Podcasts about Medicare Advantage

A new federal law is reshaping how healthcare is paid for and delivered in America.In this episode, Steve sits down with health policy expert Joe Mercer to unpack the details of the One Big Beautiful Bill Act. It's the most significant healthcare legislation since the ACA, with ripple effects across Medicaid, rural hospitals, and the ACA exchange.We cover:

In this episode, Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan, shares her experience testifying before Congress on the future of Medicare Advantage and highlights key policy changes needed to protect access, expand rural care, and ensure member choice in a rapidly evolving healthcare landscape.

Over chips and salsa, Jana and Mark sit down with Medicare Advantage broker Kirsten Falls to demystify healthcare options for seniors and some disabled individuals. Feeling overwhelmed by Medicare choices? Kirsten's expertise and resources will help you navigate plans with confidence, ensuring your health and lifestyle needs are met. Tune in for a fun, informative chat

In the "Medicare Advantage Minute" we hear more detail regarding the accusations about alleged misdeeds committed by America's largest Medicare Advantage insurance company. If the accusations are anywhere close to accurate, this behemoth may be following Arthur Anderson down the drain! In the "Your Medicare Benefits 2025" segment we discuss poop, specifically screening your poop for signs of disease. The cool part is that Medicare will pay for all this fun! Finally, how old is too old to drive? Spoiler alert: there is no one answer for everyone. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

“Pandemics are a political choice. We will not be able to prevent every disease outbreak or epidemic but we can prevent an epidemic from becoming a pandemic,” says Dr. Joanne Liu, the former International President of Médecins Sans Frontières/Doctors Without Borders and a professor in the School of Population and Global Health at McGill University. You are in for a lot of that sort of frank and clear-eyed analysis in this episode of Raise the Line from Dr. Liu, whose perspective is rooted in decades of experience providing medical care on the frontlines of major humanitarian and health crises across the globe, as well as wrangling with world leaders to produce more effective responses to those crises and to stop attacks on medical facilities and aid workers in conflict zones. Firsthand accounts from the bedside to the halls of power are captured in her new book Ebola, Bombs and Migrants, which focuses on the most significant issues during her tenure leading MSF from 2013-2019.  The book also contains insights about the geopolitical realities that hamper this work, including lax enforcement of international humanitarian law, and a focus on national security that erodes global solidarity. Join host Lindsey Smith as she interviews this leading voice on our preparedness to meet the needs of those impacted by violent conflict, forced migration, natural disasters, disease outbreaks and other grave challenges. If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Rushab Sanghvi, American Federation of Government Employees (AFGE) General Counsel, joined the America's Work Force Union Podcast to discuss the union's legal battles against the Trump administration's anti-union policies.    Merrilee Logue, Executive Director of the National Labor Office at Blue Cross Blue Shield Association and Duncan Lawson, Director of Market Intelligence for Government Programs at BCBSA, joined the America's Work Force Union Podcast to discuss Medicare and Medicare Advantage.

In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down the latest payer market trends. They explore Humana's improved earnings outlook and strategic pullbacks, contrasted with UnitedHealth's rising costs, leadership turnover, and major challenges across multiple business lines.

This Day in Legal History: Medicare and Medicaid Signed into BeingOn July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law, creating the Medicare and Medicaid programs. The signing took place at the Truman Library in Independence, Missouri, with former President Harry S. Truman—an early advocate for national health insurance—present and symbolically receiving the first Medicare card. Medicare was designed to provide hospital and medical insurance to Americans aged 65 and older, regardless of income or medical history. Medicaid, created alongside Medicare, offered healthcare assistance to low-income individuals and families.At the time, nearly half of Americans over 65 had no health insurance. The passage of Medicare was a landmark achievement of Johnson's Great Society initiative and built on decades of political struggle over healthcare reform. The legislation amended Title XVIII of the Social Security Act and was strongly opposed by many in the medical establishment and conservative politicians who labeled it as “socialized medicine.” Nevertheless, the program gained rapid popularity and provided immediate relief to millions.Administered by the federal government, Medicare initially had two parts: Part A, covering hospital insurance, and Part B, covering outpatient and physician services. It has since evolved to include prescription drug coverage (Part D) and options for private plans (Medicare Advantage). The law reshaped the American healthcare landscape and established the principle that access to healthcare for seniors was a federal responsibility.The U.S. Senate confirmed Emil Bove, a former lawyer for Donald Trump and senior Justice Department official, to a lifetime seat on the 3rd U.S. Circuit Court of Appeals in a narrow 50-49 vote. Bove faced unified Democratic opposition and criticism from over 900 former DOJ employees, who claimed he undermined the department's integrity. His nomination prompted a Democratic walkout during the Senate Judiciary Committee's vote and drew sharp condemnation from Senate Majority Leader Chuck Schumer.Despite controversy, Republicans praised Bove's background as a federal terrorism prosecutor and his legal work defending Trump in several criminal cases. His confirmation shifts the appellate court's balance back in favor of Republican appointees. Critics cited Bove's alleged directives that defied judicial authority and political interference in a corruption case against New York Mayor Eric Adams. Bove denied wrongdoing in both instances. His confirmation is part of Trump's renewed effort in his second term to reshape the judiciary, following over 230 appointments in his first term. Trump has also nominated another close adviser, Jennifer Mascott, to the same court.Trump lawyer Bove confirmed to US appeals court, overcoming Democratic opposition | ReutersBove Confirmed to Appeals Court After Whistleblowers Emerge (1)A White House crypto task force established by President Trump is set to release a highly anticipated report outlining the administration's policy goals for the digital asset sector. The report, expected Wednesday, will address tokenization, market structure legislation, and a regulatory framework for blockchain-based financial products. Created by executive order shortly after Trump took office in January, the group is led by Bo Hines and includes top officials such as Treasury Secretary Scott Bessent and SEC Chair Paul Atkins.The document is expected to support expanded use of tokenization, which converts traditional assets like stocks and real estate into blockchain-based tokens. The report may call on the SEC to create a framework enabling firms like Coinbase to offer tokenized securities, though specific language remains under wraps. It will also outline the White House's preferences for crypto legislation currently advancing in Congress, including follow-up to the recently passed stablecoin law.Trump has made pro-crypto policies a centerpiece of his administration, reversing many of the enforcement actions taken under President Biden, such as lawsuits against Coinbase and Binance. While the industry sees the report as a roadmap for mainstream integration, concerns remain about conflicts of interest, particularly given Trump's financial ties to crypto ventures and meme coins. The administration has denied any ethical violations.White House set to unveil closely watched crypto policy report | ReutersThe Trump administration has formally requested the release of grand jury transcripts related to Jeffrey Epstein and Ghislaine Maxwell, citing public interest and mounting pressure over the government's handling of the sex trafficking cases. Prosecutors filed late-night motions with U.S. District Judges Richard Berman and Paul Engelmayer, arguing that the sealed testimony should now be disclosed, though the judges had previously asked for stronger legal justification. Grand jury records are typically secret, with limited exceptions for disclosure.Trump said he directed Attorney General Pam Bondi to seek the unsealing after the Justice Department reaffirmed its conclusion that Epstein died by suicide and that there was no list of elite clients—a stance that frustrated some Trump supporters who suspect a cover-up. Epstein died in 2019 before his trial; Maxwell, convicted in 2021, is serving a 20-year sentence and has appealed to the Supreme Court to overturn her conviction.In a related effort, a Florida judge recently denied a separate request to release grand jury records from earlier state investigations into Epstein, ruling they did not meet legal exceptions. Even if the federal judges allow the current transcripts to be unsealed, the documents may not reveal new information, since much of the testimony was covered during Maxwell's trial. The transcripts also wouldn't encompass the full scope of investigative material held by the government.Deputy Attorney General Todd Blanche, a former Trump lawyer, recently met with Maxwell for two days, reportedly seeking any names or evidence she could provide about others potentially involved. Neither Blanche nor Maxwell's attorney has commented in detail on those meetings.Trump administration asks judges to release Epstein, Maxwell grand jury transcripts | ReutersA Massachusetts jury has ordered Johnson & Johnson to pay over $42 million to Paul Lovell, who developed mesothelioma after decades of using the company's talc products. Lovell and his wife sued in 2021, claiming the talc contained asbestos that he unknowingly inhaled, and accused J&J of failing to warn consumers despite knowing the risks. The jury awarded damages for pain, suffering, and medical costs.J&J denied any wrongdoing, calling the verdict “junk science” and saying its products are asbestos-free and safe, with plans to appeal the decision. The company ended U.S. sales of talc-based baby powder in 2020. This case adds to a string of multi-million-dollar verdicts against J&J in talc-related mesothelioma lawsuits, although some have been overturned on appeal.J&J is facing over 63,000 active lawsuits, and possibly up to 100,000 claims in total, most alleging ovarian cancer from talc use. The company's attempts to resolve the claims through bankruptcy have failed in court three times, including a $10 billion settlement proposal rejected in March. The Lovell case is part of ongoing litigation that continues to test J&J's legal strategy and product safety claims.Johnson & Johnson ordered to pay $42M after jury finds talc caused man's cancer | Reuters This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.minimumcomp.com/subscribe

Get access now to 7 Figure Medicare University: Lifetime access:https://sevenfigureu.com/On this episode of the Seven Figures or Bust podcast, we dive into a new proposal that could lock Medicare Advantage clients into their plans for up to three years. We break down what this means for agents, clients, and the future of plan flexibility. Don't miss this important discussion that could change the way you do business.Learn more about getting your own VA with Hire Heroes here: https://app.hireheroes.com/signup?fpr=christian43Join our free private Facebook group for insurance agents: https://www.facebook.com/groups/551409828919739/Welcome to the Christian Brindle channel brought to you by Christian Brindle & Christian Brindle Insurance Services. This channel is here for the sole purpose of bringing training, tips, success stories, and personal development from Christian Brindle. Christian is a published author, hosts the ever popular Everything Medicare Podcast, and made six figures in the Medicare business by the time he was 25 years old.

Navigating Industry Volatility: How Insurance Agents Can Thrive in a Changing Medicare LandscapeThe latest episode of the Insurance Business Babes podcast brings together host Kathe Kline, co-host Joanna Wyckoff, and industry powerhouse Neil Reich for an honest discussion of the current turbulence in the Medicare insurance world. With plan exits, shrinking commissions, regulatory uncertainties, and unprecedented price hikes, agents must now adapt, diversify, and deepen relationships to stay successful.Industry Upheaval: What's Changing in Medicare AdvantageAccording to guest Neil Reich, the past year has brought volatility unlike anything he's seen in his 27-year career. Major Medicare Advantage carriers like Humana and Aetna have pulled out of some markets due to soaring medical loss ratios, leaving consumers scrambling for alternatives and further concentrating business among remaining giants like United. Commission structures are shifting, and the legal landscape is uncertain, with the Department of Justice and new CMS rules causing ongoing anxiety about the future of FMOs (Field Marketing Organizations).Diversification Is EssentialNeil isn't deterred by the disruption—instead, he emphasizes the need for insurance agents to diversify their offerings. His new agency, Care Connect Advisors, has quickly added Medicare Supplement plans, Index Universal Life, final expense, hospital indemnity (with popular guaranteed-issue options for ages 64-70), cancer, dental, and even annuities to the product mix. This mirrors Kathe and Joanna's advice that now, more than ever, agents should be “multi-product” — cross-selling to better serve clients and protect their own earnings in the face of shrinking Medicare Advantage opportunities.Relationship Building and Technology: The Agent's GoldmineStaying connected to clients is a major theme. The podcast highlights how agents are successfully blending manual outreach (calls and texts to educate and cross-sell) with automation (drip campaigns, retention videos, and CRM tools). Touchpoints aren't just for selling—they reinforce trust, increase retention, and open natural conversations about needs like hospital indemnity or annuities.The Path Ahead: AI, FMOs, and the Advisor MindsetWhile regulators mull the impact of overrides and marketing practices, agents are also looking to the future with AI poised to disrupt the sales process. Still, both Neil and the hosts remain optimistic: FMOs like Spark are evolving, offering powerful tech and support. The key message? Agents must evolve from “order takers” to true advisors—guiding clients comprehensively through industry changes and personalized solutions.In summary, claim your power as an agent by diversifying your product line, leveraging smart tech, nurturing relationships, and embracing your advisory role. In a shifting Medicare world, these strategies are more essential—and more rewarding—than ever.This episode is sponsored by ⁠CertifiedMedicareAgents.com⁠. Use the coupon code BABES2024 for a free lifetime BRONZE membership.

Event Planning for Agent Success with Richard Oleff Welcome to the latest episode of the Agent Boost Podcast!

The rugged audit landscape has changed – and not for the better.Today, there are more potential pitfalls and traps to capture the unprepared and impact them with huge fines and possible incarceration. In fact, the Centers for Medicare & Medicaid Services (CMS) has erected a legal fortress to protect their audit process. It's not the same old ballgame – it's a new one, with lots of new players.It's also why the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to return to the broadcast to describe how you and your team can learn how to identify red flags in the process of fraud detection in order to avoid liability.The weekly broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

In the "Medicare Advantage Minute" we learn that many Medicare Advantage insurance companies have stopped paying sales commissions to agents that sell some of their Medicare Advantage and Part D prescription drug plans. Later in the episode we receive the same interesting news from Blue Shield of California. How does a company expect to sell products through insurance brokers without paying sales commissions? In the "Your Medicare Benefits 2025" segment we learn how Medicare is likely to handle claims for Mental Health Care (Partial Hospitalization). Finally, client Larry reported that Globe Life of NY was planning to increase the monthly premium of the HDG plan he and his wife have been enrolled in. What he may not have realized is that it was the first rate increase in four years...unheard of for any but the much-maligned HDG supplement plans! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

What do classic Mustangs, skyrocketing health premiums, and hidden insurance landmines have in common? Broadcasting live from the Big Red Lion Car Show at Leprino Foods, Fix It Radio kicks off with sizzling sausage sandwiches, chrome-packed nostalgia, and the best car show food in Denver. But beneath the sunny skies and polished hoods, a storm brews—one that could impact your wallet and your well-being. Why is a supposedly nonpartisan state agency using political blame games to explain a 28–40% increase in health insurance premiums? Is Medicare really your best option at 65—or could staying on your employer plan save you thousands? And what happens if your doctor refuses to take Medicare patients at all? Paul LoNigro from https://e-gia.com/ (GIA) doesn't hold back, calling out misleading headlines, exposing scare tactics, and breaking down the real drivers of rising premiums—like Obamacare mandates and the collapse of mid-sized insurers. And if you've ever wondered whether to choose Medicare Advantage or stick with Original Medicare and a supplement, this segment delivers the critical answers most people miss. But the surprises don't stop there… Could taking a lump-sum retirement distribution triple your Medicare premiums? Are you unknowingly locking yourself out of coverage options by missing a crucial six-month window? And what happens when your dream classic car gets totaled—only for your insurance to cover a fraction of its value? As the guys swap stories about restoring Mustangs, skipping arcades for carburetors, and how today's paint tech makes yesterday's muscle look like primer, they drop one last truth bomb: If you're insuring a classic on your standard auto policy, you're doing it wrong. From tax-free HSA tips and navigating Medicare chaos to insuring the car of your dreams the right way—this is the episode you didn't know you needed to hear. Cars. Coverage. Controversy. What could go wrong when politics, premiums, and pony cars collide? Tune in to https://fixitradio.com to find out more.

In this episode, Dr. Joe Kimura, Chief Medical Officer at SCAN Health Plan, discusses how SCAN is leading innovation in Medicare Advantage through personalized care, data analytics, and strategic partnerships. He also explores the critical role of technology and member engagement in improving outcomes for a growing senior population.

D-SNP integration changes are about to hit year 2 in 2026. What does that mean for the market? Lincoln Lafayette and Anthony Budhar join Sarah to chat about the D-SNP market in 2026 and the opportunities for agents selling dual-eligible special needs plans.  

In this episode, Scott Becker discusses the mounting challenges for UnitedHealthcare, including a Department of Justice investigation into its Medicare Advantage billing and a 50 percent stock drop over the past year.

A new bill in the House would guarantee parity between traditional Medicare and Medicare Advantage reimbursements. Analysis from health insurer filings signals a spike in premiums for Affordable Care Act plans. And, a national hospital operator is selling its outpatient lab services in a multimillion-dollar deal. Those stories and more coming up on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

In this episode, Scott Becker discusses the mounting challenges for UnitedHealthcare, including a Department of Justice investigation into its Medicare Advantage billing and a 50 percent stock drop over the past year.

Our "Medicare Advantage Minute" reveals a plot to force all Medicare enrollees into the gulag of Medicare Advantage plans for a 3-year stretch.  Our new favorite listener, Stalker Susie, has been offered an assignment to evaluate the efficacy of the Kindle version of "Medicare Drug Plans; A Simple D-I-Y Guide!" I sure hope she accepts the offer! Finally, in the "Your Medicare Benefits 2025" segment, we learn how Medicare will likely cover Mental Health Care (Intensive Outpatient Program Services) Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

In this episode, Stacey Richter discusses 'Three Surprising Ways Carriers Make Lots of Money' with Preston Alexander. The episode highlights how carriers leverage financial strategies—like using premium dollars as float, intracompany eliminations, and upcoding in Medicare Advantage—to enhance their profits.  The discussion emphasizes the importance for plan sponsors and policymakers to understand these tactics to better manage healthcare costs. Alexander advises collaborating with unbiased consultants who are experts in health plan design to navigate these complex financial dynamics effectively. === LINKS ===

“As parents dedicated to getting a treatment for our children in their lifetimes, we have turned the rare disease drug development landscape upside down and created a new model,” says Nicole Johnson, co-founder and executive director of the FOXG1 Research Foundation.  That's not an exaggeration, as the foundation is on track to make history as it begins patient clinical trials on a gene replacement therapy next year. The former TV news producer and media executive unexpectedly entered the world of patient advocacy and drug research after her daughter, Josie, was born with FOXG1, a genetic disorder which causes severe seizures and impedes normal movement, speech, and sleep among other problems. Johnson is also making an impact in another important dimension of the rare disease space in her efforts to educate parents, teachers, and students about disability inclusion through her Joyfully Josie book series and “Live Joyfully” education programs. Tune-in to this fascinating Year of the Zebra conversation with host Lindsey Smith to find out how the foundation is aiming to bring a drug to market in less than half the time and at a fraction of the cost than the industry standard, and how this model might impact research on other rare disorders. Mentioned in this episode:FOXG1 Research FoundationJoyfully Josie Book If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

States sue the Trump administration over an Affordable Care Act eligibility and enrollment rule. Two large northeastern health systems explore a possible merger. And, Humana sues the Centers for Medicare and Medicaid Services again over the drop in its Medicare Advantage star ratings. Those stories on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

Sponsored by Eyecon by RxSafe Guests: Joe Moose, PharmD (Moose Pharmacy) & Joe Williams, RPh (APEX Pharmacy Consulting) Podcast Series: LTC Pharmacy at Home: Redefining Independent Pharmacy Growth Episode Summary: In Part 3 of our Eyecon by RxSafe-sponsored series, we dive deep into how independently owned pharmacies can scale their business and impact patient lives by expanding into Long-Term Care at Home (LTC-at-Home). Joined by industry leaders Joe Moose of Moose Pharmacy and Joe Williams of APEX Pharmacy Consulting, we break down the Top 5 ways community pharmacies can lead the LTC-at-Home movement — offering actionable strategies to support medically complex patients, differentiate services, and integrate more deeply into the care team. This episode delivers a blueprint for pharmacies ready to go beyond traditional retail and build recurring revenue with purpose-driven patient care.

In this episode, Dr. Joe Kimura, Chief Medical Officer at SCAN Health Plan, discusses how SCAN is leading innovation in Medicare Advantage through personalized care, data analytics, and strategic partnerships. He also explores the critical role of technology and member engagement in improving outcomes for a growing senior population.

In this episode of Quality Talks With Peggy O'Kane, NCQA President Peggy O'Kane speaks with Susan Dentzer, President and CEO of America's Physician Groups. Susan brings her extensive experience in health policy to a rich discussion on the evolution, strengths and future of value-based care, particularly within Medicare Advantage.Susan explains models of care that emphasize accountability for both cost and quality. She and Peggy explore how two-sided risk, smarter reimbursement and more coordinated primary care can lead to better outcomes and lower costs. Susan shares new evidence on Medicare Advantage's impact and highlights what it will take to scale accountable care models across the health system.Peggy and Susan explore:Introducing the Value-Based Vanguard: Some physician groups have figured out how to deliver superior outcomes at lower cost.How Two-Sided Risk Works and Why It's Hard to Scale: Two-sided risk arrangements are succeeding but can't spread fast enough.Barriers to Expanding Value-Based Care: A discussion of the domains where organizations need skills and sophistication in order to succeed in value-based care.Medicare Advantage's Promise and Perception Gap:  What the 56 percent of Medicare enrollees who are in MA get and what MA's critics miss.What's Next for Accountability and Reform: Navigating provider shortages, risk adjustment and the next iteration of ACOs.This conversation offers a timely and practical roadmap for advancing value-based care.Key Quote:Health economists will tell you there's no entirely benign set of financial incentives. All financial incentives have consequences.But then there's a question of what's better and what's worse. So the old saw is what happens if you have a system that pays surgeons for amputations? You get a lot of chopped-off legs because the financial incentive is on the surgeon to amputate.This remains true today in the United States. A surgeon who performs an amputation of a limb of a diabetes patient is paid much, much more than the person who is basically working hard to help the patient with prediabetes avoid a moving to full-blown diabetes — let alone down the road to serious complications such as amputation.-- Susan DentzerTime Stamps:(02:08): Setting the Stage for Change(05:29): Comparing Incentives in Different Payment Systems(08:21): Why Expanding Value-Based Care is Hard(11:01)  Misunderstanding a Model That Works(16:31)  Expanding the Value-Based Vision(20:13) Peggy's ReflectionsLinks:Potential Spillover Effects on Traditional Medicare When Physicians Bear Medicare Advantage RiskMedicare Risk Arrangement and Use and Outcomes Among Physician GroupsConnect with Susan Dentzer

The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for the 2026 fiscal year has been released.Tucked inside the Proposed Rule from the Centers for Medicare & Medicaid Services (CMS) is the agency's recommendation to phase out the Inpatient-Only List (IPO) over the course of the next three years.Reporting the lead story on this development during the next edition of Monitor Mondays will be longtime panelist Ronald Hirsch, MD.The weekly broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior healthcare government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Randy Carson returns to share the stories of his Grand Tour of Europe! In the "Your Medicare Benefits 2025" segment we learn how Medicare will handle my eventual need for Mental Health Care (outpatient) after I go nuts one day. In UnitedHealth Group news, the company has announced the cessation of commission payments to insurance brokers for some Medicare Advantage plans. Moody's has downgraded their rating from "Stable" to "Negative". As if that weren't enough, Lefties AOC and Lloyd Doggett have formerly requested the DOJ to turn the heat up even higher! Finally, we review a list of physician specialties rated by the practitioners'' intent to either continue or withdraw. Some of the categories were very surprising. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

For this episode of Disrupt, we caught up with Ken Albert, the President and CEO of Andwell Health Partners. During the conversation, Albert discusses how nonprofit organizations can cope with Medicare Advantage, which he says is rapidly becoming a “failed policy,” home-based care delivery innovation and the need for health care reform. Listen to this episode of Disrupt to learn: – How nonprofit home-based care providers are faring in the age of private equity – The service lines that Andwell Health Partners plans to branch into – The home-based care trends Albert has his eyes on, including technological innovation and serious illness management – And more! Subscribe to Disrupt to be notified when new episodes are released. Listen today!

Today on Raise the Line, we bring you the unlikely and inspiring story of a woman who was afraid of blood as a child but became an accomplished nurse; who struggled with learning disabilities but became an effective educator; and who, despite lacking business experience or knowledge of graphics, built a successful company that produces visually rich educational materials for nurses and other providers. “I think the theme of my life has been I have struggled with learning, and I didn't want other people to struggle,” says Jennifer Zahourek, RN, the founder and CEO of RekMed which has developed a sequential, interactive learning system that includes illustrated planners, books, and videos used by millions of students and providers. The initial focus was to provide nurses with everything they needed to know from “the basics to the bedside” but RekMed now offers content for medics, respiratory therapists, medical assistants, and veterinarians as well. Driven by her belief in the power of visual learning and her “just freakin' do it” attitude, Jennifer overcame her fear of launching a business and quickly realized just how well nursing had prepared her for the hard work and unpredictability of entrepreneurship. “Nursing teaches you how to just be resilient, to pivot, to delegate, to work on a team and to handle high stress. I think nurses could literally be some of the best entrepreneurs on the planet,” she tells host Lindsey Smith. Tune in to this lively and valuable conversation as Jennifer shares lessons from bootstrapping a publishing company, insights on the evolving landscape of healthcare education, and advice on embracing change in nursing, especially with the expanding role of AI. Mentioned in this episode:RekMed If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Enrollment in Medicare Advantage plans is projected to reach about 35.7 million, according to a 2025 Senate Finance Committee report. Yet, many startup and midsize organizations face steep technical and regulatory hurdles when launching or scaling operations. As part of the broader healthcare payer enterprise landscape, these plans must manage compliance, claims adjudication, risk adjustment, and reporting. This requires robust software systems that can handle increasing complexity without driving up overhead. How can small and midsize organizations offering Medicare Advantage plans compete and scale effectively in a highly regulated, data-heavy environment?On this episode of I Don't Care, host Dr. Kevin Stevenson welcomes Chris Stanley, CEO and founder of Strategic Healthcare Management Systems (SHMS), for a deep dive into the software and operational needs of the healthcare payer enterprise. They explore how the company helps payer organizations manage everything from enrollment and risk adjustment to claims automation and regulatory reporting through a vertically integrated platform that scales fast.Key HighlightsAutomating Compliance and Operations: SHMS enables 90% reductions in staff needs for adjudication by automating plan operations, CMS risk submissions, and audits.Supporting Startup and Mid‑Sized Organizations: The company specializes in guiding small and midsize organizations within the healthcare payer enterprise from licensure through go-live, often within four months.Future‑Proofing with AI: Stanley outlines plans to integrate AI for fraud detection, contract optimization, and risk adjustment—moving from proof of concept toward scalable innovation.Chris Stanley is the CEO and Founder of Strategic Healthcare Management Systems, where he has spent nearly two decades building scalable software solutions for Medicare Advantage and payer operations. His career spans roles in software engineering, product management, and healthcare IT at organizations including WebMD, RATA Associates, and Informa. He specializes in helping healthcare payer organizations streamline operations and meet compliance standards, with deep expertise in data systems, claims processing, and regulatory reporting.

What does the “long tail” of AI really look like in a highly regulated industry? In this episode, Dave Wollenberg, VP of Enterprise Data & Analytics at Scan, breaks it down. From cautious experimentation to enabling non-technical users to build AI-driven POCs, Dave shares a grounded, practical perspective on AI adoption inside a Medicare Advantage organization.You'll hear why the real transformation isn't just technical—it's cultural. We talk about how to shift employee mindsets, educate business teams, and unlock self-service analytics while staying compliant. If you're a tech or data leader trying to separate hype from real value, this one's for you.Key Takeaways:The long tail of AI means rethinking roles—not just automating tasksReal AI enablement starts with data quality, governance, and semantic clarityNon-technical employees can (and should) build AI proof-of-conceptsChange management will make or break your AI strategyIn regulated industries, open source and secure deployment models matterTimestamped Highlights:00:55 – What Scan Health Plan does and why AI matters in healthcare03:10 – From machine learning to generative AI: how use cases have evolved08:15 – Three types of business users and how to upskill them for AI12:40 – Shifting expectations: stakeholders want AI-powered insights, now15:20 – Why self-service BI still falls short without a solid data foundation18:35 – AI adoption isn't just IT's job—business users need to lead too22:15 – Navigating AI in regulated industries: risks, rules, and realitiesQuote of the Episode:“It's not as if there's a certain amount of work in the world, and if AI takes some, there's nothing left to do. When you make people more powerful, they add more value—and you want more of them, not fewer.”Pro Tips:Host internal hackathons to build excitement and break down resistanceUse sandbox environments to safely encourage experimentationDon't wait for technical users—give your business teams the tools to tryCall to Action:Like what you heard? Share this episode with someone exploring AI adoption in their org. Subscribe to The Tech Trek for more candid conversations with tech leaders on building, scaling, and leading through change.

It's a Medicaid Madness mess.For many years, Medicaid has been providing support for America's most vulnerable populations. But now, Medicaid finds itself as a pawn, being manipulated for political gain between two opposing forces: those who view the program as a means to an end to reduce government spending, and those who hold the opposite point of view.Who will be the winners and losers? During the next live edition of the venerated Monitor Mondays, senior healthcare consultant Dennis Jones will report on how hospitals can save money in the face of the inevitable Medicaid cuts.Jones, senior director of revenue cycle at Jefferson Health, was among the first of hand-picked subject-matter experts heard nearly 14 years ago on the weekly Internet broadcast produced by RACmonitor.The Monday's broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Sitting in for healthcare attorney David Glaser will be attorney Marguarite Ahman, a shareholder in the law offices of Fredrikson & Byron.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

The One Big Beautiful Bill Act could upend healthcare for millions. In this must-hear conversation, Jae Oh, CFP® and Medicare expert, unpacks how Medicaid work rules, Medicare Advantage cost shifts, and ACA premium spikes could impact retirees, workers, and families.In This Video00:00:00 Medicaid Ejections Are Happening Now00:01:15 Should Retirees Worry About Medicare Changes?00:03:00 New Medicaid Work Requirements Explained00:04:30 Why Everyone on Medicaid Must Verify Monthly00:05:45 Medicare Savings Program Disruption Risks00:07:10 Could Part B Costs Rise? The Budget Battle Impact00:08:45 ACA Marketplace Chaos and Premium Uncertainty00:11:00 Enhanced APTC Ending? What It Means for You00:13:00 Employer Open Enrollment: Don't Just “Check the Box”00:20:00 COBRA vs ACA After Layoffs: Planning Under Pressure

In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down key developments in the payer world including a deepening DOJ investigation into UnitedHealth Group's Medicare Advantage billing and the far-reaching implications of the newly passed One Big Beautiful Bill.

“Very often, doctors try to suppress what they feel or don't even have the vocabulary to describe their emotions,” says Professor Alicja Galazka of the University of Silesia, an observation based on decades of work with physicians to enhance their emotional intelligence and resilience. Galazka, a psychotherapist, psychologist, lecturer and coach, believes this deficit is rooted in part in a lack of instruction in the internal and external psychological dimensions of being a medical provider. “There is not enough space created in medical school for teaching and training students about how to deal with their own stress and all of the skills connected to building relationships with patients,” she tells host Michael Carrese. Those same skills are also critical to working effectively as a member of a care team, which is an increasingly common arrangement in hospitals and clinics. Galazka employs simulations, dramatic role-playing, mindfulness, Acceptance and Commitment Therapy and other methods in her work with an eye on increasing the emotional agility and sensitivity of her trainees and clients. Tune in to this thoughtful episode of Raise the Line to hear Galazka's ideas on how to reshape medical training, why she is a proponent of narrative medicine, and the merits of embedding psychologists on care teams as a resource for both patients and providers. Mentioned in this episode:University of SilesiaInternational Association of Coaching Institutes If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast

Agent Boost Podcast: Major Announcement! Agent Boost Marketing Joins AmeriLifeWelcome to a special edition of the Agent Boost Podcast!

For this week's episode I'm bringing you something a little different, but of such importance that I had to share it with my Off the Record audience: The massive audit expansion of Medicare Advantage announced by CMS. In case you missed it, CMS in May rocked the mid-revenue cycle industry with the unveiling of a startling mandate. It will hire 2000 medical coders, beef up its audit technology, and expand its current limited auditing scope from 60 Medicare Advantage Plans to some 550 plans nationwide in an attempt to check widespread allegations of HCC upcoding. My colleague Jason Jobes has been closely following the news and presented this topic in June—the most attended webinar Norwood has ever hosted. This is a replay of that very well-received show. It covers: The evolving risk adjustment landscape and the rise of Medicare Advantage CMS broad and bold audit scope and strategy  Best practice techniques to survive in risk adjustment and avoid potential risks Jason refers to several slides during the presentation, which you don't necessarily need, but if you'd like to follow along or see the exact references and data we've posted them to the Norwood website with a link in the show notes. Enjoy the show!  Show notes and resources View the webinar slides here (free; requires registration) Read the full CMS audit announcement. 

We've got the breakdown of all the Medicare and Medicare Advantage enrollment periods that beginner agents need to know.   Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.   Resources: 10 Essential Tools for Beginner Insurance Agents: https://ritterim.com/blog/10-essential-tools-for-beginner-insurance-agents/ Apps for Comparing Healthcare & Prescriptions: https://lnk.to/ASGA85 Medicare Advantage Open Enrollment Do's and Don'ts: https://ritterim.com/blog/medicare-advantage-open-enrollment-dos-and-donts/ Self-Guided Training with Knight School: https://ritterim.com/knight-school/ The Difference Between Medicare & Medicaid: https://lnk.to/ASGAE01 What is AHIP Certification and How Do I Get It? https://lnk.to/asg672   References: Franchina, Chris. “AEP vs. OEP: Understanding the Differences for Medicare.” Policy Engineer, 11 Jan. 2025, https://policyengineer.com/aep-vs-oep-understanding-the-differences-for-medicare/. “Get Ready to Buy.” Medicare.Gov, https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy. Accessed 17 June 2025. “Joining a Plan.” Medicare, “Joining a Plan.” Medicare, www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan. Accessed 10 June 2025. Worstell, Christian. “Medicare AEP vs. OEP: Know Your Enrollment Periods.” Medicare AEP vs. OEP | How to Enroll or Change Your Medicare Plan | MedicareAdvantage.Com, MedicareAdvantage.com, 18 Mar. 2025, https://www.medicareadvantage.com/enrollment/medicare-aep-vs-oep. “Medicare Open Enrollment.” CMS.Gov, https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources. Accessed 10 June 2025. “Medicare Open Enrollment Fact Sheet 2025.” CMS.Gov, Centers for Medicare & Medicaid Services, https://www.cms.gov/files/document/2024-medicare-open-enrollment-fact-sheet.pdf. Accessed 10 June 2025. “Special Enrollment Periods.” Medicare, Medicare.gov, https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods. Accessed 10 June 2025. “What Is the Medicare Annual Enrollment Period? | News & Articles | UnitedHealthcare.” UHC.Com, UnitedHealthcare, https://www.uhc.com/news-articles/medicare-articles/what-is-the-medicare-annual-enrollment-period. Accessed 10 June 2025. “What If I Missed My Initial Enrollment Period? | News & Articles | UnitedHealthcare.” UHC.Com, UnitedHealthcare, https://www.uhc.com/news-articles/medicare-articles/what-if-i-missed-my-initial-enrollment-period. Accessed 10 June 2025. “What Is the Medicare General Enrollment Period?” NOCA.Org, National Counsel of Aging, https://www.ncoa.org/article/a-closer-look-at-the-medicare-general-enrollment-period/. Accessed 10 June 2025.   Follow Us on Social!  Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance     Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Not affiliated with or endorsed by Medicare or any government agency.

In our "Medicare Advantage Minute" we learn about Humana's "cautious defense" of Medicare advantage plans. In a refreshing change of pace, Humana seems to be willing to admit that MA plans have room for improvement. In a related conversation we touched on the ongoing legal action of the 250,000 retirees from New York City who have been engaged in a llawsuit against the city since 2021. They do not want the crappy Medicare Advantage retiree plan that the city says will save $600 million per year. On a lighter note, we spend the "Your Medicare Benefits 2025" segment learning all about how Medicare would cover medical nutrition therapy services.   Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

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

The Transparency in Coverage (TiC) Final Rule represents one of the most significant regulatory shifts in healthcare pricing since the implementation of the Patient Protection and Affordable Care Act.During the next live edition of Monitor Mondays, senior healthcare analyst Frank Cohen will walk you and your team through the comprehensive labyrinth of changes.Recent enforcement developments, including President Trump's Executive Order 14221, directing actual hospital price disclosure within 90 days, also signal an intensified regulatory environment requiring proactive compliance strategies.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Moesha Baptiste, intern regulatory analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Looking back and looking ahead, we must reckon with a major shift in America's judicial landscape: the elimination of the so-called Chevron Deference. Last year, at about this same time, physician and attorney Dr. John K. Hall was the special guest here on Monitor Mondays, and he began his segment explaining the legal concept.Now, more than a year after the U.S. Supreme Court's landmark decision overturning 40 years of judicial precedent and upending statutory construction and enforcement, we must ask, has anything really changed?Dr. Hall will return to examine the changes – or maybe lack of changes – and what we might still expect regarding legal challenges to executive actions.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior regulatory affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

Medicare may feel overwhelming, but this fast-paced episode breaks down what you really need to know in just 10 minutes. In this episode, Nick and Jake walk you through the basics: when you're eligible, how enrollment works, and what each part (A, B, C, D) actually covers. They also explain the difference between Medicare Advantage and Original Medicare with supplements, how your income can impact premiums, and why certain medical expenses like long-term care and alternative treatments might not be covered. Get tips on how Medicare fits into your broader retirement plan and the importance of working with an independent Medicare agent. Here's what we discuss in this episode:

In episode 207, Coffey talks with Nicole Morgan about what HR professionals need to know about Medicare to help employees navigate the transition from employer-provided health insurance to Medicare coverage. They discuss the four main parts of Medicare (A, B, C, and D) and how they work together; the differences between Medicare Advantage plans (Part C) and traditional Medicare with supplemental coverage; how creditable coverage determinations affect employees who continue working past age 65; the coordination of benefits between employer group health plans and Medicare based on company size; timing considerations for Medicare enrollment and the importance of planning three months before turning 65; why brokers may have financial incentives to sell Medicare Advantage plans over traditional Medicare; the risks and benefits of different Medicare options including network limitations and out-of-pocket maximums; and the role HR should play in connecting employees with qualified Medicare experts rather than providing specific coverage advice. Good Morning, HR is brought to you by Imperative—Bulletproof Background Checks. For more information about our commitment to quality and excellent customer service, visit us at https://imperativeinfo.com.  If you are an HRCI or SHRM-certified professional, this episode of Good Morning, HR has been pre-approved for half a recertification credit. To obtain the recertification information for this episode, visit https://goodmorninghr.com.  About our Guest: Nicole A. Morgan is a seasoned healthcare professional with over two decades of experience, seamlessly blending her clinical expertise as a Registered Occupational Therapist with her proficiency as a Licensed Independent Insurance Agent. As the founder of Morgan Medicare Solutions, LLC, based in Sherman, Texas, Nicole is dedicated to guiding individuals through the complexities of Medicare, ensuring they make informed decisions tailored to their unique needs.  Her extensive background encompasses various healthcare settings, including inpatient and outpatient rehabilitation, acute care, skilled nursing, home health, and community-based services. This diverse experience has equipped her with a deep understanding of the challenges seniors face, particularly in navigating the transition to Medicare. Nicole holds multiple certifications, such as Certified Senior Advisor (CSA), Certified Long-Term Care (CLTC®), and Certified Living in Place Professional (CLIPP), underscoring her commitment to senior care and wellness.  Beyond her professional endeavors, Nicole is deeply rooted in her community. A native of Sherman, she has been married to her husband, Brad, for nearly 30 years and is a proud mother of three young adults. Her passion for service extends to active involvement in her church and local initiatives, reflecting her dedication to making a positive impact both personally and professionally.  At Morgan Medicare Solutions, Nicole offers personalized consultations, educational workshops, and ongoing support, ensuring clients feel confident and secure in their Medicare choices. Her holistic approach, grounded in compassion and expertise, has made her a trusted advisor for many navigating the intricacies of healthcare in their retirement years. Nicole Morgan can be reached athttps://www.morganmedicaresolutions.comhttps://www.linkedin.com/in/nicole-a-morganotr/https://www.facebook.com/morganmedicare/  About Mike Coffey: Mike Coffey is an entrepreneur, licensed private investigator, business strategist, HR consultant, and registered yoga teacher.In 1999, he founded Imperative, a background investigations and due diligence firm helping risk-averse clients make well-informed decisions about the people they involve in their business.Imperative delivers in-depth employment background investigations, know-your-customer and anti-money laundering compliance, and due diligence investigations to more than 300 risk-averse corporate clients across the US, and, through its PFC Caregiver & Household Screening brand, many more private estates, family offices, and personal service agencies.Imperative has been named a Best Places to Work, the Texas Association of Business' small business of the year, and is accredited by the Professional Background Screening Association. Mike shares his insight from 25+ years of HR-entrepreneurship on the Good Morning, HR podcast, where each week he talks to business leaders about bringing people together to create value for customers, shareholders, and community.Mike has been recognized as an Entrepreneur of Excellence by FW, Inc. and has twice been recognized as the North Texas HR Professional of the Year. Mike serves as a board member of a number of organizations, including the Texas State Council, where he serves Texas' 31 SHRM chapters as State Director-Elect; Workforce Solutions for Tarrant County; the Texas Association of Business; and the Fort Worth Chamber of Commerce, where he is chair of the Talent Committee.Mike is a certified Senior Professional in Human Resources (SPHR) through the HR Certification Institute and a SHRM Senior Certified Professional (SHRM-SCP). He is also a Yoga Alliance registered yoga teacher (RYT-200) and teaches multiple times each week. Mike and his very patient wife of 28 years are empty nesters in Fort Worth.   Learning Objectives: 1.       Understand the basic structure of Medicare parts A, B, C, and D to provide foundational guidance when employees ask about Medicare options and transitions.2.       Recognize when employer group health plans have creditable coverage for prescription drugs and ensure proper notification letters are sent to Medicare-eligible employees by October 15th annually.3.       Establish relationships with trusted Medicare brokers and implement processes to proactively reach out to employees approaching age 65 to ensure proper planning and coordination of benefits.

Health plans continue to face operational delays due to fragmented systems and an over-reliance on manual reporting cycles. While data analysts work across multiple platforms to produce static reports, the insights often arrive too late to support real-time decisions. This episode explores why traditional models are no longer sustainable and how self-service dashboards, powered by a connected data ecosystem, are transforming operational agility. Listeners will hear how prebuilt metrics provide immediate visibility across functions such as claims, call center performance, and ID card fulfillment, enabling teams to respond faster, stay compliant, and enhance member outcomes. The discussion also covers adoption strategies, ROI considerations, and the organizational shift toward on-demand, decision-ready data.Listen now to discover how leading health plans are moving from reactive operations to real-time insight, without relying on analysts.About Our Guest: Michael Waxman is a health plan operations leader with over 20 years of experience as a health payer consultant at PwC and EY. He recently served as the Director of Business Operations for the post-implementation operations of HealthProof's technology ecosystem for a Medicare Advantage client. Using HealthProof's self-service dashboard, he ensured operational alignment for the health plan's provider data, claims, credentialing, cross-functional alignment for call center, disputes, utilization management, and more. Today, Waxman is a member of the Advisory Services team at HealthProof.

In this episode of Quality Talks With Peggy O'Kane, NCQA President Peggy O'Kane has an energizing, constructive conversation with Dr. Will Shrank, a Venture Partner at Andreessen Horowitz.Will shares his vision for a more cohesive health care system that works based on aligned incentives, meaningful measurement of patient outcomes and savvy implementation of value-based care.Peggy and Will discuss:The ‘Systemness' Solution: Will emphasizes that while American health care has the right components—technology, talent and intent—it lacks the integration to make them work together. Systemness means aligning care delivery, data and incentives to function as a cohesive whole.Measurement Makeover: Current quality metrics often miss what matters most to patients and providers. Will calls for fewer measures that are focused on outcomes, not just process checks. Digital measurement can help, but fragmented data remains a challenge.Reimagined Reimbursement Prioritizes Primary Care: Will envisions a future where primary care providers take on meaningful financial risk for the cost and quality of care. This approach could help simplify incentives, foster collaboration with specialists and drive better outcomes.From Waste to Wellness: Health care wastes billions of dollars on administrative complexity. Meanwhile, prevention—arguably the most cost-effective strategy—struggles to gain traction due to delayed ROI. Will argues that aligning incentives around long-term health is essential to reducing waste and improving outcomes.Will concludes by assessing Medicare Advantage as a model of high-value care. Listen to the whole conversation for a warm, witty tour of quality's accomplishments and prospects.Key Quote:We just have to make this simpler. We've got to make it easy for doctors to do the right thing and to create the right relationships and to set the right paths.I think most people would agree a model where primary care docs have some meaningful accountability for the populations they serve would be better than what we have today.And if we as a system decided that's the direction we're going to go and make that the North Star, I think we in a much shorter time could get efficient, higher quality, and deliver better outcomes at lower cost, and deliver more equitable care for all Americans.”Will Shrank, MD Time Stamps:(01:06) A Systematic Approach to a Better Future(04:12) Challenges in Quality Measurement(09:24) Payment Models and Primary Care (13:55) Addressing Waste (24:49) Medicare Advantage and Value-Based Care(28:43) Peggy's Final Thoughts Links:Studies by Will Shrank (Google Scholar)Connect with Will

Enhancing Payment Integrity in Health Systems: An In-depth Discussion with Kimberly Carleson. In Episode 481 of Relentless Health Value, host Stacey Richter speaks with Kimberly Carleson, CEO of US Beacon, about payment integrity within health systems. They delve into strategies some hospitals use to maximize revenue without raising rates and discuss the importance of accurate billing.  Key takeaways include the high prevalence of billing errors, which can lead to significant overcharges for plan sponsors, often due to documentation gaps and complex coding systems. Kimberly provides actionable advice for both healthcare providers and plan sponsors on how to mitigate billing inaccuracies and enhance transparency.  Emphasized points include the necessity of third-party claim audits, understanding legal rights under various acts, and the importance of maintaining clear communication and compliance with legal billing standards. === LINKS ===

This episode recorded live at the Becker's Hospital Review 15th Annual Meeting features Tiffany Miller, Chief Executive Officer, Yoakum Community Hospital. Tiffany shares how her team is cultivating a vibrant organizational culture through leadership development while navigating challenges like Medicare Advantage reimbursement and preparing a compassionate, resilient workforce for the future.

Some of the sickest Medicare Advantage patients ran into problems getting end-of-life care. Ultimately many patients switched to traditional Medicare, costing taxpayers billions, according to an investigation by the Wall Street Journal. This is one of many Medicare Advantage practices that is now under government scrutiny. Both Congress and Medicare agency head Dr. Mehmet Oz are pushing for reforms to curb tactics that can boost federal payments to private insurers. The Department of Justice is also investigating major private insurance companies UnitedHealth, Aetna, Elevance Health and Humana. Jessica Mendoza discusses the investigations with WSJ's Anna Wilde Mathews. Further Listening: -Medicare, Inc. Part 1: How Insurers Make Billions From Medicare  -A Life-or-Death Insurance Denial  Sign up for WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices