ADE) Project, a collaborative project engaging healthcare organizations to reduce and prevent patient harm from the use of anticoagulants, insulins, and opioids. He has published numerous articles in the pharmacy literature, including regular columns in P&T and is a journal reviewer for a number of publications including the Joint Commission Journal on Quality and Patient Safety, Pharmacoepidemiology, Journal of Managed Care and Specialty Pharmacy, BMJ Quality and Drug Safety, and Annals of Internal Medicine. He is a chapter contributor to a textbook published by McGraw-Hill entitled Pharmacy Management: Essentials for All Practice Settings, Essentials of Nurse Informatics, Remington: The Science and Practice of Pharmacy, and Medication Errors. He is recently completed the Just Culture certification course. Mr. Grissinger serves as the Chair for the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP), and Co-Chair of the National Quality Form (NQF) Common Formats Expert Panel. He is also on the Faculty Advisory Board for the Pharmacy Learning Network (PLN) and the Publications Advisory Board for Davis's Drug Guide for Nurses. He also served on the WHO Focus Group on Measurement Tools for Medication Safety, United States Pharmacopeia's (USP) Safe Medication Use Expert Committee from 2005-2010, the FDA Proprietary Name Review Concept Paper workshop panel in 2008, FDA Naming, Labeling, and Packaging Practices to Minimize Medication Errors workshop panel in 2010 and the Joint Commission Home Care Compounding Pharmacy Technical Advisory Panel in 2013. He is also an adjunct assistant professor for Temple University School of Pharmacy. Mr. Grissinger received a BS in Pharmacy from the Philadelphia College of Pharmacy and Science and is a fellow of the Institute for Safe Medication Practices as well as the American Society of Consultant Pharmacists.   Subscribe to or follow The Pharmacist's Voice ® Podcast to get each new episode delivered to your podcast player and YouTube every time a new one comes out!     Apple Podcasts   https://apple.co/42yqXOG  Spotify  https://spoti.fi/3qAk3uY  Amazon/Audible  https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt   Links from this episode Matt Grissinger on LinkedIn https://www.linkedin.com/in/matthew-grissinger-63231ab/  ISMPs new website

Colby Takeda, Pear Suite Co-Founder and CEO, shares how his upbringing, including serving in a nursing home as a teenager, was an inspirtation into serving his community and and ultimately becoming a national leader in the community health worker space. Since 2022's approval of the community health worker benefit in California, Colby shares how his tech enabled platform organization, Pear Suite, has helped community based organizations, including a barber shops, become commuinty health worker sites that are able to bill for their important work in the community.

On this episode of Managed Care Cast, we're talking with Illinois CancerCare's Pankaj Kumar, MD, and Stephanie Parker, PharmD, 2 authors of a commentary published in the May 2024 issue of The American Journal of Managed Care. Their commentary, "Access Denied: CMS' Action Hurts Patients With Cancer in Rural America," discusses how recent CMS rules restricted the access of rural patients with cancer to medically integrated pharmacies, emphasizing the need for regulatory change.

On this Episode 456 of Health Solutions, Shawn & Janet Needham R. Ph. discuss how health insurance hinders comprehensive patient care with Dr. Yazan Abdullah. 00:00 - Start 00:35 - Topic Introduction 06:06 - Doctors Work for Insurance Companies 08:50 - Managed Care 12:01 - HRT in Managed vs. Private Care 13:57 - Male Patient Story in Managed Care 22:54 - Importance of Testosterone for Women 27:00 - Estrogen Levels in Managed Care 30:00 - Progesterone Levels in Managed Care 32:49 - Progesterone Regardless of Uterus 34:52 - Thyroid Levels in Managed Care 37:43 - Listener Comment 38:05 - Hormones Are Only a Piece of the Puzzle 40:29 - Having Goals for Patients 44:48 - Endocrinologist 49:00 - Treating Diabetes 49:55 - Unhealthy Doctors 52:28 - Red Meat 53:02 - Doctors Who Choose Managed Care 56:53 - Living a Life to Help People 01:02:34 - Dr. Yazan's Passion 01:04:22 - The Importance of Sex 01:08:56 - Dr. Yazan's Contact Information 01:09:45 - Closing Comment Episode Resources Instagram ~ https://www.instagram.com/newport_vitality/ YouTube ~ https://www.youtube.com/channel/UCIr-IMWRpwK3iE1uEGXW2hQ Website ~ https://www.nhvitality.com/ EP 456: How Health Insurance Hinders Comprehensive Patient Care with Dr. Yazan Abdullah ~ #doctor #insurance #healthinsurance #patientcare #patients #insurancecompany #hormones #hormonereplacementtherapy #hormonereplacement #hormonebalance #hormonebalancing #hormoneimbalance #womenshealth #menshealth #podcastshow #podcast #podcastguest #optimalhealth #healthfreedom #MedicalFreedom #medicaleducation #medicalcare #HealthCare #PriceTransparency #freemarket #Liberty #FitAfter50 #FitOver50 #fitover40 #fitafter40 #Boise #IdahoFalls #Tricities #SiouxFalls #Wenatchee #EducateAndEmpower #NeedhamHealthSolutions #TeamNeedham #ShawnNeedham #HealthSolutions #MosesLakeProfessionalPharmacy #MLRX #SickenedTheBook #ShawnNeedhamRPh #ThinkOutsideTheSystem #OptimalHealthMatters #ItsTime ~ *** #BenShapiro & #DaveRamsey Fans. Learn how to be in the driver's seat for your healthcare choices {not the system or doctors!}

Joe Paduda is the principal of Health Strategy Associates and the author of the thought-provoking Managed Care Matters blog. He is also the president of CompPharma, LLC, a research and consulting firm dedicated to improving pharmacy programs in workers' compensation. In 2012, Joe received IAIABC's President's Award for his efforts to address the opioid problem in workers' compensation. He currently participates in the “Comparative Effectiveness of Two State Payer Strategies to Prevent Unsafe Opioid Prescribing” research project funded by the U.S. Department of Health and Human Services' Patient Centered Outcomes Research Institute. Before starting his consulting business in 1997, Joe held executive positions with major insurers, including Travelers, United Healthcare, and Liberty Mutual, and earned a Master of Science degree in Health Management from American University. In today's episode of the In The Know podcast, Chris Hampshire and Joe dive into the current state of the workers' compensation space, positive changes that have already been made, and where the industry needs to go from here to remain relevant and successful.   Key Takeaways   Joe highlights his career path in the workers' comp sector. Appealing aspects of the workers' compensation space. The role of functionality is the efforts of workers' comp. Three primary sectors that turn to workers' comp and what they are looking for. Insights into the current positive state of the workers' compensation industry. The dangers of underinvesting in technology in insurance. Major post-pandemic changes to the workers' comp industry. The current climate of activity in the regulatory environment. Insights from the evolution of the Managed Care Matters blog. Joe's thoughts on the pros and cons of workers' comp conferences. The future of workers' compensation, according to Joe. Strategies for attracting quality talent to the insurance industry. A five-year look at the future of the industry. Joe's advice to his early-career self.   Quotes “Workers' comp is the only healthcare system that cares about functionality.” “In workers' comp, we care about the health part of healthcare.” “Good medical care drives positive outcomes.” “The more there is honest debate around a lot of topics, the better off we're going to be.” “I hope people will get more conversant with and invest more intellectually in what's driving the healthcare system.”

Jazz-laden melodies are typically the sonic output of “The Big Easy” but this week, it's a special episode as we take you to the Academy of Managed Care Pharmacy (AMCP) Annual Meeting, which was in New Orleans. Leading researchers from Prime Therapeutics and Magellan Rx are at the show, and we talk with these health care experts from our Clinical and Health Outcomes teams who are using integrated medical and pharmacy claims data to evaluate real-world drug utilization, managed care pharmacy programs, and associated costs of care for a range of conditions, including weight loss, cardiovascular disease, cancer, and multiple sclerosis.  And, in the spirit of our host city, we have a little fun with our guests and see how much they know about “The Big Easy.”  We even had a drop in visit from Susan Cantrell, AMCP CEO, who talked with us about how AMCP is on the forefront of pharmacy trends, but also how the organization seeks to improve access to care and reduce costs, particularly as health care trends show that the pharmacy benefit is becoming more expensive.  Dig into the research All newsroom content https://www.primetherapeutics.com/ Guests:   Landon Marshall, principal, health outcomes research  Ben Urick, senior principal, health outcomes research  Yuqian Liu, senior director, clinical account services  Kyle Thompson, principal, data scientist  Nick Friedlander, clinical program pharmacist  Pat Gleason, assistant vice president, health outcomes  David Eckwright, senior director, clinical project and program management  Kristen Reimers, senior vice president of specialty clinical solutions