Podcasts about medicaid innovation

Based on AHLA's annual Health Law Connections article, this special ten-part series brings together thought leaders from across the health law field to discuss the top ten issues of 2026. In the third episode, Anna M. Lozoya, General Counsel, Physician Alliance Group PC, speaks with Miranda Franco, Senior Policy Advisor, Holland & Knight LLP, about the forces currently shaping public health policy and why 2026 marks a turning point. They discuss the advancement of the administration's “Make America Healthy Again” agenda through the Center for Medicare and Medicaid Innovation, drug pricing, vaccine policy, and where health systems can devote resources based on current public health trends. From AHLA's In-House Counsel Practice Group.Watch this episode: https://www.youtube.com/watch?v=_aCBcqNZRJgRead AHLA's Top Ten 2026 article: https://www.americanhealthlaw.org/content-library/connections-magazine/article/a879dda5-35f9-46fb-ad45-1b0799343d74/Health-Law-Forecast-2026 Access all episodes in AHLA's Top Ten 2026 podcast series: https://www.americanhealthlaw.org/education-events/speaking-of-health-law-podcasts/top-ten-issues-in-health-law-podcast-seriesLearn more about AHLA's In-House Counsel Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/in-house-counsel Essential Legal Updates, Now in Audio AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Comprehensive members. Get all your health law news from the major media outlets on this podcast! To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org/dailypodcast. Stay At the Forefront of Health Legal Education Learn more about AHLA and the educational resources available to the health law community at https://www.americanhealthlaw.org/.

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we delve into the significant events of 2025, a year marked by pivotal scientific breakthroughs, regulatory changes, and industry trends that have reshaped drug development and patient care.One of the standout advancements was Novo Nordisk gaining FDA approval for an oral version of Wegovy, a glucagon-like peptide-1 (GLP-1) receptor agonist for obesity management. This marks a notable shift in treatment accessibility, as it provides an easier alternative to injectables for those managing weight and cardiovascular risks. This development could significantly enhance patient adherence and broaden access to this critical therapy.However, not all news was positive. Pfizer faced a challenging situation when a patient death occurred in the extension of their Hympavzi hemophilia study. Such incidents highlight the intrinsic risks of clinical trials, especially within gene therapy realms where safety monitoring is paramount. These events remind us of the delicate balance between innovation and patient safety in advanced biologic therapies.In legal news, Johnson & Johnson was ordered by a Baltimore jury to pay $1.56 billion in a talc-related cancer case. This ruling underscores heightened scrutiny on product safety and consumer protection within the pharmaceutical industry, potentially influencing future litigation and regulatory measures.Clinical trial outcomes also presented mixed results. Neurocrine Biosciences' Ingrezza did not meet efficacy endpoints in its phase 3 trial for cerebral palsy-related dyskinesia. Although it is approved for other movement disorders, this setback reflects the complexities involved in expanding drug indications. Such challenges highlight ongoing hurdles in translating preclinical successes into clinical realities.Despite geopolitical tensions, particularly between China and the U.S., Chinese biotech firms thrived, maintaining robust deal activity. China's continued growth as an innovation hub is driven by strategic investments and collaborations that bolster global drug development efforts, underscoring its increasing influence in life sciences.Regulatory landscapes also shifted with proposals from the Center for Medicare & Medicaid Innovation to align U.S. drug prices with international rates under Medicare Parts B and D. These proposed models could significantly impact pricing strategies and market dynamics within the U.S., requiring pharmaceutical companies to adapt while ensuring equitable access to medications.Ethical challenges surfaced as six individuals were charged with insider trading involving biotech stocks. Such incidents highlight the necessity for stringent ethical standards and regulatory oversight to maintain investor confidence and market integrity.Meanwhile, AstraZeneca's extended partnership with Niowave for actinium-225 supply reflects an interest in radiopharmaceuticals as targeted cancer therapies. This collaboration highlights the potential of radiopharmaceuticals in oncology, opening promising avenues for precision medicine approaches.As 2025 closes, it's clear that this year has been one of both triumphs and trials for the pharmaceutical and biotech industries. Scientific innovations like Novo Nordisk's oral GLP-1 receptor agonist offer new hope for patients, yet challenges such as clinical trial setbacks and legal battles indicate ongoing hurdles in drug development and commercialization. These developments will likely influence industry strategies and regulatory policies as we advance into 2026.The sustained momentum of China's biotech industry amid global trade tensions remains notable. This trend reflects China's strategic investments in biotech capabilities and its growing role in global markets despite geopolitical frictions.In clinical research, Hope BioscienceSupport the show

In this Bright Spots in Healthcare episode, host Eric Glazer brings together an all-star panel of leaders who are reshaping the future of Medicaid and social care. Our guests include: Laurie Stradley, CEO, Impact Health Lori Andrade, EVP, Health Equity Alliance of Long Island (HEALI) Joneigh Khaldun, MD, President & CEO, Public Health Accreditation Board (PHAB) Evan Jones, Chief Strategy Officer, Vircho Together, they explore: How community-based organizations (CBOs) are evolving into trusted healthcare partners Practical strategies for bridging healthcare and social care at scale The role of technology, data, and community health workers in building sustainable Medicaid networks Real-world success stories—from disaster recovery in North Carolina to integrated care models in New York and beyond You'll hear how leaders are overcoming compliance, billing, and operational challenges while keeping people, not just systems, at the center of care. If you're looking for bright spots you can replicate to drive innovation, equity, and efficiency in Medicaid, this episode is packed with lessons and inspiration. Panelist Bios: https://www.brightspotsinhealthcare.com/events/doubling-down-on-medicaid-innovation-in-a-post-obbb-world/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://www.brightspotsinhealthcare.com/wp-content/uploads/2025/09/Episode-Guide_Doubling-Down-on-Medicaid-Innovation.pdf  Resources: 2025 HRSN Innovations Learning Lab Conference, Oct. 23-24, 2025, Asheville NC Guided by Impact Health and the WNC Health Policy Initiative, participants will navigate hands-on workshops, build teams through peer networking, and discover practical paths to success beyond Medicaid—all while connecting with trailblazing experts from across the country. Learn more and register here - https://ihorg.jotform.com/251884444887979 Check out PHAB's new podcast In Service of Health with Dr. Joneigh Khaldun, which explores what it really takes to build healthier communities. Learn more and subscribe here - https://in-service-of-health.podcastpage.io/ Thank you to our Episode Partner, Vircho: Vircho partners with health plans, Government, and Community Care Hubs to connect healthcare with the social needs that impact health. Their tools make it easier to deliver community-based services efficiently and improve outcomes for the people we all serve. To learn more, visit https://vircho.com/ Schedule a meeting with Evan Jones, Chief Strategy Officer, Vircho: To dive deeper into how social care networks are optimizing capacity and outcomes, schedule a meeting with Evan Jones. Reach out to hkrish@brightspotsventures.com to schedule the meeting. 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.

In this episode, Brendan Harris, president of UPMC for You and state programs, shares how initiatives like the Pathways to Work program and Neighborhood Centers are addressing social determinants of health, supporting Medicaid members, and strengthening local communities.

In this episode, Brendan Harris, president of UPMC for You and state programs, shares how initiatives like the Pathways to Work program and Neighborhood Centers are addressing social determinants of health, supporting Medicaid members, and strengthening local communities.

How are innovators driving sustainable ventures to transform Medicaid and improve care for underserved populations? During May's Digital Healthcare Innovation Summit, Zeena Johar, entrepreneur in residence of Frist Cressey Ventures; Chris Johnson, founder and CEO of Bluebird Kids Health; Aditi Mallick, former CMO of Medicaid and director of Minority Health at CMS; and Jenny Ismert, CEO of Community Plan of Kansas at UnitedHealthcare Community & State gathered to discuss scalable solutions, funding strategies, and the role of technology in addressing complex challenges within Medicaid. Moderated by .406 Ventures' Payal Agrawal Divakaran, the panel provided insights into creating lasting impact while navigating the evolving digital health and policy landscape. 

Send us a textIn this episode of Healthcare Trailblazers, host speaks with Dr. Boris Vabson, head of Medicare Advantage policy at CMMI (Center for Medicare & Medicaid Innovation). Dr. Vabson shares his fascinating journey from being born in the Soviet Union to becoming a Harvard health economist focused on dysfunctional healthcare systems. The conversation explores Medicare Advantage's evolution since 1965, current challenges including cost inefficiencies and prior authorization burdens, and CMMI's ambitious plans to transform the program. Dr. Vabson discusses the ongoing debate about Medicare Advantage overpayments, risk adjustment auditing using AI technology, and how CMMI plans to leverage its statutory flexibility to test innovative reforms that could be scaled nationwide. With recent leadership changes under Dr. Mehmet Oz at CMS, this timely discussion provides crucial insights into the future direction of Medicare Advantage policy affecting over 30 million Americans.Timestamps: 00:00:00 - Introduction and Dr. Vabson's Background 00:05:35 - Healthcare System Problems and Technology Solutions 00:09:42 - Medicare Advantage Overview and Current Challenges 00:18:25 - Policy Debates and Reform Efforts 00:32:44 - CMMI's Future Plans for Medicare Advantage Transformation

In this episode, Erfan Karim, Chief Clinical Operations Officer at NYC Health + Hospitals/Bellevue, discusses the critical role of Medicaid in public health, the impact of recent policy shifts, and how innovation in care delivery can help safeguard vulnerable communities. He also shares how personal experience drives his commitment to equitable access for all.

In this episode, Erfan Karim, Chief Clinical Operations Officer at NYC Health + Hospitals/Bellevue, discusses the critical role of Medicaid in public health, the impact of recent policy shifts, and how innovation in care delivery can help safeguard vulnerable communities. He also shares how personal experience drives his commitment to equitable access for all.

The new iteration of the Center for Medicare and Medicaid Innovation promises to focus on health, not healthcare. Will its plans come to fruition? David W. Johnson and Julie Murchinson graded CMMI's new strategic direction on, “CMMI Pursues an Ounce of Prevention,” the new episode of the 4sight Health Roundup podcast, moderated by David Burda

It has been over 100 days since President Donald Trump began his second term. During that time, Radio Advisory has received a steady stream of questions from leaders seeking guidance in an uncertain policy and business environment. With looming funding cuts, the restructure of HHS, the arrival of DOGE and MAHA, and more, leaders are grappling with what to focus on, how to respond, and how to engage productively with the federal government. To help answer these questions, Radio Advisory turned to policy experts from both parties to address your questions, acknowledge your anxieties, and highlight shared opportunities. This week, host Rachel (Rae) Woods welcomes Liz Fowler, former director of the Center for Medicare and Medicaid Innovation under the Biden Administration, and Eric Hargan, former Deputy Secretary of the Department of Health and Human Services during the first Trump term. Together, they discuss how to navigate the shifting policies and priorities of the Trump administration's second term. Plus, stay tuned to the end of the episode, where co-host Abby Burns discusses the bill proposed by the House Energy and Commerce Committee that would reduce federal Medicaid spending by more than $600 billion over the next ten years. Links: Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF Ep. 244: What's happened in Washington (so far) and what policy changes we're bracing for Ep. 230: Elections results are in: What healthcare leaders need to know Thousands laid off at HHS: What you need to know Healthcare policy updates Listen to Radio Advisory's Health Policy playlist Subscribe to Advisory Board's Daily Briefing newsletter and get the most important industry news in your inbox – every day. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

5/22 Update: The House early Thursday narrowly passed the One Big Beautiful Bill Act, a budget bill that includes a number of healthcare provisions that could have a significant impact on Medicaid, Medicare, and the Affordable Care Act. It has been over 100 days since President Donald Trump began his second term. During that time, Radio Advisory has received a steady stream of questions from leaders seeking guidance in an uncertain policy and business environment. With looming funding cuts, the restructure of HHS, the arrival of DOGE and MAHA, and more, leaders are grappling with what to focus on, how to respond, and how to engage productively with the federal government. To help answer these questions, Radio Advisory turned to policy experts from both parties to address your questions, acknowledge your anxieties, and highlight shared opportunities. This week, host Rachel (Rae) Woods welcomes Liz Fowler, former director of the Center for Medicare and Medicaid Innovation under the Biden Administration, and Eric Hargan, former Deputy Secretary of the Department of Health and Human Services during the first Trump term. Together, they discuss how to navigate the shifting policies and priorities of the Trump administration's second term. Plus, stay tuned to the end of the episode, where co-host Abby Burns discusses the bill proposed by the House Energy and Commerce Committee that would reduce federal Medicaid spending by more than $600 billion over the next ten years. Links: Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF Ep. 244: What's happened in Washington (so far) and what policy changes we're bracing for Ep. 230: Elections results are in: What healthcare leaders need to know Thousands laid off at HHS: What you need to know Healthcare policy updates Listen to Radio Advisory's Health Policy playlist Subscribe to Advisory Board's Daily Briefing newsletter and get the most important industry news in your inbox – every day. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Over 160 million Americans are served by Optum, yet many still don't fully understand what it actually does—or why it matters.Dr. Patrick Conway, newly appointed CEO of Optum and former head of CMS Innovation Center and Blue Cross NC, joins Steve for a wide-ranging discussion on the state of healthcare delivery, affordability, and the potential of value-based care at a national scale. With experience spanning the frontlines of medicine to top government and corporate leadership, Conway breaks down how Optum aims to improve care while controlling costs—and why he continues to practice as a pediatric hospitalist on weekends.We cover:

Rajaie Batniji, MD, PhD, Afia Asamoah, JD, and Sanjay Basu, MD, PhD, cofounders of Waymark, join Vineeta Agarwala, MD, PhD, a16z Bio + Health general partner, to discuss their transformative approach to Medicaid care delivery. This episode dives into their rising risk signal prediction framework, where cutting-edge machine learning predicts patient needs and enables community-based care teams to reduce preventable ER visits and improve health outcomes at scale. The team recently published their real-world results—including a 23% reduction in unnecessary acute care—in the New England Journal of Medicine Catalyst.Additional resources:Supporting Rising-Risk Medicaid Patients Through Early Intervention, NEJM CatalystThe Body Economic: Why Austerity Kills, by David Stuckler and Sanjay Basu

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In EPISODE 177 OF GROWING OLDER LIVING YOUNGER, Dr. Gillian Lockitch talks with Dr. Brad Stuart about his book "Facing Death: Spirituality, Science, and Surrender at the End of Life." Dr. Stuart discusses his transition from emergency medicine to hospice care, emphasizing how he came to realize the importance of healing over simply curing. He shares personal experiences and scientific insights into near-death experiences and the role of the default mode network in the brain. He highlights the spiritual and emotional aspects of end-of-life care, advocating for a holistic approach that includes mental, emotional, and spiritual well-being. He also touches on the potential of psychedelic therapy in addressing death anxiety and depression. Brad Stuart, MD is a physician specializing in end-of-life care, a healthcare innovator, and an author and international speaker. He has devoted his career to helping make the end of life a vital part of life itself. After graduating from Stanford Medical School and practicing internal medicine in the ER and ICU, he switched over to hospice practice to care for the dying. As Senior Medical Director for the largest healthcare system in Northern California, he created the first large-scale Advanced Illness Management (AIM) program in the US, funded by a $13 million award from the Center for Medicare and Medicaid Innovation. He was featured in the HBO special, Letting Go: A Hospice Journey. Brad has been recognized as Physician of the Year by the California Association of Health Services at Home, named a Top 20 national difference-maker by HealthLeaders' Media, and designated as a Visionary by the American Academy of Hospice and Palliative Medicine. Episode Timeline 0:01 Introduction to Dr. Stuart's journey from ER/ICU doctor into end-of-life care 12:48 The evolution of Dr. Stuart's approach to medicine 17:49 Personal experiences with death and recalled experiences   36:42 Neuroscience and Near-Death Experiences   43:16 Conclusion and Final Thoughts   Book : Facing Death: Spirituality, Science, and Surrender at the End of Life. https://www.bradstuartmd.com Schedule a free Discovery Call with Dr. Gillian And if you have not already done so, follow, rate and review this Growing Older Living Younger podcast.

Caprice Knapp, a seasoned health economist with over 20 years of experience in Medicaid and healthcare policy, shares her journey through various roles in government, academia, and private insurance. In this episode, Caprice offers a unique perspective on the challenges of measuring quality in healthcare, the importance of data-driven decision-making, and how global healthcare models can inspire innovation in Medicaid. From pediatric palliative care to cost-effective policy solutions, Caprice sheds light on how improving quality of care can transform healthcare outcomes for vulnerable populations.

Imagine a world where health care is as personalized and easy to use as your favorite streaming service. That's the vision of CJ Stimson, MD, urological surgeon, Executive Vice President of Population Health and Chief Medical Officer for the Employee Health Plan at Vanderbilt University Medical Center. In this episode, he hops in the miniVHAN to share how his personal experience and time as senior advisor at the Center for Medicare and Medicaid Innovation have fueled his passion for value-based care – an approach he believes can revolutionize patient outcomes and increase provider satisfaction.     With an aging population and too few doctors, traditional ways of providing care aren't working. Dr. Stimson will explore how a team-oriented approach, focused on patient needs, can empower providers, reduce clinician burnout and improve patient care. We'll learn how better communication and cooperation between patients, employers and providers can overcome the challenges of the value-based care shift and drive this transformation forward. 

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. To read the full article and show notes which include mentioned links, visit the episode page.  If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, paywalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. This waste can be categorized into administrative and clinical failures. Dr. Shrank emphasizes the need for aligning incentives with higher quality care, paying for patient outcomes, and highlights the potential rising power of PCPs. The discussion covers the progress made towards value-based care, the challenges faced by the current fee-for-service model, and the future landscape of primary care and healthcare delivery. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. 06:54 Can we cut healthcare waste while improving patient care? 07:33 What does “healthcare waste” consist of? 07:46 What are the six categories of “healthcare waste”? 10:23 EP363 with David Scheinker, PhD. 10:37 How much money does Dr. Shrank estimate is wasted each year in healthcare? 13:09 Where is that healthcare waste going, and why does it happen? 20:07 Uncaring by Robert Pearl, MD. 21:18 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 22:16 EP409 with Larry Bauer, MSW, MEd. 24:24 EP359 with Dan O'Neill. 26:02 Dr. Shrank's warning to providers out there. 30:03 Summer Shorts 2 with Scott Conard, MD. 31:41 Why there might be a generational shift among younger providers looking to work with different models.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs Editor-in-Chief Alan Weil welcomes Liz Fowler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services, to A Health Podyssey to discuss the future of health care payments, CMMI's specialty care strategy, mandatory models versus voluntary alternative payment models, CMS' newly-proposed Medicare Physician Fee Schedule for 2025, and more!Related Articles from Liz Fowler on Health Affairs:The CMS Innovation Center's Strategy To Support Person-Centered, Value-Based Specialty Care: 2024 UpdateAdvancing Health Equity Through Value-Based Care: CMS Innovation Center UpdateUpdate On The Medicare Value-Based Care Strategy: Alignment, Growth, EquityOrder the July 2024 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone. Subscribe to UnitedHealthcare's Community & State newsletter.

We're discussing Breaking Barriers in Primary Care through Innovative Models! Faisel and Dan are joined by Liz Fowler, PhD, JD – Director of the Centers for Medicare and Medicaid Innovation.Our conversation revolves around incentives to expand access and increase equity, multi-organization collaboration for healthcare policy, and public perception of Primary Care.This conversation was recorded as a live interview at Primary Care for America's annual event PrimaryCare24.

Hosts Tod Ibrahim and David White discuss the Center for Medicare and Medicaid Innovation's recently announced Increasing Organ Transplant Access (IOTA) Model proposed rule.

Hosts Tod Ibrahim and David White discuss the Center for Medicare and Medicaid Innovation's recently announced Increasing Organ Transplant Access (IOTA) Model proposed rule.

Marinah identifies as an indigiqueer chicana daughter of a spiritual, artistic mother from Chihuahua, Mexico who taught her traditional medicine, a Chicano musician and Engineer father from the borderlands, and mother to indigenous mixed-race children and grandchildren.Marinah is the owner of Phoenix Midwife and the founder of Indigenous Birth, an umbrella organization for diverse advocacy and health justice projects which affirms the importance of traditional and indigenous midwives and assembles initiatives and coalitions nationally and internationally. She is also a sometime podcaster, public speaker and writer.Marinah has served as consultant, facilitator, board member, Executive Director, and midwife for health justice projects in the U.S, North America, Central America, and Uganda, facilitating policy initiatives on public health responses, indigenous/immigrant reproductive and primary healthcare access, education programs, birth center development, and workforce development.Marinah is a founding member of Phoenix Allies for Community Health, a free clinic primarily serving immigrant families, a direct result of her active street medic work. Marinah is the past president of the Midwives Alliance of North America, and worked in a dedicated coalition with national midwifery groups for United States Midwifery, Education, Regulation, and Association (USMERA).Marinah is a Culture of Health Leader, advisory board member for Birth Detroit, Team Leader for an all POC midwifery learning collaborative in Arizona through a project initiated by the Institute of Medicaid Innovation, working alongside native and indigenous immigrant communities on reclamation of birth sovereignty, and planning essential convenings for midwives and healers.Marinah is a practitioner in Somatic Experiencing, with advancing certification in the prenatal and perinatal period, as part of her dedication to traditional medicine and healing.Marinah is the past Director of Organizational Wellness with Birth Center Equity, and is currently under Fellowship.Marinah's current roles, besides the multiple projects of Indigenous Birth, focus primarily in facilitation with Breath of My Heart Birthplace, the only Native-led nonprofit free standing birth center in the United States, Center for Indigenous Midwifery, learning indigenous data collection in partnership with The Firelight Group, and working with her traditional teachers in Mexico learning traditional medicine, and creating artistic and medicinal resources.Website: https://www.indigenousbirth.org/Contact: info@indigenousbirth.org

This episode is part of a continued series that will provide insights into the experiences of GSA Policy Interns from various cohorts. Join former policy intern Bailee Brekke ('23) as she speaks with the 2021 interns, Lei Chen and Kaleigh Ligus, about their internship experience and how it has impacted their current work.   Guest Bios: Lei Chen, PhD, is a postdoctoral scholar at the University of California, San Francisco (UCSF) Philip R. Lee Institute for Health Policy Studies. She is a transdisciplinary and cross-cultural researcher whose work focuses on long-term services and supports, immigrants' access to health care, migrant workforce, aging and health policy, aging and technology, and cross-cultural study. Dr. Chen is working on a National Institutes of Health–funded project that aims to advance research on the health care workforce that serves people living with dementia. She applies quantitative and qualitative methodologies to her research. Before joining UCSF, she worked on several research projects at the University of California, Los Angeles (UCLA) Center for Health Policy Research and collaborated with the UCLA Human-Centered Computing and Intelligent Sensing Lab. Dr. Chen also engages in policy-related work such as assisting in developing and implementing the Master Plan for Aging in California. Kaleigh Ligus, PhD, is a social science research analyst at the Center for Medicare and Medicaid Innovation. Her work includes developing, implementing, and evaluating new CMS patient care models aimed at improving Medicare beneficiaries' health care experiences and health outcomes. Dr. Ligus currently works on the team for the Guiding an Improved Dementia Experience Model. She has been dedicated to serving older adults living with chronic disease since 2015 during her experience at the University of Connecticut (UConn) Health Center on Aging. She earned her doctoral degree in human development and family sciences, with a specialization in adulthood, aging and gerontology, from UConn in 2023. During graduate school, she served as the Greg O'Neill Policy Intern for the Gerontological Society of America (summer 2021) and Health Policy Fellow at AcademyHealth (summer of 2022), working with like-minded community collaborators and political leaders to advocate for health policy change.

Two decades of collaborative innovation have reshaped policies, showcasing the transformative power of interdisciplinary collaboration. In this episode, Malaz Boustani, an agile and innovative implementation neuroscientist, author, and entrepreneur, discusses the groundbreaking advancements and policy changes related to brain health, particularly dementia care. He shares the challenges and successes of creating a comprehensive care model for dementia patients and their caregivers. Malaz delves into the model's positive outcomes, the hurdles faced within the fee-for-service healthcare system, and the Center for Medicare and Medicaid Innovation's announcement to test an alternative payment model for evidence-based dementia care services. He explains how this new payment model includes per-member-per-month payments to healthcare organizations and additional funds for patient respite care, aiming to enhance accessibility and sustainability. Get ready to be inspired and informed about the challenges and triumphs in crafting a transformative care model for dementia patients and their caregivers. Resources:  Connect and follow Malaz on LinkedIn here. Visit Malaz's website. Check out Malaz's previous Outcomes Rocket episode!

Jacob and Nikhil sit down with Toyin Ajayi, Co-Founder and CEO of Cityblock Health, an SDoH-focused provider of primary care, behavioral health, and chronic disease management for Medicaid and dual eligible patients. They discuss innovating in Medicaid, engaging patients with digital solutions, building sustainable companies, and more. (0:00) intro(0:50) the state of Medicaid innovation today(2:33) Toyin's time at Commonwealth(7:33) incubators in the current climate(11:02) biggest risks starting Cityblock(14:46) surprises in building Cityblock(23:06) how Cityblock chooses which services to offer and which to outsource(29:22) lower acuity patients(33:23) state-by-state differences(37:59) policy changes to improve Medicaid(42:15) a shift towards profitability(45:01) generative AI Out-Of-Pocket: https://www.outofpocket.health/

The Congressional Budget Office says the CMS Center for Medicare and Medicaid Innovation's experiments in value-based reimbursement have cost Medicare and taxpayers money. David Johnson and Julie Murchinson debate the right way to measure the return on investment in Medicare value-based care models on the new episode of the 4sight Health Roundup podcast, “Calculating the ROI of VBC,” moderated by David Burda.

My conversation today is with Will Shrank, MD. Dr. Shrank led the evaluation group at CMMI (Center for Medicare and Medicaid Innovation). He has spent time in the private sector, first at CVS Health and UPMC (University of Pittsburgh Medical Center) as chief medical officer of the health plan in Pittsburgh, and then as the chief medical officer for Humana. Now he is a venture partner at Andreessen Horowitz and doing some consulting for CMMI. We start out this conversation talking about waste in healthcare. In fact, Dr. Shrank was on a team who did a study about waste in the US healthcare system. (The article is, unfortunately, firewalled.) In that study, it says estimates suggest we have upwards of a trillion dollars of waste a year. There's two main groupings of said waste, turns out. The first is in administrative failures. There's three subcategories here: fraud, waste, and abuse; administrative complexity; and pricing failures. Then there's the clinical failures side of the waste house. There's three subcategories here as well, and they are failures in care coordination, failure in care delivery, and then low-value care. Dr. Shrank digs in a bit on each of these in the interview that follows, but I have to say, I go in fast for the now what. Great that we know where the waste is coming from, because gotta know the problems to solve for them. But really, what's the best way to solve for this waste? You know me by now, so I, of course, point out immediately that someone's waste is someone else's profit. So, that's a wrinkle. And it's a really rough wrinkle, because now you have groups lobbying to basically protect the waste. As just one example, what are pricing failures, after all, if not someone else's margin? Major spoiler alert here, but Dr. Shrank says one sort of broad-stroke solution is aligning incentives with higher-quality care, paying for the longitudinal patient journey, and paying for outcomes. If you do this, then at least the clinical failures side of the equation could improve. The implication here is that if the incentive is to be accountable for value—which is, you know, numerator quality denominator cost—then the supply chain has an incentive to reduce its own waste because effectively, at that point, it's coming out of their pocket as opposed to somebody else's. Will this resetting of the financial model happen overnight? That was a rhetorical question that we all know the answer to. Commercial payers are slow to change, and all but the best employers have been (historically, at least) busy making extremely lateral moves and going nowhere fast. Few seem super inclined to reward and pay for what they care about rather than just negotiating a price. I sort of say this to Dr. Shrank, and he says, yeah, true enough. I'm paraphrasing with a lot of creative license right now, but he says, let's reset our expectations with reality. We've actually come a pretty long way, baby, in not a particularly long time if you consider the whole value-based thing really only started not that long ago, relatively speaking. So, there will be problems to overcome and bumps in the road. We should expect that, and we haven't had the time to work them all out yet. I think a couple of other interesting insights for me, one was a little sidebar we go off on about the power that PCPs might find themselves wielding if they can gang up and harness it. And this is kind of starting. We'll see if it goes anywhere. I recently heard a story about a bunch of employed PCPs who went to their health system bosses and asked to stand up an APCP (advanced primary care practice) able to coordinate care, etc, do all the things that at this juncture we know are the right things to do for patients. Now they got shot down—bam!—with the backhands from above. I hope those engaged and activated PCPs quit and start up their own thing. Maybe they will. PCPs getting together here could be a way to solve for waste if they can gang up and harness it. And that's actionable if you happen to be a PCP or are looking to continue to employ them moving forward. The potential rising power of PCPs might cause some health systems to rethink some of the choices they are making (ie, the choice to employ PCPs as RVU [relative value unit] referral machines). PCPs, better than anyone, can see the harm inflicted by the business model that forces a drive-by PCP level of care. Moral injury is at an all-time high, and in addition, I just saw that study recently that showed to do all the administrative work of a PCP these days, it would take longer than 24 hours in a day. If you're a self-insured employer, I'd also kind of take note of this because it also could be actionable for you. Someone who would know told me recently that if enough employers demanded some value-based accountability, some advanced primary care going on, even a dominant consolidated health system would listen. So there seems to be some alignment here between employers and PCPs if these groups can come together and collaborate. In sum, we have a waste problem in this country. Aligning incentives might be one way to curb that waste. Can I just share with you some of the reviews that we got on iTunes recently? They make my heart so warm. I just want to acknowledge these individuals who took the time to write reviews. Here's the first one. It's from Jspeaks1987. He wrote, “[RHV is] my weekly go-to for smart takes on VBC [value-based care]. I have recommended this podcast to literally hundreds of people (including onstage at our recent customer success summit). Anyone who cares about the sustainability of our healthcare system owes it to themselves to give [Relentless Health Value] a permanent spot on their playlist. Always smart, often provocative, scrupulously fair [I like that … scrupulously fair], it's well worth the listen.” Thank you so much, Jspeaks1987. Here's another one. And this is from happygilmore80. I know who you are, happygilmore. “RHV is an amazing podcast and sorely needed in the healthcare community. I tell everyone about it. … I'm a recent listener and have learned so much from [episode] 399 and 400 [which are the manifestos]. Episode 410 was packed with knowledge, 407 was great, etc. Let's start a hundred RHV communities across the US where we implement small experiments so change is grassroots and ubiquitous. Then the status quo will concede.” And yeah, for sure with that. If anyone is interested in creating a meetup or something in your local area, reach out. I'll try to hook you up with others in the Relentless Tribe. Here's a third one, and this is by Miriam. Thank you so much for this, Miriam. Miriam says, “I scoured the podcast world to find a healthcare industry podcast that offers intelligent, relevant, clear information and dialogue. I found it. Stacey and RHV cover the US healthcare industry across all sectors while managing to go deep within those sectors. Most importantly, [RHV] highlights how all of those sectors interact, supposedly with the patient at the center, while performing as businesses that are really driven by capitalism.” Miriam says she never misses an episode. To the three of you, thank you so much. It's actually reviews like this that keep me and the team going over here.   You can learn more by connecting with Dr. Shrank on LinkedIn.     William H. Shrank, MD, MSHS, is serving as venture partner, bio and health, at Andreessen Horowitz. Previously, Dr. Shrank served as chief medical officer for Humana, where his responsibilities included implementing Humana's integrated care delivery strategy, with an emphasis on advancing the company's clinical capabilities and core objective of improving the health outcomes of its members. Dr. Shrank previously held the position of chief medical and corporate affairs officer, during which time he oversaw government affairs. From 2016 to 2019, Dr. Shrank served as chief medical officer, insurance services division, at the University of Pittsburgh Medical Center. Previously, Dr. Shrank served as senior vice president, chief scientific officer, and chief medical officer of provider innovation at CVS Health. Prior to joining CVS Health, he served as director of the Research and Rapid-Cycle Evaluation Group for the Center for Medicare and Medicaid Innovation. Dr. Shrank began his career as a practicing physician with Brigham and Women's Hospital in Boston and as an assistant professor at Harvard Medical School. He has published more than 270 papers on improving the quality of prescribing and the use of chronic medications. Dr. Shrank received his MD from Cornell University Medical College. He completed his residency in internal medicine at Georgetown University and his fellowship in health policy research at the University of California, Los Angeles. He also earned a master of science in health services from the University of California, Los Angeles, and a bachelor's degree from Brown University.   05:56 Can we cut healthcare waste while improving patient care? 06:35 What does “healthcare waste” consist of? 06:48 What are the six categories of “healthcare waste”? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 “We've built a backbone of extraordinary waste on a fee-for-service chassis.” 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O'Neill. 25:04 Dr. Shrank's warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models.   You can learn more by connecting with Dr. Shrank on LinkedIn.   @WillShrank discusses #healthcarewaste, #vbc, and #PCPs on our #healthcarepodcast. #podcast #digitalhealth #valuebasedcare   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Carly Eckert (Encore! EP361), Dr Robert Pearl, Larry Bauer (Summer Shorts 8), Secretary Dr David Shulkin and Erin Mistry, Keith Passwater and JR Clark (Summer Shorts 7), Lauren Vela (Summer Shorts 6), Dr Jacob Asher (Summer Shorts 5), Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer  

More than 75,000 Kaiser healthcare workers are set to strike across several states this week as their current employment contract expires. Cigna will pay $172 million to settle its Medicare Advantage fraud suit. And, a new report finds that the Center for Medicare and Medicaid Innovation has raised federal spending, not lowered it. That's coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The Congressional Budget Office released a report showing that the Center for Medicare and Medicaid Innovation, created under Obamacare to test new ways to pay for health care, will increase federal spending rather than reducing it. In 2010, CBO projected CMMI would reduce spending by $2.8 billion over 10 years, but current estimates show it increasing $1.3 billion from 2021 to 2030. Host Ben Leonard talks with Robert King about why.

Note: this episode is cross-posted with the Rx for Biotech podcast, hosted by Chris Leidli.  Emily Walsh Martin, PhD, at Tremont Therapeutics Consulting, works with gene and cell therapy companies and investors who are seeking to advance novel therapies in the clinic. ASGCT's Policy Summit is a big deal to her: It provides a full view of the clinical pipeline and helps her guide clients past the drug approval process and into considerations of patient access, manufacturing, and insurance reimbursement. In this special episode, Dr. Walsh Martin shares her highlights from the fifth annual Policy Summit: the chance to see top decision makers, patients, and advocates in the same room; the discussion of the recent CGT Access Model from the Centers for Medicare and Medicaid Innovation (with deputy director Laura McWright); and, of course, the first in-person speaking engagement of Nicole Verdun, MD, director of FDA CBER's new Office of Therapeutic Products (OTP). Hear Dr. Walsh Martin's thoughts on patient-focused development, public access to data, and FDA's support of platform designations for new CGT treatments. Her interviewer is Chris Leidli, host of the Rx for Biotech podcast and member of ASGCT's Communications Committee.  This year's Policy Summit featured its highest-profile line-up yet—and it's still available to view on-demand until October 23! Learn more at asgct.org/advocacy/policy-summit. Not sure if on-demand access is worth it? Let Dr. Walsh Martin convince you why you don't want to miss the event!Show your support for ASGCT!: https://asgct.org/membership/donateSee omnystudio.com/listener for privacy information.

In June, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested under the Center for Medicare and Medicaid Innovation in eight states. We welcome CMS Deputy Administrator and Center for Medicare and Medicaid Innovation Director Dr. Liz Fowler to discuss the Making Care Primary Model, the process in developing the model, and it's connections with health equity. 

The fragmentation of outpatient health care drives up the cost of care and worsens the quality of care that patients receive, posing a risk to patients' health. On this episode of Mathematica's On the Evidence podcast, guests James Lee of the Center for Medicare & Medicaid Innovation, Knitasha Washington of ATW Health Solutions, Bob Phillips of the Center for Professionalism and Value in Health Care, and Lori Timmins of Mathematica discuss recent research on the nature of the problem and federal initiatives that have sought to address it. A full transcript of the episode is available at https://www.mathematica.org/blogs/understanding-and-addressing-fragmented-outpatient-health-care Read a press release synthesizing key takeaways from a series of peer-reviewed journal articles on fragmented outpatient care based on studies conducted by Mathematica with support from the Centers for Medicare & Medicaid Services: https://www.mathematica.org/news/new-studies-reveal-that-fragmented-care-persists-despite-efforts-to-improve-primary-care-and-care Learn more about how the Innovation Center and Mathematica are advancing understanding of primary care through an evaluation of the Comprehensive Primary Care Plus model: https://www.mathematica.org/projects/evaluating-the-nations-largest-primary-care-delivery-initiative Learn more about an ongoing evaluation by Mathematica for the Center for Medicare & Medicaid Innovation to determine whether medical practices' participation in the Primary Care First alternative payment model improves quality and reduces costs for Medicare fee-for-service beneficiaries: https://www.mathematica.org/projects/evaluation-of-the-primary-care-first-model Read the 2021 report from the National Academies of Sciences, Engineering, and Medicine on implementing high quality primary care: https://nap.nationalacademies.org/catalog/25983/implementing-high-quality-primary-care-rebuilding-the-foundation-of-health

IEC founder Dr. Mai Pham discusses their work transforming healthcare for people with intellectual and/or developmental disabilities Hoangmai (Mai) H. Pham, MD MPH, President and CEO of Institute for Exceptional Care (IEC), is a general internist and national health policy leader and mother to two beautiful young men, one of whom is autistic. Dr. Pham was previously Vice President, Provider Alignment Solutions at Anthem, Inc., responsible for value-based care initiatives at the country's second largest health insurance company. Prior to Anthem, she served as Chief Innovation Officer at the Center for Medicare and Medicaid Innovation, where she was a founding official, and the architect of Medicare's foundational programs on accountable care organizations and primary care. She has published extensively in the medical literature on provider payment policy and its intersection with health disparities, care coordination, quality performance, provider behavior, and market trends. Dr. Pham serves on the boards of Atlantic Health Systems and the Coalition to Transform Advanced Care, and the National Advisory Council for the Agency on Healthcare Research and Quality. She also serves on Faculty at the Institute for Healthcare Improvement. Dr. Pham earned her A.B. from Harvard University, her M.D. from Temple University, and her M.P.H. from Johns Hopkins University where she was also a Robert Wood Johnson Clinical Scholar. For information about Institute for Exceptional Care, visit: https://www.ie-care.org/ Follow Different Brains on social media: https://twitter.com/diffbrains https://www.facebook.com/different.brains/ https://www.instagram.com/diffbrains/ Check out more episodes of Exploring Different Brains! http://differentbrains.org/category/edb/

Host Katherine Ellen Foley talks with Robert King about some House Republicans' opposition to a cost-cutting proposal from the Center for Medicare and Medicaid Innovation that would reduce payments for drugs that have won FDA approval but haven't yet proven their clinical benefit. The GOP representatives argue it will curtail innovation and access to promising therapies.

Kevin Siebs, Moore & Van Allen, and Derek Skoog, Principal, PricewaterhouseCoopers, discuss the Center for Medicare and Medicaid Innovation's (CMMI's) latest ACO model, ACO Realizing Equity Access and Community Health (REACH) Model. They cover reasons for provider participation in ACO REACH and common characteristics among participants, the model's payment mechanisms, aspects of the model's benchmark methodology, and key compliance issues related to the model. From AHLA's Regulation, Accreditation, and Payment Practice Group.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Every year, Mathematica publishes dozens of new papers and reports, some of which surface fresh insights about how public agencies and private organizations can be more effective at improving public well-being. For the 91st episode of Mathematica's On the Evidence podcast, we're launching an occasional series focused on examples of solutions that recent research suggests are effective. All three solutions in this episode involve financial incentives that seek to reduce health care costs while improving the quality of care patients receive. One seeks to reduce the incidence of heart attacks, strokes, or other events related to cardiovascular disease. Another is focused on bringing down the cost of health care and improving patient health by providing primary care services at home. And the last one, again, seeks to keep costs down while improving patient health, but this time by using a unique payment model that provides incentives to hospitals to change the way they do business. Email jwogan@mathematica-mpr.com to provide feedback about our approach to covering solutions on the podcast. A full transcript of this episode is available here: https://mathematica-mpr.com/blogs/solutions-for-preventing-heart-attacks-improving-patient-health-and-reducing-health-spending Read the fourth annual report from Mathematica for the Centers for Medicare & Medicaid Services on the evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: https://www.mathematica.org/publications/evaluation-of-the-million-hearts-cardiovascular-disease-risk-reduction-model-fourth-annual-report Learn more about the ongoing evaluation of the Million Hearts Cardiovascular Disease Risk Reduction Model: https://www.mathematica.org/projects/million-hearts-cardiovascular-disease-risk-reduction-model Read the seventh annual report from Mathematica for Center for Medicare & Medicaid Innovation on the evaluation of the Independence at Home Demonstration: https://www.mathematica.org/publications/evaluation-of-the-independence-at-home-demonstration-an-examination-of-year-7-the-first-year Learn more about the ongoing evaluation of the Independence at Home Demonstration: https://www.mathematica.org/projects/evaluation-of-the-independence-at-home-demonstration Read the report from Mathematica for the Center for Medicare & Medicaid Innovation on impacts from the first three years of the Maryland Total Cost of Care Model: https://www.mathematica.org/publications/evaluation-of-the-maryland-total-cost-of-care-model-quantitative-only-report-for-the-models-first Learn more about Mathematica's ongoing evaluation of the Maryland Total Cost of Care Model for the Center for Medicare & Medicaid Innovation: https://www.mathematica.org/projects/evaluating-accountability-for-statewide-health-cost-and-quality-outcomes-cpc

Meet Elizabeth Fowler:Dr. Elizabeth Fowler is Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation at CMS. Dr. Fowler previously served as Executive Vice President of programs at The Commonwealth Fund and Vice President for Global Health Policy at Johnson & Johnson. Before that, she was special assistant to President Obama on health care and economic policy at the National Economic Council. From 2008 to 2010, she was Chief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where she played a critical role developing the Senate version of the Affordable Care Act. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). Dr. Fowler has over 25 years of experience in health policy and health services research. She earned a bachelor's degree from the University of Pennsylvania, a Ph.D. from the Johns Hopkins Bloomberg School of Public Health, and a law degree (J.D.) from the University of Minnesota. She is admitted to the bar in Maryland, the District of Columbia, and the U.S. Supreme Court. Dr. Fowler is a Fellow of the inaugural class of the Aspen Health Innovators Fellowship and was elected to the National Academy of Medicine in 2022. Key Insights:Dr. Fowler is committed to the goal of reducing healthcare spending on a net basis into the future.Efficiency. Part of the ACA passed in 2010, the CMS Innovation Center aims to reduce barriers to care delivery, making healthcare more affordable and efficient. Long Term Plans. Dr. Fowler suggests that changing our healthcare system for the better is a project of immense scope. Prepare to measure progress on a scale of decades. Realism and Risk. Value-based care remains the goal, but Dr. Fowler understands that many organizations still face challenges that prevent them from adopting value models.This episode was made possible by our partnership with Edwards Lifesciences.Relevant Links:Follow Dr. Fowler on TwitterLearn about the CMS Innovation Center

Hoangmai (Mai) H. Pham, MD MPH, is President and CEO of Institute for Exceptional Care, a nonprofit committed to transforming healthcare for people with intellectual and/or developmental disabilities. She is a general internist and national health policy leader. She was Vice President, Provider Alignment Solutions at Anthem, Inc., responsible for value-based care initiatives at the country’s second largest health insurance company. Prior to Anthem, Dr. Pham served as Chief Innovation Officer at the Center for Medicare and Medicaid Innovation, where she was a founding official, and the architect of Medicare’s foundational programs on accountable care organizations and primary care. She was Co-Director of Research at the Center for Studying Health System Change and has published extensively in the medical literature on provider payment policy and its intersection with health disparities, care coordination, quality performance, provider behavior, and market trends. Dr. Pham serves on numerous advisory bodies, including the National Advisory Council for the Agency on Healthcare Research and Quality, the Maryland Primary Care Program, and the National Business Group on Health, and was a member of the Board Executive Committee at the Health Care Transformation Task Force. She is an Adjunct Fellow at the Leonard Davis Institute of Health Economics of the University of Pennsylvania, and Faculty at the Institute for Healthcare Improvement. Dr. Pham earned her A.B. from Harvard University, her M.D. from Temple University, and her M.P.H. from Johns Hopkins University where she was also a Robert Wood Johnson Clinical Scholar. Here’s a glimpse of what you’ll learn: The importance of engagement strategies to achieve an inclusive healthcare environment. Understand that meaningful engagement can promote joy in healthcare practices. Learn resources and tools available that may not have been provided in traditional medical educational programs Collaboration with patients, families and caregivers is a key component when providing patient care In this episode…. This podcast features Hoangmai (Mai) H. Pham, MD MPH. She discusses how her organization provides training for clinicians and hospital staff around creating an environment of inclusion. IEC was founded by healthcare professionals who also have disabled loved ones. They share the anxiety and isolation of navigating an opaque, disconnected, and underfunded world of support services. Through their training and services healthcare providers can learn how to better engage with patients who have disabilities fostering an environment of inclusion.

Mass General Brigham joins other health systems in adopting a code of conduct for patients. A new study aims to prove–or disprove–the prevailing hypothesis about the cause of Alzheimer's. And the Center for Medicare and Medicaid Innovation updates its strategy for implementing value-based care. That's all coming up on today's episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

In our current healthcare system, patients can sometimes spend half a day waiting to see one healthcare provider. And the average wait time in the United States to schedule a consultation can take anywhere from six to eight weeks. The long wait to see a provider can be stressful for families, can raise healthcare costs, and limit provider impact and satisfaction. Kelsey Mellard realized that the system needs to be transformed through bigger, bolder changes. Kellsey is on a mission to revolutionize the system with Sitka - a virtual, value-based multi-specialty primary care network.  In this episode, Kellsey shares how Sitka started and how they are improving access and delivering healthcare across the nation through their partnerships with primary care providers.  About Our Guest: Kelsey P. Mellard is the CEO and Founder of Sitka, a virtual, value-based multi-specialty network that is expanding the scope of primary care. Kelsey has been a leader in healthcare innovation across companies within the healthcare, government, and technology industries. Previously, Kelsey led Health System Integration for Honor, a technology-backed home care company. Prior to this, she led the development of the Post-Acute Care Center for Research, where she served as Executive Director. Earlier in her career, she also served in VP roles at naviHealth and UnitedHealth Group and she was on the initial team to establish the Center for Medicare and Medicaid Innovation. Kelsey sits on the board of Crossover Health and volunteers with the National Investment Center for Senior Housing (NIC) Board. During her free time, she enjoys the great outdoors with her partner George, son Dalman, and pup Arlo.  Connect with Kelsey Mellard: Website | www.trustsitka.com LinkedIn | www.linkedin.com/in/kelsey-mellard Twitter  | @KelseyMellard Facebook | Kelsey Pope Mellard

You can't talk about Value Based Care without including CMS and the Center for Medicare in the conversation.  In many of the past episodes on VBC we repeatedly refer to Medicare.  Today we get their input with the help of Douglas Jacobs, MD, Chief Transformation Officer, Center for Medicare at the CMS.  I really appreciate CMS allowing this conversation to happen. Doug is going to help us understand what CMS is, more specifically what the Center for Medicare is, bundled payments, VBC, ACOs, The Center for Medicare and Medicaid Innovation, The council for technology and innovation, the importance of health equity and more.  We frequently relate these issues to MedTech. For anyone that wants to better understand the CMS and the Center for Medicare specifically, you will want to listen to this episode. Now Go Win Your Week!! Doug's LinkedIn link CMS website link Medicare Website link The overall Medicare vision link Medicare & Health Equity link Medicare and Accountable Care link Ted Newill's LinkedIn Profile link  More Medical Device Success podcasts link Medical Device Success website link  MedTech Leaders Community link Link to Ted's contact page 

Jacob sits down with Dr. Mandy Cohen - former Secretary of North Carolina's Department of Health and Human Services, COO of the Center for Medicare & Medicaid Services and current CEO of Aledade's newest business line Aledade Care Solutions. They discuss her work in North Carolina around Social Determinants of Health, how Medicaid policy and innovation works, the new business line she's building at Aledade and what's required for primary care practices to succeed under risk.

In this week's episode, Dr. Antraneise Jackson, DrPH, MPH shares her journey. She has recently started as a Social Science Research Analyst for the Center for Medicare and Medicaid Services within Centers for Medicare and Medicaid Innovation. She is an active Public Health Professional working to improve the health of communities through her work within the public health field and her passion for exploring ways to develop and improve processes within the public health field through various avenues. She got her Bachelor of Science in Health Services Administration at Keiser University – Tallahassee while working in Customer Service Management before getting her Master of Public Health at Florida State University and beginning her career within the public health field. She then got her Doctor of Public Health at Florida Agricultural and Mechanical University (FAMU).  Shownotes: https://thephmillennial.com/episode112Dr. Antraneise Jackson, DrPH, MPH on LinkedIn: https://www.linkedin.com/in/antraneise-jackson-drph-mph-81502b64/Omari on IG: https://www.instagram.com/thephmillennial Omari on LinkedIn: https://www.linkedin.com/in/omari-richinsAll ways to support The Public Health Millennial: https://thephmillennial.com/support/Shop at The Public Health Millennial Store for discount: https://thephmillennial.com/shop/Support the show

Jacob sits down with Adam Boehler - former CEO of Landmark Health, Head of the Center for Medicare and Medicaid Innovation and current CEO of Rubicon Founders. They discuss how building a value-based care business has changed, how Adam came up with the idea for Landmark and his other businesses, what makes different patient segments a fit for value-based models and where the space is headed. They also touch on Adam's hopes for future policy and the changes he's seen in healthcare talent.

In February, CMS announced a redesign of the Global and Professional Direct Contracting Model for 2023. The Center for Medicare and Medicaid Innovation also released an RFA to solicit a cohort of participants for the new version of Direct Contraction, the ACO REACH Model. Aisha Pittman and Mara McDermott discuss how the renamed model better aligns with the purpose of encouraging providers to coordinate care to people with Medicare and better reach participants in underserved communities.

“For me, the beauty of diabetes was that it was the anchor but it allowed me to explore so many different areas of research and interest.” -Robert A. Gabbay, MD, PhD   In episode 158 of the podcast, we welcome Dr. Robert Gabbay. Dr. Gabbay is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. DocWorking Founder and CEO, Dr. Jen Barna talks with Dr. Gabbay about how it all started for him, his journey in medicine, how he balances it all and what advice he was given and what advice he would give to his younger self. He speaks about difficult decisions he made that affected the direction of his career. Dr. Gabbay also talks about the importance that mentors have had in his life and how they helped to shape him.    Robert A. Gabbay, MD, PhD is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. His research focuses on innovative models of diabetes care to improve diabetes outcomes and the lives of people with diabetes. Throughout his vibrant career he has had many accomplishments as a basic science researcher, developer of patient communication tools, creator of the first broad scale diabetes registry, designer of care management training programs, and leader of one of the largest primary care transformation efforts in the US around the Patient Centered Medical Home. The reach of his work has been recognized through leadership roles around the world to transform diabetes care including leading the International Diabetes Federation BRIDGES program that implements evidence based translational research to low resource global settings. Dr. Gabbay has received funding from the National Institute of Health Diabetes, Digestive and Kidneys Diseases (NIDDK), the Agency for Healthcare Research and Quality (AHRQ), and the Center for Medicare and Medicaid Innovation for his care transformation work. Along with an extensive peer reviewed publication record, his views have appeared in popular press such as the New York Times, CNN, the Washington Post, People, Oprah, and National Public Radio. Formerly, he held the role of Chief Medical Officer at Joslin Diabetes Center.   Find full transcripts of DocWorking: The Whole Physician Podcast episodes on the DocWorking Blog  DocWorking empowers physicians and entire health care teams to get on the path to achieving their dreams, both in and outside of work, with programs designed to help you maximize life with minimal time.   Are you a physician who would like to tell your story? Please email Amanda, our producer, at Amanda@docworking.com to be considered.   And if you like our podcast and would like to subscribe and leave us a 5 star review, we would be extremely grateful!   We're everywhere you like to get your podcasts! Apple iTunes, Spotify, iHeart Radio, Google, Pandora, Stitcher, PlayerFM, ListenNotes, Amazon, YouTube, Podbean   You can also find us on Instagram, Facebook, LinkedIn and Twitter.    Some links in our blogs and show notes are affiliate links, and purchases made via those links may result in payments to DocWorking. These help toward our production costs. Thank you for supporting DocWorking: The Whole Physician Podcast!   Occasionally, we discuss financial and legal topics. We are not financial or legal professionals. Please consult a licensed professional for financial or legal advice regarding your specific situation.   Podcast produced by: Amanda Taran

Co-host Brian (@chiglinsky) is joined by Dr. Farzad Mostashari (@Farzad_MD), CEO and co-founder of Aledade, and Dr. Richard Gilfillan, former Deputy Administrator of the Centers for Medicare and Medicaid Services and Director of the Center for Medicare and Medicaid Innovation from 2010 to 2013, for a special episode of The ACO Show. They discuss the future of Medicare and Dr. Gilfillan's recent co-authored, two-part piece in Health Affairs, “Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine'.”   

Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healthcare costs in the name of profit?  On today's podcast, we are joined by UCSF geriatrics fellow Alex Kazberouk to talk with Dr. Don Berwick (founder of the Institute for Healthcare Improvement, former administrator of Center for Medicare and Medicaid Services) and Dr. Richard Gilfillan (former CEO of Geisinger Health Plan and Director of the Center for Medicare and Medicaid Innovation). Their recent two part post on the Health Affairs Blog about the Medicare “Money Machine” has stirred up a debate about challenges and misaligned incentives within Medicare Advantage. We talk about: What Medicare Advantage is all about - its history, operations, potential benefits, and what it means for us and our patients Rick and Don's Health Affairs post on the downsides of MA plans and the Medicare “Money Machine” Policy solutions to improve the system without throwing the baby out with the bathwater We also touch upon prior podcast topics such as the area deprivation index and population health. As a special, Alex plays a superb rendition of this song which is definitely not a Rickroll. This is part one of a two part series on Medicare Advantage and healthcare financing. We have a follow-up with Claire Ankuda and Cheryl Philips on Special Needs Plans and the Medicare Advantage Hospice Carve-In coming soon.