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Progress on FY 2026 Appropriations President Releases “Great Healthcare Plan” as Progress on Bipartisan Compromise Stalls Senate HELP Committee Advances Four Health Bills Sen. Grassley Report Details “Gaming” of Medicare Advantage by UHG Republican Study Committee Releases Reconciliation 2.0 Framework Sen. Wyden, Rep. Pallone Question Child Immunization Data Measurement Change Florida Rep. Neal Dunn to Retire and more...
With the American republic hanging in the balance, Ralph calls on Democrats to pressure Republicans in the House and Senate to impeach Trump before the midterms or suffer the consequences. Then, we welcome Dino Grandoni, co-author of a Washington Post report on the surprising ways various species of animals and plants help advance our own health and longevity.Dino Grandoni is a reporter who covers life sciences for the Washington Post. He was part of a reporting team that was a finalist for the 2025 Pulitzer Prize in National Reporting for coverage of Hurricane Helene. He previously covered the Environmental Protection Agency and wrote a daily tipsheet on energy and environmental policy. He is co-author (with Hailey Haymond and Katty Huertas) of the feature “50 Species That Save Us.”The Democrats—while there are people like constitutional law expert Jamie Raskin (who has said a shadow hearing to publicly educate the American people on impeachment “is a good idea”) he's been muzzled by Hakeem Jeffries and Charlie Schumer, who basically don't want the Democrats to use the word impeachment. So who's using the word impeachment the most? Donald Trump—not only wants to impeach judges who decide against him, but he's talking about the Democrats impeaching him, and he uses the word all the time. So we have an upside-down situation here where the opposition party is not in the opposition on the most critical factor, which is that we have the most impeachable President in American history, getting worse by the day.Ralph NaderIf the founding fathers came back to life today, would any of them oppose the impeachment, conviction, and removal of office of Donald J. Trump, who talks about being a monarch? That's what they fought King George over. Of course, they would all support it.Ralph NaderWhat we have in these cards and in our stories at the Washington Post here are examples of the ways we know, the ways that scientists have uncovered how plants and animals help us. But we don't know what we don't know. There are likely numerous other ways that plants and animals are protecting human well-being that we don't know and we may very well never know if some of these species go extinct.Dino GrandoniI'm always eager to find these connections between human well-being and the well-being of nature and try to describe them in ways that are compelling to readers that get them to care about protecting nature. And also finding those instances (because I want to be objective here) of when human well-being and the well-being of nature might be in conflict, and that might involve some tough decisions that we as a society or policymakers have to make.Dino GrandoniNews 1/16/25* Our top two stories this week concern corporate wrongdoing. First, Business Insider reports that the New York City Department of Consumer and Worker Protection has released a new report which estimates Uber Eats and DoorDash, by altering their tipping processes in the city – moving tipping prompts to less prominent locations after checkout so upfront delivery costs would appear lower – have deprived gig delivery workers of $550 million since December 2023. As this piece notes, that was the month that New York City's minimum pay law for delivery workers took effect. As a result, “The average tip for delivery workers on the apps dropped 75%...from $3.66 to $0.93, one week after the apps made the changes…The figure has since declined to $0.76 per delivery.” This report presages a new city law that “requires the apps to offer customers the option to tip before or during checkout. Both Uber and DoorDash have sued the City over the law, which is set to take effect on January 26.” Whether the administration will stick to their guns on this issue, in the face of corporate pressure, will be a major early test for Mayor Zohran Mamdani.* Meanwhile, the Wall Street Journal reports UnitedHealth Group “deployed aggressive tactics to collect payment-boosting diagnoses for its Medicare Advantage members.” As the Journal explains, “In Medicare Advantage, the federal government pays insurers a lump sum to oversee medical benefits for seniors and disabled people. The government pays extra for patients with certain costly medical conditions, a process called risk adjustment.” A new report from the Senate Judiciary Committee found that UnitedHealth had “turned risk adjustment into a business,” thereby exploiting Medicare Advantage and systematically and fraudulently overbilling the federal government. Due to its structure, advocates like Ralph Nader have long warned that Medicare Advantage is ripe for waste fraud and abuse, in addition to being an inferior program for seniors compared to traditional Medicare. This report supports the accuracy of these warnings. Yet, Dr. Mehmet Oz Trump's appointee to head the Centers for Medicare & Medicaid Services, is a longtime proselytizer for Medicare Advantage and this setback is unlikely to make him reverse course, no matter the cost to patients or taxpayers.* Yet, even as these instances of corporate criminal lawlessness pile up, the Trump administration is all but abolishing the police on the corporate crime beat. In a new report, Rick Claypool, corporate crime research director at Public Citizen, documents how the administration has “canceled or halted a total of 159 enforcement actions against 166 corporations.” This amounts to corporations avoiding payments totaling $3.1 billion in penalties for misconduct. This report further documents how these corporations have ingratiated themselves with Trump, via donations to his inauguration or ballroom project, or more typical revolving door or lobbying arrangements. As Claypool himself puts it, “The ‘law enforcement' claims the White House uses as a pretext for authoritarian anti-immigrant crackdowns, city occupations, and imperial resource seizures abroad lose all credibility when cast against the lawlessness Trump allows for the pursuit of corporate profits.”* In another instance of a Trump administration giveaway to corporations, the New York Times reports the Environmental Protection Agency will “Stop Considering Lives Saved When Setting Rules on Air Pollution.” Under the new regulatory regime, the EPA will “estimate only the costs to businesses of complying with the rules.” The Times explains that different administrations have balanced these competing interests differently, always faced with the morbid dilemma of how much, in a dollar amount, to value human life; but “until now, no administration has counted it as zero.”* Moving to Congress, the big news from the Legislative Branch this week has to do with Bill and Hillary Clinton. NPR reports Congressman James Comer, Chair of the House Oversight Committee, issued subpoenas to the former president and former Secretary of State to testify in a committee hearing related to convicted sex offender Jeffrey Epstein. In a letter published earlier this week, the Clintons formally rejected the subpoenas, calling them “legally invalid.” The Clintons' refusal to appear tees up an opportunity for Congress to exercise its contempt power and force the couple to testify. Democrats on the Oversight Committee, who agreed to issue the subpoenas as part of a larger list, have noted that “most of the other people have not been forced to testify,” indicating that this is a political stunt rather than an earnest effort. That said, there is little doubt that, at least, former President Clinton knows more about the Epstein affair than he has stated publicly thus far and there is a good chance Congress will vote through a contempt resolution and force him to testify.* In the Senate, Elizabeth Warren, Chris Murphy and other liberal Senators are “urging their Democratic colleagues to pivot to economic populism by ‘confronting' corporate power and billionaires, warning that just talking about affordability alone won't move swing voters who backed President Trump in 2024,” per the Hill. Senators Adam Schiff of California and Tina Smith of Minnesota also signed this memo. The Senators cited a recent poll that found Americans “increasingly cannot afford basic goods such as medical care and groceries,” but they also warned that “Bland policy proposals — without a narrative explaining who is getting screwed and who is doing the screwing – will not work.” Hopefully this forceful urging by fellow Senators will move the needle within the Democratic caucus in the upper house. Nothing else seems to have driven the point home.* One candidate who seems to understand this message is Graham Platner of Maine. Platner, who is endorsed by Bernie Sanders, has a controversial past that includes a career in the Marines and a stint working for the private military contractor Blackwater. However, he is running as a staunch economic populist and New Deal style progressive Democrat – and the message appears to be working. According to Zeteo, a poll conducted in mid-December found Platner up by 15 points in the primary over his opponent, current Governor Janet Mills. More concerning is the fact that this same poll shows both Platner and Mills in a dead heat with incumbent Republican Senator Susan Collins, indicating this could be a brutal, protracted and expensive campaign.* On the other end of the spectrum, Axios reported this week that former Congressman Sean Patrick Maloney, who once led the Democratic Congressional Campaign Committee and then served as President Biden's ambassador to the Organization for Economic Co-operation and Development, has accepted a role as CEO and president of the Coalition for Prediction Markets. The coalition is essentially a trade association for betting websites; members include Kalshi, Crypto.com Robinhood and Coinbase, among others. The coalition will leverage Maloney's influence with Democrats, along with former Republican Congressman Patrick McHenry's influence across the aisle, to lobby for favorable regulation for their industry.* Turning to foreign affairs, prosecutors in South Korea have announced that they are seeking the death penalty for former President Yoon Suk-Yeol on “charges of masterminding an insurrection over his brief imposition of martial law in December 2024,” per Reuters. In a stunning courtroom revelation, a prosecutor said during closing arguments that “investigators confirmed the existence of a scheme allegedly directed by Yoon and his former defence minister, Kim Yong-hyun, dating back to October 2023 designed to keep Yoon in power.” The prosecutor added that “The defendant has not sincerely regretted the crime... or apologised properly to the people.” As this piece notes, South Korea has not carried out a death sentence in nearly three decades. Even still, it is remarkable to see how this case has unfolded compared to the reaction of the American judicial system to Donald Trump's attempted self-coup on January 6th, 2021.* Finally, turning to Latin America, many expected the fall of Nicolás Maduro to mean a redoubled energy crisis for the long-embargoed island nation of Cuba. Yet, the Financial Times reports that in fact, “Mexico overtook Venezuela to become Cuba's top oil supplier in 2025…helping the island weather a sharp drop in Venezuelan crude shipments.” CBS adds that “Despite President Trump's social media pronouncement…that ‘there will be no more oil or money going to Cuba — zero,' the current U.S. policy is to allow Mexico to continue to provide oil to the island, according to Energy Secretary Chris Wright.” For the time being, the administration seems open to maintaining this status quo – including maintaining cordial relations with Mexican President Claudia Sheinbaum – though this appears more strained than ever. Sheinbaum harshly criticized the kidnapping of Maduro, stating “unilateral action and invasion cannot be the basis for international relations in the 21st century,” while Republican Congressman Carlos Gimenez has threatened that there could be “serious consequences for trade between our countries” if Sheinbaum “continues to undermine US policy by sending oil to the murderous dictatorship in Cuba.”This has been Francesco DeSantis, with In Case You Haven't Heard. Get full access to Ralph Nader Radio Hour at www.ralphnaderradiohour.com/subscribe
In this episode, Scott Becker shares 9 timely healthcare updates, including a new federal affordability plan, hospital leadership turnover, telehealth utilization declines, Medicare Advantage legal developments, and more.
In this episode, Part 2 of Top News Stories from 2025, and Predictions for 2026, Chris Comeaux and Cordt Kassner break down the most important healthcare and hospice stories from 2025—and share clear, grounded predictions for what's coming in 2026. Rather than headline-driven chaos, 2025 revealed a year of incremental change, with persistent challenges around staffing, Medicare Advantage, hospice quality, reimbursement pressure, and cautious AI adoption shaping the landscape.Looking ahead, 2026 is framed as a hinge year for healthcare leadership. Policy decisions made today—including the long-term impact of healthcare legislation, reimbursement shifts, and political volatility leading into the midterms—are expected to create pressure without immediate resolution. This episode explores why 2026 may feel turbulent, yet ultimately serves as the setup year for deeper structural change across healthcare and hospice in 2027 and beyond.Chris and Cordt also examine emerging trends in healthcare technology and innovation, including artificial intelligence, virtual reality training, workforce models, and quality transparency. Rather than rapid disruption, they argue that healthcare—especially hospice and palliative care—will adopt these tools deliberately, balancing efficiency with trust, ethics, and human connection.At its core, this conversation is about leadership in uncertain times. As systems grow more complex, leaders must navigate policy, technology, and workforce challenges while staying anchored to mission and care quality. This episode offers insight for healthcare executives, hospice leaders, clinicians, and anyone shaping the future of care.
In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to discuss UnitedHealthcare's accelerated Medicare Advantage payments for rural hospitals and the growing federal scrutiny of major insurers as policymakers weigh rising healthcare costs and industry consolidation.
New research is transforming the outlook for cervical and uterine cancers -- two of the most serious gynecologic malignancies worldwide – and we'll be hearing from one of the people shaping that progress, Dr. Mary McCormack, on this episode of Raise the Line. From her perch as the senior clinical oncologist for gynecological cancer at University College London Hospitals, Dr. McCormack has been a driving force in clinical research in the field, most notably as leader of the influential INTERLACE study, which changed global practice in the treatment of locally advanced cervical cancer, a key reason she was named to Time Magazine's 2025 list of the 100 most influential people in health. “In general, the protocol has been well received and it was adopted into the National Comprehensive Cancer Network guidelines which is a really big deal because lots of centers, particularly in South and Central America and Southeast Asia, follow the NCCN's lead.”In this conversation with host Michael Carrese, you'll learn about how Dr. McCormack overcame recruitment and funding challenges, the need for greater access to and affordability of treatments, and what lies ahead for women's cancer treatment worldwide. Mentioned in this episode:INTERLACE Cervical Cancer Trial 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/podcast
Send us a textPart 1 | Top Stories from 2025, and Predictions for 2026 by Chris Comeaux and Cordt KassnerThis episode of TCNtalks / Anatomy of Leadership brings together a year-in-review and a forward-looking conversation, as Chris Comeaux and Cordt Kassner reflect on the most important healthcare and hospice stories from 2025 and share their predictions for what lies ahead in 2026.In Part One, Chris and Cordt review key headlines from late 2025, connecting policy shifts, technology trends, workforce realities, and financial pressures to the everyday leadership decisions facing hospice and healthcare organizations. Rather than reacting to news in isolation, the discussion focuses on how these forces intersect at the front lines of care.A central theme throughout the episode is the role of technology and artificial intelligence. While AI continues to gain momentum, the conversation reinforces a critical insight: technology is an accelerator, not a solution. Leadership, governance, and values ultimately determine whether innovation strengthens care or amplifies existing challenges.The episode also examines hospice-specific issues, including Medicare Advantage pressures, care pathways in skilled nursing facilities, financial strain on nonprofit providers, and the often underutilized role of volunteers in extending care and culture.The discussion concludes by framing 2026 as a hinge year—one where deeper forces are shaping the future beneath the surface. While change may come incrementally, the choices leaders make now will influence care delivery, trust, and sustainability in the years ahead.Episode Continues in Part II - Dropping Friday, January 16th, 2026Host:Chris Comeaux, President/CEO of TELEIOSCo-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today& CEO and Founder of Hospice AnalyticsThe Anatomy of Leadership podcast explores the art and science of leadership through candid, insightful conversations with thought leaders, innovators, and change-makers from a variety of industries. Hosted by Chris Comeaux, each episode dives into the mindsets, habits, and strategies that empower leaders to thrive in complex, fast-changing environments. With topics ranging from organizational culture and emotional intelligence to navigating disruption and inspiring teams, the show blends real-world stories with practical takeaways. The goal is simple yet ambitious: to equip leaders at every level with the tools, perspectives, and inspiration they need to lead with vision, empathy, and impact. https://www.teleioscn.org/anatomy-of-leadership
Part 1 | Top Stories from 2025, and Predictions for 2026 by Chris Comeaux and Cordt KassnerThis episode of TCNtalks / Anatomy of Leadership brings together a year-in-review and a forward-looking conversation, as Chris Comeaux and Cordt Kassner reflect on the most important healthcare and hospice stories from 2025 and share their predictions for what lies ahead in 2026.In Part One, Chris and Cordt review key headlines from late 2025, connecting policy shifts, technology trends, workforce realities, and financial pressures to the everyday leadership decisions facing hospice and healthcare organizations. Rather than reacting to news in isolation, the discussion focuses on how these forces intersect at the front lines of care.A central theme throughout the episode is the role of technology and artificial intelligence. While AI continues to gain momentum, the conversation reinforces a critical insight: technology is an accelerator, not a solution. Leadership, governance, and values ultimately determine whether innovation strengthens care or amplifies existing challenges.The episode also examines hospice-specific issues, including Medicare Advantage pressures, care pathways in skilled nursing facilities, financial strain on nonprofit providers, and the often underutilized role of volunteers in extending care and culture.The discussion concludes by framing 2026 as a hinge year—one where deeper forces are shaping the future beneath the surface. While change may come incrementally, the choices leaders make now will influence care delivery, trust, and sustainability in the years ahead.Episode Continues in Part II - Dropping Friday, January 16th, 2026Host: Chris Comeaux, President/CEO of TELEIOSCo-Host:Cordt Kassner, PhD, Publisher of Hospice & Palliative Care Today& CEO and Founder of Hospice AnalyticsTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast
MEDICARE ADVANTAGE MINUTE: GOVERNMENT PLANS AGGRESSIVE MEDICARE ADVANTAGE AUDITS! NYC employee health insurance fund is mysteriously insolvent! You don't think there has been any fraudulent activity there, do you? One of my favorite client/listeners shared a list of 15 health systems that are dropping some or all Medicare Advantage plans. Tax breaks coming to Medicare premiums? Rand Paul has proposed that the USA establish HSA for all! Finally, I located a cartoon nurse spewing a big fat lie. She spews: Until 1973, all health insurance companies were non-profit. Evil Republicans changed the law!* * The word "evil" is just my little joke. Whoever wrote that lying caption needs to take a chill-pill! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: ENROLLMENT GUIDE!" (coming soon) 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.
If you'd like to work with us on your Medicare health plan, we're licensed in 45 states and actively helping clients across the country. Christian and the team at Everything Senior Insurance represent many of the top insurance companies in the Medicare space. We're happy to help—just reach out! ➡️ Visit our site: https://www.eseniorinsurance.com✅ Call us: (801) 255-5340
“The world is a very volatile place, with currently 110 conflicts globally, and yet healthcare staff in the hospitals, even here in London, are not prepared to be the only clinician who can help in a crisis or hostile setting,” says Dr. David Gough, CEO of the David Nott Foundation, which equips providers with the skills and confidence needed to function in war and other extraordinary situations. A former British Army doctor injured in Afghanistan, Gough brings lived experience as well as a background in tech to his current role at the Foundation, which itself is anchored in decades of field work amassed by its namesake, a renowned war surgeon. As Dr. Gough points out to host Lindsey Smith, the cause could be helped by augmenting medical school curricula, but in the meantime, the Foundation is filling the knowledge gap by using prosthetics, virtual reality simulations and cadavers to train a broad swath of health workers including surgeons, anesthetists, and obstetricians. Tune in to this important Raise the Line conversation as Dr. Gough reflects on the strengths and weaknesses of NGOs in doing this work, his plans to expand the Foundation's footprint in the US, and the gratifying feedback he's received from trainees now operating on the frontlines in Ukraine and elsewhere. Mentioned in this episode:David Nott Foundation 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/podcast
MEDICARE ADVANTAGE MINUTE: CHART REVIEWA INCREASE PAYMENTS TO MA INSURERS FOR 1 in 6 ENROLLEES 12 FAQs ABOUT MEDICARE: YOUR MEDICARE QUESTIONS ANSWERED....BY ME! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: ENROLLMENT GUIDE!" (coming soon) 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 of The Broker Link Podcast, the focus is on the Medicare Advantage Open Enrollment Period (OEP), which runs from January 1 through March 31. Josh Slattery breaks down what OEP means for both beneficiaries and agents, emphasizing that this window allows Medicare Advantage members to make a one-time plan change if their current coverage no longer meets their needs. The discussion covers key effective dates—and clarifies important marketing and compliance guidelines. While agents cannot actively urge beneficiaries to enroll during OEP, general marketing and education remain permitted. Josh also highlights the importance of retail presence and community outreach, particularly for members experiencing buyer's remorse after AEP. He provides historical context on OEP, noting its reintroduction in 2019, and clarifies that standalone Part D plans are not included during this period. This episode equips agents with the knowledge they need to stay compliant, support their clients effectively, and identify meaningful opportunities during OEP. Learn more about partnering with The Brokerage Inc. by visiting our website, www.thebrokerageinc.com. Remember to like, share, and subscribe to our show! New episodes are available every Tuesday. Join our Community! LinkedIn: https://www.linkedin.com/company/the-brokerage-inc-/ Facebook: https://www.facebook.com/thebrokerageinc/ Instagram: https://www.instagram.com/thebrokerageinc/ YouTube: https://www.youtube.com/@TheBrokerageIncTexas Website: https://thebrokerageinc.com/
MEDICARE ADVANTAGE MINUTE: THE FUTURE FOR(?) MEDICARE ADVANTAGE! Includes a hint that funding for SHIP may be on the bubble in 2026! Eleven costly Medicare Mistakes you should avoid! These include The Drug plan selection problems, HSA precautions and MA vs Medicare Supplement differences. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" 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.
Wendell Potter exposes Medicare Advantage as a Wall Street scam draining Medicare while media manipulates the narrative after Charlie Kirk's death. A hard truth conversation America needs.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE
Thank you P. J. Schuster, Lana, Bev Ferguson, Don, Sue Saunders, and many others for tuning into my live video! Join me for my next live video in the app.* The Medicare Advantage Scam Wendell Potter Reveals How Insurers Drain Public Funds: Whistleblower Wendell Potter reveals how Medicare Advantage denies care, inflates costs, and enriches Wall Street while draining the Medicare trust fund. [More]* Eg… To hear more, visit egberto.substack.com
The ultimate challenge of operating an OBL is staying profitable. In this episode of BackTable, we bring on healthcare administrator Laurie Bouzarelos and interventional radiologist Dr. Mary Costantino to talk through the intricacies of revenue cycle management as an IR managing an OBL. --- SYNPOSIS The conversation covers the full lifecycle of getting paid in an IR practice, from initial patient contact through final claim resolution. Key topics include credentialing, determining medical necessity, coordination of benefits, prior authorizations, and the importance of working with billing and practice management teams experienced in interventional radiology. The episode also examines how EHR and practice management platform selection impacts clinical workflows and reimbursement, and closes with a discussion on payment plans and how emerging technologies, including AI, may shape the future of revenue management in IR-led OBLs. --- TIMESTAMPS 00:00 - Introduction 01:08 - The Importance of Revenue Cycle Management09:29 - The No Surprises Act and Data Transparency12:03 - Professional Societies and Continuing Education17:50 - Credentialing and Taxonomy Codes40:28 - Impact of Insurance Credentialing on Patient Care42:08 - Revenue Cycle Management Walkthrough48:18 - Challenges with Medicare Advantage and Coordination of Benefits54:20 - Covered vs. Non-Covered Services59:03 - Medical Necessity and Insurance Policies01:01:04 - Prior Authorization and Payment Issues01:13:11 - Payment Plans and Compliance01:23:10 - Practice Management Software01:31:10 - AI in Healthcare and Compliance01:38:57 - Final Thoughts --- RESOURCES Medical Group Management Administration (MGMA)https://www.mgma.com/
MEDICARE ADVANTAGE MINUTE: HOSPITALS ARE DROPPING MEDICARE ADVANTAGE PLANSLEFT AND RIGHT! YOUR MEDICARE BENEFITS 2025: WHEELCHAIRS AND SCOOTERS Tragedy struck the Content Curator: Her Part D drug plan was hijacked by an unscrupulous scoundrel who enrolled her in a Medicare Advantage plan. The goal? Over $600 in ill-gotten sales commissions. Many Medicare participants and eligibles are being hounded by telemarketers. Some are receiving 50 to 60 phone calls per day and many of those calls can result in fraudulent activity. Finally, another Christmas quiz closes out the episode. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" "MEDICARE FOR THE LAZY MAN: BARE BONES!" 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.
Why do doctors often prefer Medicare Supplement over Medicare Advantage? In this episode, we break down what most ads don't tell you, how Medicare Supplement plans can mean broader provider access, fewer claim denials, and the freedom to get care without referrals or network restrictions. If you want to understand how your Medicare choice impacts the care you receive, this is a must-listen.
Tired of surprise denials, shrinking provider networks, and healthcare uncertainty? In this episode, we break down why a growing number of retirees are leaving Medicare Advantage in 2025—and making the switch to Medicare Supplement for greater freedom, stability, and peace of mind. Learn what's driving this shift and what it could mean for your healthcare choices moving forward.
Prior authorization can cost you more than time. In this episode, we uncover the hidden impact of prior authorization in Medicare Advantage plans, from delayed care and denied treatments to frustrating administrative roadblocks. Learn how these barriers affect your health and peace of mind, and discover why a Medicare Supplement plan may provide the flexibility, access, and control you deserve.
The status quo is expensive, exhausting, and unsustainable—so we set out a practical playbook to do better in 2026. Nathan Kaufman shares ten no‑nonsense resolutions for health system leaders who want measurable outcomes, stronger teams, and smarter payer strategies without falling for vendor hype or wishful thinking.We get specific about capital discipline and why “mission” can't justify chronic losses that drain resources from services that actually improve patient care. We talk through what it takes to win the talent war by treating physicians as true partners, then dive into dyad leadership that cuts across supply chain, HR, and IT to remove friction and accelerate results. Culture becomes operational with real-time metrics, fast feedback loops, and leaders spending more time in the field and less time in meetings that signal low trust and unclear decisions.Payment strategy is front and center. We explain how to use 340B responsibly to close funding gaps, why some value-based schemes are a race to the bottom, and how to negotiate Medicare Advantage so contracts yield at least 100% of Medicare after accounting for administrative burden. Affordability demands that we take significant cost out by removing layers, standardizing clinical pathways, and focusing on core services rather than chasing panaceas like provider-owned health plans or sponsored “research” that flatters a product.If you're ready to lead with data, align teams, and make tough calls that protect patient access and quality, this conversation is your roadmap. Subscribe, share with a colleague who needs a dose of operational courage, and leave a review telling us which resolution you'll tackle first.Support the showEngage the conversation on Substack at The Common Bridge!
Sarah reveals the top Agent Survival Guide Podcast episodes of 2025. Did your favorite episode make the cut? You'll have to listen to find out!
MEDICARE ADVANTAGE MINUTE: WATCH OUT FOR THE "MEDIGAP TRAP" YOUR MEDICARE BENEFIT 2025: URGENTLY NEEDED CARE OBAMACARE: the parties are preparing to wrestle over the imploding health insurance plans we have been stuck with for 15 years. The Dems want to keep it limping along as the next step towards socialized health insurance while the Republicans want to begin a trend toward privatization via establishment of Health Savings Accounts (HSAS). Norb writes to share the advice he got from a local Bay Area Medicare broker who made up some crap about HDG resulting in claim problems as the insured's age. I explained that was not true and used my personal experience as proof. Epilogue: He decided to ignore me and purchase the expensive Plan G rather than my recommended High Deductible Plan G. The episode, which began with sports trivia ends with a rousing series of Christmas trivia questions. 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" "MEDICARE FOR THE LAZY MAN: BARE BONES!" 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.
“People are not looking for a perfect, polished answer. They're looking for a human to speak to them like a human,” says Jessica Malaty Rivera, an infectious disease epidemiologist and one of the most trusted science communicators in the U.S. to emerge from the COVID-19 pandemic. That philosophy explains her relatable, judgement-free approach to communications which aims to make science more human, more accessible and less institutional. In this wide-ranging Raise the Line discussion, host Lindsey Smith taps Rivera's expertise on how to elevate science understanding, build public trust, and equip people to recognize disinformation. She is also keen to help people understand the nuances of misinformation -- which she is careful to define – and the emotional drivers behind it in order to contain the “infodemics” that complicate battling epidemics and other public health threats. It's a thoughtful call to educate the general public about the science of information as well as the science behind medicine. Tune in for Rivera's take on the promise and peril of AI-generated content, why clinicians should see communication as part of their professional responsibility, and how to prepare children to navigate an increasingly complex information ecosystem.Mentioned in this episode:de Beaumont Foundation 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/podcast
Hosts Heidi and Joel Heitkamp welcome Cynthia Cox from the Kaiser Family Foundation (KFF) to discuss the Affordable Care Act (ACA) and its impact on healthcare costs. Cynthia shares insights into how the ACA supports individuals without employer-provided insurance, including small business owners and farmers.You will learn more about the complexities of the challenges and opportunities in the current healthcare landscape. Tune in if you're interested in understanding the intricacies of healthcare policy. Join us on The Hot Dish every week, where we serve up hearty conversations that resonate with every corner of the country. The Hot Dish is brought to you by the One Country Project, making sure the voices of the rest of us are heard in Washington. To learn more, visit https://onecountryproject.org or find us at https://onecountryproject.substack.com/. (06:00) - Cynthia Cox from KFF discusses her role and expertise on the Affordable Care Act (ACA) with hosts Heidi and Joel Heitkamp. (00:00) - Chapter 2 (12:00) - Cynthia urges listeners to pay attention to healthcare cost increases and the role of Congress. (00:00) - Chapter 4 (18:00) - Heidi and Cynthia debate the numerous Republican arguments against Obamacare and the impact on healthcare costs. (00:00) - Chapter 6 (24:00) - Cynthia details the work she's doing with KFF on Medicare Advantage and its implications.
MEDICARE ADVANTAGE MINUTE: Medicare vs. Medicare Advantage: Ill Health often Leads to a Plan Switch YOUR MEDICARE BENEFIT 2025: Travel Outside the USA Correspondence from Anita in Fountain Hills, AZ: She has Medicare supplement Plan G but wants to consider switching to High Deductible Plan G. After some thought she... What's the deal with Long Covid anyway? We take a somewhat closer look to see if there is any sign of hope on the horizon. Finally, we close out the episode with a Christmas Quiz! 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" "MEDICARE FOR THE LAZY MAN: BARE BONES!" 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 of the 9Innings Podcast, Kevin Thompson, founder and CEO of 9i Capital Group, breaks down the most important financial planning considerations retirees need to understand heading into 2026. Kevin explains key tax changes, including the Enhanced Senior Deduction and the new above-the-line auto loan interest deduction, and outlines strategies for maximizing the standard deduction. He also discusses rising Medicare premiums, IRMAA exposure, and how to evaluate Medicare Advantage versus Original Medicare with Medigap. Throughout the episode, Kevin emphasizes proactive planning to manage taxes and healthcare costs, helping retirees make informed decisions and protect long-term retirement income.Enhanced Senior Deduction (00:01:07)Above-the-Line Car Loan Interest Deduction (00:03:12)Stacking Deductions and Standard Deduction Planning (00:04:21)Medicare Premiums and IRMAA (00:05:31)IRMAA Triggers and Tax Coordination (00:07:55)Medicare Advantage vs. Original Medicare (00:08:52)Medigap and Underwriting Considerations (00:10:39)NEWSLETTER (WHAT NOW): https://substack.com/@9icapital?r=2eig6s&utm_campaign=profile&utm_medium=profile-page Follow Us: youtube: / @9icap Linkedin: / kevin-thompson-ricp%c2%ae-cfp%c2%ae-74964428 facebook: / mlb2cfp Buy MLB2CFP Here: https://www.amazon.com/MLB-CFP%C2%AE-90-Feet-Counting-ebook/dp/B0BLJPYNS4 Website: http://www.9icapitalgroup.com Hit the subscribe button to get new content notifications. Corrections: Editing by http://SwoleNerdProductions.com Disclosure: https://sites.google.com/view/9idisclosure/disclosure
A holiday-flavored Friday Q&A that covers a lot of ground without selling a single candy cane. Don answers listener questions on Medicare vs. Medicare Advantage (and the IRMAA buzzsaw), how to safely reposition an elderly parent's taxable account, whether to ditch target-date funds for a DIY equity portfolio, how to think about international small-cap ETFs, why teaching kids to pick stocks is a terrible idea, and what to expect when a “free portfolio review” comes from a company whose name literally includes the word annuity. Skeptical, practical, and very on-brand. 0:17 Corny holiday Q&A musical intro and setup 0:33 Friday Q&A format, how questions get on the show, and holiday vibe 2:00 Medicare vs. Medicare Advantage, IRMAA penalties, and why private insurers are exhausting 3:37 Why capital gains can make Medicare shockingly expensive 4:15 The profit motive problem with Medicare Advantage plans 4:37 Question transition and listener call-in reminder 5:43 Managing an 82-year-old's taxable account: safety vs. yield 6:18 Why bond funds like BND diversify interest-rate risk better than savings accounts 7:15 CD ladders: how they work and why discipline matters 7:39 Treasury funds vs. total bond funds for capital preservation 7:47 Closing thoughts on preservation-focused portfolios 8:52 Target-date funds vs. DIY 401(k) portfolios 9:20 Glide paths, rebalancing, and what target-date funds do well 10:35 100% equity risk, volatility, and why down markets help accumulators 10:53 Choosing between AVDV and AVES (international small value vs. emerging markets) 11:47 Why the correct answer is often “both” 12:33 Teaching high school students about investing 13:52 Why stock-picking education reinforces a dangerous myth 14:28 Luck vs. skill and the evidence against beating the market 15:39 Index funds, market efficiency, and investor behavior 16:49 Morningstar vs. other research tools 17:18 Empower's “free portfolio review” and what might be coming next 18:06 Portfolio concentration concerns and tech exposure 19:33 Humor break and annuity skepticism 20:55 What Empower actually is and what that implies 21:16 Empower as an RIA and how to treat their recommendations 21:52 Getting a second opinion from a fee-only advisor 22:58 Thanks, holiday wrap-up, and call for more questions Learn more about your ad choices. Visit megaphone.fm/adchoices
The Friday Five for December 12, 2025: Wrapping Up AEP 2026 Spotify Wrapped 2025 Pebble Index 01 2026 ACA Enrollment Snapshot #1 KFF 2026 Medicare Advantage Spotlight Get Connected:
MEDICARE ADVANTAGE MINUTE: WHY MA CONTRACT NEGOTIATIONS ARE GETTING HEATED YOUR MEDICARE BENEFITS 2025: TRACTION EQUIPMENT Close friend Marlene figured out how to send me a lively online discussion regarding the new Medicare experiment with Prior Authorization. She saw my repeated warnings in some of these online comments. Full disclosure mandated that I read an AI generated list of the exact procedures included within this five year trial program. New client Cal had an unusual introduction to MLM enrollment service. The state of Nebraska, an unfamiliar insurance company and some careless errors conspired to create a less than smooth introduction to my normally stellar client service! 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" "MEDICARE FOR THE LAZY MAN: BARE BONES!" 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.
“Delivering a baby one day and holding a patient's hand at the end of life literally the next day...that continuity is very powerful,” says Dr. Jen Brull, board chair of the American Academy of Family Physicians (AAFP). And as she points out, that continuity also builds trust with patients, an increasingly valuable commodity when faith in medicine and science is declining. As you might expect given her role, Dr. Brull believes strengthening family medicine is the key to improving health and healthcare. Exactly how to do that is at the heart of her conversation with host Lindsey Smith on this episode of Raise the Line, which covers ideas for payment reform, reducing administrative burdens, and stronger support for physician well-being. And with a projected shortage of nearly forty thousand primary care physicians, Dr. Brull also shares details on AAFP's “Be There First” initiative which is designed to attract service-minded medical students – whom she describes as family physicians at heart -- early in their educational journey. “I have great hope that increasing the number of these service-first medical students will fill part of this gap.”Tune-in for an informative look at a cornerstone of the healthcare system and what it means to communities of all sizes throughout the nation. Mentioned in this episode:AAFP 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/podcast
Paul has trouble with his hearing and shares a story about earwax. Which companies are selling Medicare Advantage plans? Kaiser Workers on strike. New prescription drug website: TrumpRX.com. GoodRx and generic drugs. Real life couple suffers from health issues.
The Good & Bad of Medicare. Client email shares their story about Medicare HMOs and they weren't interested in Medicare Advantage plan feeling it was substandard care. Advantage plans bring in more money but aren't that good for the client. Special Enrollment period. HRA: Health Reimbursement Arrangement. MFN: Most Favored Nation clause.
Value-based enterprises depend on timely, accurate data, yet the rules that govern how that data moves between the Centers for Medicare & Medicaid Services (CMS), accountable care organizations, payors, and providers remain complex and often inconsistent. On this episode, Epstein Becker Green attorneys Kevin Malone and Karen Mandelbaum unpack the regulatory frameworks shaping data exchange in value-based care. They outline how federal privacy laws, CMS rules, the Health Insurance Portability and Accountability Act (HIPAA), and state requirements intersect; why CMS-sourced data operates under a different regime than Medicare Advantage; and where organizations face the biggest operational hurdles when using, sharing, and governing data across large networks. Key Takeaways: Distinct Legal Frameworks: CMS data is controlled by the Privacy Act, while Medicare Advantage data falls under HIPAA. Disclosure Tracking Requirements: CMS data use agreements demand strict tracking and downstream compliance. Operational Data Challenges: Silos and uneven data quality remain major barriers to effective value-based care. Tune in to learn how today's rules shape data access, data quality, and the real-world mechanics of value-based care. Visit our site for related resources and email contact information: https://www.ebglaw.com/dhc92 Subscribe for email notifications: https://www.ebglaw.com/subscribe. Visit: http://diagnosinghealthcare.com. - This podcast is presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.
Medicare is a cornerstone of retirement planning, but its complexity can leave many retirees feeling overwhelmed. In this episode, host John Bryson, head of investment consulting, investment data analytics, and education savings at Manulife John Hancock Investments, welcomes Danielle to break down the Medicare essentials you need to know for 2026 and beyond.Danielle, author of the book 10 Costly Medicare Mistakes You Can't Afford to Make, discusses the latest expected changes to Medicare. She emphasizes the importance of early research and understanding the difference between supplemental plans, such as Medicare Advantage plans and Medicare Supplement Insurance (Medigap). She also offers strategies to help avoid higher Income-Related Monthly Adjustment Amount (IRMAA) surcharges.Here's a snippet from the conversation:1 What changes are expected to Medicare in 2026?Danielle: While we don't have some Medicare figures due to the government shutdown, we can expect Part B premiums to increase a bit. Projections suggest they could rise to $206 next year. Another major change stems from the Inflation Reduction Act of 2022, which led several carriers to exit the Part D market. As a result, about 2 million people are likely to lose their Medicare Advantage plans. If you've received a notice that your plan is exiting the market, it's important to shop for a new plan promptly to ensure you have coverage in place for January 1.2 What's IRMAA and how does it affect Medicare costs?Danielle: IRMAA is a surcharge on Medicare Part B and Part D, based on your income. While the base rate in 2025 is $185, an IRMAA surcharge will increase that amount. As a result, Part B premiums for people in really high-income brackets can increase to over $600 per month. So, decisions you make at ages 63 and 64 can affect your Medicare premiums at 65 and 66. It's wise to work with your financial advisor to plan ahead to explore spreading out income or avoiding large distributions that may help prevent higher premiums later.
In this Bright Spots in Healthcare episode, host Eric Glazer brings together Medicare Advantage leaders who are rethinking how digital first and whole person strategies can meet rising Stars expectations. The conversation explores how plans are simplifying engagement, strengthening provider alignment, and integrating specialty and virtual care models to improve quality, experience, and overall performance in the new ratings era. Our guests include: Lisa Franklin, Director of Medicare Business, Product, and Marketing, Strategic Growth and Government Programs, Carefirst Christine McKinney, Vice President Customer Experience and Digital Transformation Blue Shield of California Mary O'Connor, MD, Chief Medical Officer & Co-Founder, Vori Health Together, they explore: How CareFirst reduced member friction by consolidating 175 touchpoints a year into a coordinated digital first experience built around scrolling content cards, real time click behavior, and simplified onboarding. How Vori Health is integrating whole person MSK care with payers through value based arrangements that support coaching, nutrition, behavioral health screening, and earlier risk identification. How Blue Shield of California built a continuous CAHPS simulation program to uncover pain points and used those insights to create the Care Navigation Desk for real time access help. How digital tools like online scheduling, integrated member health records, and proactive pharmacy cost transparency are reducing friction and helping seniors navigate the ecosystem more independently. How plans are using AI and preference based engagement to support new Medicare members, improve medication adherence, and scale outreach during market disruptions. Panelist Bios: https://www.brightspotsinhealthcare.com/events/falling-stars-rising-standards-how-digital-first-whole-person-care-is-fueling-success-in-the-new-ratings-era/ 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/2025/12/Episode_Guide_120425_Vori-Falling-Stars-Rising-Standards.docx.pdf Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation. https://www.brightspotsinhealthcare.com/wp-content/uploads/2025/12/Key-Takeaways-Erics-Notes-Falling-Stars-Rising-Standards.docx.pdf Resources: Report: How Physician Led MSK Care Supports Stars Improvement and Whole Person Outcomes This companion report highlights how Vori Health's physician-led, virtual first musculoskeletal care model helps Medicare Advantage plans strengthen performance in the new ratings environment. It includes data and real member stories showing how hybrid specialty access, early gap closure, and whole person support improve outcomes, reduce unnecessary MSK spend, and enhance member experience. Inside you will find insights on Improving access through forty eight hour specialty appointments Reducing opioid use and unnecessary surgeries Supporting preventive screenings and chronic condition management Elevating member satisfaction across measures tied to the 2026 Stars program To request your copy, email nroberts@brightspotsventures.com. Buyer's Guide: The Comprehensive Guide to MSK Care for Health Plans This companion report gives health plans a clear framework for improving MSK strategy, highlighting how fragmented, high cost pathways drive unnecessary imaging, procedures, and surgeries without resolving pain. It outlines four MSK care models and the key elements of a high value program such as physician led care, holistic support, non opioid management, strong engagement, and real claims based ROI. It also shows how solutions like Vori Health bring these components together through coordinated, hybrid access and measurable improvements in outcomes and cost. Inside you will find insights on Improving MSK access and coordination across care models Designing physician led, whole person programs that address root causes of pain Reducing unnecessary imaging, procedures, and surgeries Driving stronger engagement, better outcomes, and meaningful cost savings To request your copy, email nroberts@brightspotsventures.com. Thank You to Our Episode Partner, Vori Health: Vori Health is a physician-led musculoskeletal care practice that delivers fast, evidence-based hybrid care for back, neck, and joint pain. Their whole person approach improves outcomes, reduces unnecessary MSK costs, and supports stronger Medicare Advantage Star Ratings. Learn more at vorihealth.com. Schedule a Meeting with a Dr. Mary O'Connor of Vori Health: To explore how Vori Health can help your organization strengthen whole person MSK care and support better Stars performance, reach out to nroberts@brightspotsventures.com to schedule a meeting with Dr. Mary O'Connor, CMO and Co-founder, Vori Health. 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 of the Industry Matters podcast, hosts Tyler Coulander and Alan Morris explore the rapidly changing payer landscape and its impact on the Durable Medical Equipment (DME) industry. Get the latest insights on Medicare Advantage, private insurance, and Medicaid, and learn how these shifts could affect your business strategy.What you'll learn in this episode:The latest trends in Medicare Advantage enrollment and projectionsHow payer decisions are influencing DME providersThe importance of understanding and adapting your payer mixActionable steps for building strong relationships with key payers and referral partnersWhat to watch for in the DME industry in the coming yearsWhether you're a DME provider, healthcare professional, or industry stakeholder, this episode of Industry Matters delivers valuable information and practical takeaways to help you stay ahead in a dynamic market.If you found this episode helpful, please like, share, and subscribe for more insights from Industry Matters!
This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to outcomesrocket.com What if the most powerful force in healthcare isn't a new drug or device, but the ability to change patient behavior at scale? In this episode, Kempton Presley, Chief Executive Officer of AdhereHealth, discusses how the company enhances medication adherence and closes care gaps for high-risk populations through data-driven, science-informed behavioral interventions. He explains how AdhereHealth partners with Medicare Advantage plans, providers, and pharmacies to identify care gaps and influence positive patient behavior change, backed by an at-risk financial model tied to measurable outcomes. Presley also reflects on the challenges in the healthcare economy, shares his personal lessons on navigating career stagnation, and emphasizes the importance of aligning head and heart to create momentum. He highlights AI, automation, and advancements in genetic sequencing as key forces shaping the future of healthcare. Tune in to hear how AdhereHealth is reshaping behavior change at scale and driving sustainable health outcomes! Resources Connect with and follow Kempton Presley on LinkedIn. Follow AdhereHealth on LinkedIn and discover their website!
In this episode we're highlighting some important things to think about while AEP is still fresh in your mind. Read the text version
This episode announces the launch of CMS's ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model - a groundbreaking payment innovation that enables technology-enabled care organizations to treat Medicare fee-for-service patients with chronic conditions through outcome-aligned payments rather than traditional fee-for-service. Abe Sutton (Director of CMMI) and Jacob Shiff (Chief AI & Technology Officer at CMMI) explain how the model addresses a fundamental gap in healthcare: while commercial and Medicare Advantage patients have access to digital therapeutics and technology-enabled chronic disease management, original Medicare beneficiaries have been left behind. ACCESS changes this by paying providers monthly fees for managing conditions like diabetes, hypertension, obesity, behavioral health issues, and musculoskeletal pain - but only when patients achieve measurable clinical improvements. The model is designed to be deflationary rather than inflationary, encourages innovation by simplifying go-to-market for digital health startups, integrates with existing risk-bearing models like ACOs, and represents a broader CMMI strategy to shift from activity-based to outcome-based payments while leveraging new AI capabilities to democratize high-quality care. (0:00) Intro(0:57) The ACCESS Model: Advancing Chronic Care(4:35) Outcome-Aligned Payments and Technology(7:40) Encouraging Innovation and Investment(09:23) Practical Implementation and Examples(24:28) Evaluating Success and Future Goals(26:18) Connecting the Dots: Broader CMMI Initiatives(28:40) Generous and Its Impact on Drug Pricing(30:11) Challenges and Benefits of Prior Authorization(35:19) The Role of Technology in Healthcare(37:59) AI and Technology-Enabled Care(40:26) Reflections on Value-Based Care Models(43:51) Encouraging Competition in the Healthcare Market(48:24) Quickfire Out-Of-Pocket: https://www.outofpocket.health/
Ameren Missouri's new rates for data centers are now in effect. But a consumer advocacy group is asking for a redo. St. Louis Public Radio's Kate Grumke explains the case and the latest updates. Plus, Midwest seniors have two options for Medicare coverage– traditional Medicare through the government, or a private Medicare Advantage plan. While Advantage plans cost less up front, experts say seniors could pay the price with their health.
In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, breaks down CMS' proposed 2027 Medicare Advantage rule, challenges facing smaller MA plans, and the shrinking access to GLP-1 medications on ACA marketplaces. He also highlights the evolving dynamics between payers, providers and consumers as policy and costs rapidly shift.
“This is a time to reimagine public health and public health/healthcare system integration,” says Dr. Deb Houry, the former chief medical officer for the US Centers for Disease Control and Prevention. In this thoughtful Raise the Line conversation, Dr. Houry reflects on unprecedented federal action in vaccine guidance and other issues since her noteworthy resignation from the CDC in August, and sees a more decentralized landscape emerging where states and localities play a larger role in providing public health recommendations. And while she acknowledges upsides to this shift, she's also concerned what the absence of a national consensus on health standards could mean. “Diseases don't recognize borders, and it's also important that people have equitable access to preventative services, vaccines, and other things,” she tells host Lindsey Smith. Tune in for Dr. Houry's seasoned perspective on this consequential moment in public health, and her encouraging message for learners and early career providers considering a career in the sector.Mentioned in this episode:DH Leadership & Strategy Solutions 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/podcast
The Centers for Medicare and Medicaid Services is considering updates to how it calculates Medicare Advantage star ratings. The United States and the United Kingdom have agreed to a zero percent pharmaceutical tariff. The House passes legislation to extend the hospital-at-home waiver. Hear more on today's episode of The Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
Recorded live at HLTH, this episode of Bright Spots in Healthcare takes you inside Health2047, the venture studio founded by the American Medical Association to tackle some of healthcare's gnarliest problems. Host Eric Glazer sits down with Warren Templeton, Managing Director at Health2047, to explore how the AMA is backing founders at the earliest stages to reshape physician workflows, chronic disease management, and data liquidity. Warren shares how Health2047 partners with science- and clinician-led startups at the pre-seed and seed stages, wrapping founders with commercial strategy, clinical and billing expertise, and an evergreen capital model that matches healthcare's longer time horizons. He also unpacks why humility and conviction are the two non-negotiable traits he looks for in founders. You'll hear real-world examples from Health2047's portfolio, including: Zing Health – a Medicare Advantage plan built for underserved communities, rooted in social determinants of health and community-based design Phenomics Health – an obesity phenotyping company born from a "failed" diabetes prevention bet, now helping match patients to the right GLP-1s, procedures, and care pathways ScholarRx – a global medical education platform partnering with the WHO to enable high-quality "tertiary care in the wild" for clinicians around the world Warren and Eric also dig into: Why traditional 5–7 year VC timelines often clash with healthcare reality How to balance breakthrough science with practical workflow integration and commercial viability The impact KPIs Health2047 tracks beyond IRR, including lives and care teams impacted If you're a founder, investor, or healthcare leader trying to build something that actually works in the real world—not just on a pitch deck—this conversation offers a candid look at what it takes to design, fund, and scale the next generation of healthcare companies. Bio: https://health2047.com/leadership/warrentempleton/ References: Health2047's portfolio companies mentioned in the episode: Zing Health - https://www.myzinghealth.com/ Phenomics Health - https://www.phenomicshealth.com/ ScholarRx - https://scholarrx.com/ Partner with Bright Spots Ventures: If you are interested in speaking with the Bright Spots Ventures team to brainstorm how we can help you grow your business via content and relationships, email hkrish@brightspotsventures.com 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. Visit our website: www.brightspotsinhealthcare.com. Follow Bright Spots in Healthcare: https://www.linkedin.com/company/shared-purpose-connect/
Twila Brase is president and co-founder of Citizens' Council for Health Freedom, a national patient-centered, privacy-focused, free-market policy organization to support health care choices, individualized patient care and medical and genetic privacy. Twila is a certified public health nurse and author of the eight-time award-winning book, Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records. She's the speaker on the daily Health Freedom Minute heard on stations across the nation. Twila returned to Crosstalk with an important update as it relates to your health care and privacy concerns. You'll want to review this broadcast as she discussed the following: Was the Affordable Care Act about health care accessibility and affordability or was it perhaps a transfer of wealth and a move toward socialized medicine? What you need to know concerning the Obamacare subsidies that highlighted the debate during the recent government shutdown. The problems with Medicare Advantage vs. regular Medicare. Real I.D.--Twila explains why it's far more than just a driver's license and what it means in terms of your privacy.
Ditch the Suits - Financial, Investment, & Retirement Planning
Health insurance and Medicare often feel like a black box, especially for retirees, entrepreneurs, and anyone facing a major life transition. In this episode, Travis Maus (CEO of S.E.E.D. Planning Group) welcomes Cole Craven, founder and Head of Growth at Move Health, to shine a light on the complexities of healthcare coverage and empower listeners with practical, actionable knowledge. Whether you're planning for retirement, launching a business, or simply trying to make sense of your options, this conversation breaks down common myths, uncovers industry realities, and offers insights to help you make informed decisions about your health coverage. Cole shares his personal journey into the healthcare space, the founding story of Move Health, and why education is the key to overcoming uncertainty and fear around health insurance. Listeners will learn how Move Health helps advisors and clients navigate the maze of coverage options, why understanding your unique health and financial situation matters, and how to avoid common pitfalls, like choosing plans based solely on price or following advice that isn't tailored to your needs. Key Takeaways: Why health insurance is a top concern for retirees and entrepreneurs The importance of education and healthcare literacy How Move Health empowers advisors and clients with real data and objective advice The difference between Medicare Advantage and Medicare Supplement plans Why working with a trusted, objective partner is crucial Call to Action: Don't let health insurance be a source of stress or confusion. Seek out education, ask questions, and make sure you're working with someone who puts your best interests first. If you're unsure about your coverage, get informed and don't be afraid to ask for help.
Thanksgiving is upon us and the expense can get crazy. Clark shares ways to spend less on the family feast. Later - you may be charged more when purchasing online because of the WAY you shop, among other factors. How do you know you're getting the best price? Clark explains “surveillance pricing” and money saving tricks of the trade. Plus, at the very end of the podcast Clark has an important tip for Medicare Advantage plan holders. Save On Thanksgiving Dinner: Segment 1 Ask Clark: Segment 2 Savvy Shopping Online: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Aldi's Thanksgiving dinner is just $4 per person The Best Deals of Aldi's Middle Aisle in November #1 Way To Protect Yourself From Credit Card Skimmers Is a HELOC a Good Idea? The Simple Answer How To Get the Best Price Possible Shopping Online How To Use Camelcamelcamel Clark Deals - Laptops Booking a Cruise? Here Are 5 Ways To Do It for Less Don't miss out on the early Christmas gift from your Insurance Company when your Medicare Advantage (MA) plan gets canceled.Clark.com resources: Episode transcripts Community.Clark.com / Ask Clark Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices: megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices
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