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This episode of the Agent Survival Guide podcast explores 5-Star Medicare Advantage plans. We'll break down what they are, how they became 5-star plans, and why you can sell them throughout the year! Read the text version Get Connected:
The Friday Five for June 12, 2026: Apple WWDC 2026 Takeaways Instagram Grid Arrangement Feature IntegrityCONNECT Annuities & What's Coming Soon KFF MA Enrollment Stats & Trends for 2026 CMS Medicaid Work Requirements Get Connected:
"Do nothing for us without us." According to today's guest Robyn Bussey, that operating principle is the basis for effective community health work. "You don't go into a community and dictate. You go and listen and trust and be a partner," she adds. As you'll learn in this enlightening conversation, Bussey is following that approach in her current work as Just Health Director at the Partnership for Southern Equity, an Atlanta-based nonprofit advancing racial equity and shared prosperity across the South. On this episode of Raise the Line from Elsevier, Bussey provides illuminating examples of community-rooted work in South Fulton County and rural Georgia, and explains why community health workers may be the most underutilized asset in addressing health disparities. This wide-ranging interview with host Michael Carrese also explores: Bussey's candid perspective on what happened to the surge of interest in health equity that occurred during COVID; Why life expectancy gains in many Southern states have lagged behind the rest of the country; Her advice to students and early-career clinicians about where they're needed most. Mentioned in this episode: Partnership for Southern Equity 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
Tonight, Don is back on the streets of New York to check in with Knicks fans ahead of the next big game. Is the energy different now that Trump isn't in attendance? And after the last loss, do New Yorkers really think he jinxed the team?
Social determinants of health, including housing, food access, insurance status, and structural inequities, significantly influence stroke prevention, recovery, and long term outcomes. These factors affect biological risk, treatment adherence, and disparities in care, even when traditional clinical measures are addressed. This episode highlights practical strategies for integrating screening, leveraging multidisciplinary teams, and identifying opportunities for advocacy to improve patient outcomes. In this episode, Teshamae Monteith, MD, FAAN, speaks with Nneka L. Ifejika, MD, MPH, author of the article "Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Ifejika is an adjunct professor of physical medicine and rehabilitation at UT Southwestern Medical Center in Dallas, Texas, and the chief scientific officer of the Division of Academics at Ochsner Health System in New Orleans, Louisiana. Additional Resources Read the article: Social Determinants of Health and Their Impacts on Stroke Prevention and Outcomes Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Monteith: Two patients have the same stroke, but when they return, they have very different outcomes. We can look into some of their comorbidities, but something we don't spend enough time talking about is the social determinants of health. Stay tuned to this discussion. I promise you, you'll become a better neurologist. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr. Teshamae Monteith. Today I'm interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. How are you? Welcome to our podcast. Dr Ifejika: Thanks for having me. I'm doing great. Dr Monteith: Great. So, can you introduce yourself to our audience? Dr Ifejika: Sure. I'm Dr. Nneka Ifejika. I am the Chief Scientific Officer of Ochsner Health System in New Orleans, Louisiana. But I'm also a cerebrovascular rehabilitation doctor. I've been practicing for about nineteen years, and am happy and honored to be a contributor to this Continuum Neurology article. It's a really important topic. Dr Monteith: Great. So, what got you into this field, first of all? Dr Ifejika: Well, I was deciding between PM&R and neurology, and I was putting in both match lists. And I thought about it and I leaned toward PM&R, but stroke still had a grasp on my heart and my mind. And so, after I finished my residency, I joined the UT Houston stroke team, and I did a, thankfully did a two-year fellowship and became cross-trained in stroke as well as physical medicine rehab. So, I am a jack of both trades. Dr Monteith: So, you got your way in a way. Dr Ifejika: I did. Dr Monteith: You know, we have a lot of learners that are listening, so it's always, uh, nice for them to be inspired, I think, by people's career paths. So why don't we talk about the objectives of your article? Dr Ifejika: Sure. So, one of the most important things that we wanted to do was make sure that medical students, residents, faculty, and fellows understood the impact of social determinants of health on stroke recovery and stroke rehabilitation. It's not as simple as you have hypertension, hyperlipidemia, we're going to manage your stroke risk factors. Oh, you had an ischemic stroke. You presented in time for the window. We're going to give you endovascular therapy and then modified Rankin scale at hospital discharge in ninety days. No, no, no. The stroke survivor and their caregivers and their family have a lot more to deal with outside of what we look at during the acute stroke hospitalization and post-acute rehabilitation. Things like, can they afford the medication that we're prescribing? Antiplatelet agents or anticoagulation can be extremely expensive. Do they have housing insecurity? Is there food insecurity? What's going on behind the scenes that we are not addressing that can directly impact the admission rate and the readmission rate after we take care of a stroke survivor? Dr Monteith: I love the article because you took a real deep dive into social determinants of health, what they are, why they matter, and what we can do about them. And so why don't we talk a little bit about the NINDS framework for social determinants of health? I think many of us might not be familiar with the framework per se. Dr Ifejika: So, the framework consists of multiple domains specifically that relate to social determinants of health that were published in Neurology a couple of years ago. So, I do hope that people who are hearing this recording actually read them. There are interpersonal domains, there are classic medical domains, there are indeterminate domains, and there are six total domains. And health domains are the last domain. So, things like when it comes to housing insecurity, food insecurity, that's a domain of social determinants of health. When it comes to chronic racism, when it comes to biases that patients experience, those actually impact outcomes. So, there are six separate indices that we're going to get into in detail and how we address them as clinicians, whether it be at the medical student level, resident level, faculty level, to integrate the social determinants of health in our care plans, because we could be doing a much better job. And I think it'll be really important from the interpersonal perspective when we really relate to our patients and their families that we ask these questions. For example, if we're prescribing someone to have treatment for their diabetes mellitus and ha- and, and be taking insulin, if they have housing insecurity and they're in a homeless shelter, they have to leave the homeless shelter during the day. So, what happens to the insulin that we prescribe? These are variables that we are not considering on a regular basis, but they directly relate to compliance. Dr Monteith: Great. So that was one thing I wanted to bring up. We're very good at measuring blood pressure and trying to determine, uh, the association between stroke outcomes and things that we can measure, glucose, lipids, blood pressure. What is the evidence for social determinants of health and stroke outcome? Dr Ifejika: The evidence is growing, and there have been many publications that have come out that are, are going to be highlighted in this article related to structural determinants of health inequities, like structural racism, as well as disparities related to ethnicity and race. There's geographical disparities. For example, a lot of patients are, are primarily concerned about rural versus urban, whether you have access to different post-acute rehabilitation, whether you have access to secondary stroke prevention because you simply don't have the transportation from a, a rural area to get to a drugstore to get things available to you. Social status. There are actually publication related to socioeconomic status and the concerns when it comes to air pollution. So particulate matter 2.5, we know that that has a direct impact on stroke outcomes and health overall, but we don't really think about it as a structural determinant of health inequity. There's several multiple layers of research that have gone on specifically that have been cited in the literature that relate directly to social determinants of health and how we can address them moving forward. Dr Monteith: And what I found interesting in your article in that you gave at least a few examples where social factors like income, education were controlled for, and maybe in large part it is, but even when you control for some of these very obvious social risk factors, you still have inequities. Dr Ifejika: Absolutely. And I think it was really important to show that we had strong peer review evidence behind this, as it wasn't just something that we were creating or hypothesizing about. There have been studies that have been done over this over decades of time, showing the impacts of social determinants of health on outcomes. But the question and concern that we have is we know this growing body of literature continues to expand. What are we doing about it when it comes to education of the future generations of providers who will be caring for this population? Dr Monteith: Before we get into how, you know, what we're going to do about that, let's just kind of put that link, cause the evidence is there. How does it drive biology? Dr Ifejika: It's a great question. So, for example, particulate matter 2.5 in air pollution has been shown to have an existing impact on hypertension, raising your blood pressure. So that's a direct effect of a social determinant of health related to socioeconomic status because people who live in areas with higher air pollution are... They're not green spaces. They live near highways. Those are areas that unfortunately are also impacted by food deserts. Food deserts, if you're not able to get fresh fruits, vegetables, whole foods, increases your risk of developing diabetes, hyperlipidemia, also increases your sodium intake, again, increasing hypertension. These things are all connected to biological determinants. It's just that we're not asking about them necessarily within the social history when we're taking people into the hospital, but they have direct effects. Dr Monteith: Great. Neurologists tend to be busy and, you know, we're... have all of these things that we're being asked to do and chart and click and all of that stuff. And so how can we more readily integrate screening for social determinants of health and that conversation into the work we do? We recognize it's important. We recognize it's an important risk factor. There's a lot of these determinants. So, what is a good way to do so? And I, I know that in the paper you've, you've given different roles to different team players, so I want you to talk about that too, but just kind of even a regular routine office visit. Walk us through a way we can more easily integrate that kind of conversation. Dr Ifejika: It's an excellent question, and what I've recommended that we do in a standard office visit is utilize the time before the visit to send out screeners. So, for example, usually with an electronic medical record, you can send documents before the visit even starts, where people can check off whether they have any concerns regarding housing, food insecurity. They can check out their location of where they live, whether they live near a highway or not near a highway. It's specifically related to socioeconomic status. We can ask about insurance status, whether they have insurance, insured versus uninsured, but then also types of insurance, whether they have Medicaid insurance versus Medicare insurance. Then even drilling even further, type of Medicare insurance, Medicare Advantage versus traditional Medicare, cause all of those things actually play a role in this. Dr Ifejika: And evaluate these things and don't take time during your office visit. Send these screeners out beforehand. Have them be assimilated by your medical staff. Make sure you're utilizing every resource that you have at your disposal to help streamline things, so by the time the person comes in for the visit, you've primed the pump. You have this information already in your hands at your fingertips cause it was sent out in advance, and you have your medical staff already have an understanding of. If they didn't fill it out electronically, give it to them in the lobby. Make sure they have a handwritten copy in the lobby so that when they come into the office visit, you have the information at your fingertips. Dr Monteith: Are there any particular resources that you recommend for those types of screeners? Dr Ifejika: What I've used in the past, if you have patient-reported outcomes, so the PROMIS instruments, that's a good start. It doesn't get into the details of housing insecurity, food insecurity, but it's a good start to help prime questions and to start the conversation during your office visit. In my clinics, I do a PROMIS 27 on every patient, as well as a PHQ-9 for depression on everyone. And then I collect data longitudinally, and I can always drill down on factors that I noticed that could become a problem moving forward. Dr Monteith: Yeah. And then also in your article, you spoke a bit about this impact from the acute presentation in the hospital to rehab. Dr Ifejika: Yeah. Dr Monteith: So why don't you talk about these different entry points where we can really engage our patients and try and help reduce their burden? Dr Ifejika: Sure. So, healthcare can be quite fragmented, and the stroke patient, stroke survivor, and their family member have no grasp of that. They've had a stroke, and they may be going from the ER to the ICU to the stroke unit to the floor to the rehab unit, and we see it as multiple levels of care, multiple types of providers. They see it as one hospital. And the concern that we have is, at those branch points, things get dropped, and we have the opportunity to pick things up at those branch points. So, during the acute care hospitalization-Primarily, that's the establishment of what has happened, how we're gonna treat it, what are the variables that we can control for right now to address those determinants of health moving forward, and to specifically looking at whether they were taking medications before, whether they could afford medications before, what that looks like at hospital discharge. Is there any duplication of medications? If a person is taking Coreg and you prescribe metoprolol, but they still have the Coreg at home, should we have really prescribed the metoprolol? We're just spending money that they may have concerns when it comes to access to care and the cost of these prescriptions. So, it's the responsibility of the acute care physician to kind of look at that. Those are subtle things that we think are subtle, but they add up quickly for the family when it comes to having one group of medications that's the same class and having to buy another type. When it comes to post-acute rehabilitation, it's really an important time to screen for whether the caregiver can handle what's occurring. So specifically, if the caregiver is already burning out and the average length of stay for a stroke patient is five days and they've come to rehab for two weeks, what's gonna happen in the next two years or the next four years? So, during the post-acute rehabilitation phase, it's time to kind of look at that and drill down on those kind of questions. Also, the levels of care, Dr Ifejika: it's really important to look at other levels of rehabilitation, so skilled nursing facilities, making sure people have access to that if they need to, if the caregiver is burned out and they don't have the ability to go straight home. Because acute inpatient rehab, the goal of it afterwards, is to go straight home. It's not to go to another facility. So, you need to have that screener in place when it comes to whether the family can take care of this person, and whether the family can do it in an effective way to prevent them being readmitted. Dr Monteith: Great. I also like that you spoke about kind of the team approach and different roles, both for screening and for intervention, both being very important, especially the intervention. And so why don't you give us a few examples how the team could break up the responsibility and how also for the intervention component that can be done. Dr Ifejika: Sure. So, I broke up the team into several levels. So, the team medically is the medical student, resident, and faculty physician. However, the team also includes the support staff, so your case manager, your social worker, the therapist, physical therapy, occupational therapy, speech therapy, the pastoral services, all these members of the team. You know, sometimes as physicians, we don't read those notes. There's a lot of information in the notes from social work, care coordination, and the therapist. They get down to subtleties cause they're asking questions, for example, "What kind of equipment do you have at home? How many stairs do you have at home? What level of house do you have, one story, two story? If you live in an apartment, do you have an elevator access?" That's important for someone with hemiparesis. When it comes to medications, when it comes to insurance status, when it comes to your ability to have the mechanisms to pay for care as an outpatient, social workers are required to ask these questions cause they have to figure out resources for the patient and their family to help facilitate improved outcomes. So, they have to ask questions regarding these tasks. The concerns are, do we read what they're saying? So, it's really important to interact with them, and if it's not something that you're looking at in the chart, cause we're all so tied to our computers, find where they are in the hospital. Walk by their office and have a chat. Run your list with them, especially for people who you're concerned have vulnerabilities, and make sure that you're setting an example for your medical students with your faculty doing so. If you're looking at it from the medical student, resident, faculty perspective, medical students, listen. This is your opportunity to really contribute to the team as well as learn about social determinants of health and research in their fields. You are the boots on the ground for the medical team. You are the ones who should be priming the pump and asking these questions of the family members. We're sending you into the rooms to do a history and physical. Social determinants of health should be a part of your history and physical, and you should be taking what we're saying in this article and asking these questions and tying it into your resident. Now, the resident is the work person of the hospital. We all know this. Things run through the resident. Things run through the fellow. It's really important that they have this information in a manner that is negotiable. The list keeps getting longer, and a resident doesn't need to be overburdened. It needs to be synthesized in a manner that can help facilitate the resident being able to act as well as communicate any concerns to the faculty. And at the faculty level, we are the voices that can affect change. So, if there's any concerns when it comes to advocacy, research, making sure that people are accessing care in a way that makes sense, particularly when it comes to the ability for us to galvanize change on a national level, that's kind of our job. Dr Monteith: Great, and so let's talk about intervention. What are things that, let's say, the neurologist can do to deal with some of these social factors? Dr Ifejika: From the neurology perspective, I think it's really important to identify missed opportunities and making sure that we address them. For example, the conversations around the ability to have access to care related to insurance versus no insurance. There are many, many ways that neurologists are able to advocate for a person being able to get to Medicare insurance, particularly in the outpatient setting. When we see patients in clinic, it takes two years, them, to qualify for Medicare, two years at a minimum. But there's a gap there that can be filled by us making sure that we document what's happened, contact their providers, facilitate communication with their employers, if they're employees, they can get some short-term disability benefits to help bridge that gap prior to receiving Medicare insurance. It behooves us to do this because if we do not, they fall into the gap and they get readmitted and they're back on service anyway. So, what's important is the outpatient that we really kind of focus on things that we can impact and things like insurance and getting people transitioned from having employer-based insurance versus getting to Medicare is a really important way that we can effect change in a, in a way that's viable and, and replicable. So, in the outpatient setting, neurologists have a wonderful opportunity to effect change in social determinants of health. When it comes to employed persons, who had a stroke transitioning to Medicare, it takes two years to do so. So, in the outpatient clinic, if you have an employed person, make sure that you fill out their short-term disability benefits forms, their long-term disability benefits form. Bridge the gap. Get that information to their employer so they can maintain constant coverage. Because if they do not, if they have to choose between refilling medications and putting food on the table, they're going to choose putting food on the table, and that's going to directly impact their outcomes if they're not taking the medication that we recommend. Dr Monteith: I think that's a great point. I mean, there's a lot that we can do, and in some ways, it may not take that much to document and to be able to ask the questions and to include some of that information into the assessment and plan is really a, a great idea. Dr Ifejika: And you know, if we don't bring these things up and have these conversations, it doesn't get addressed. And that's why I'm very, very thankful that I had the opportunity to do so, cause this is a part of what I do all day. I think that if I wasn't integrating these kind of conversations into my practice, I wouldn't have the ability to share these tips and these abilities to move things forward in a manner that will be constructive for our field overall and for our patients. Dr Monteith: And towards the end of the article, you brought up something I think we don't see in many articles, and that's the role of advocacy and getting involved in health policy. So, can you talk a little bit about that? Dr Ifejika: You know, it's really important to facilitate change when you see that there are things that need to be changed. And the best way to do that is through advocacy at the local or state or federal level. A lot of these variables that we're dealing with can be addressed through legal changes. I'll give you an example. End-stage renal disease, if you have immediate hemodialysis and you have that requirement upon hospital discharge, you qualify for Medicare immediately. Immediately. Before you even leave the hospital. Why wouldn't something be similar for a stroke? Well, the reason why is because there was a level of advocacy that came around end-stage renal disease and a member of Congress's wife had hemodialysis requirements. And so, a law was passed to make sure Medicare covered it immediately after hospital discharge. So, it requires advocacy in some significant ways to get things done, but we have the bandwidth to do this. We take care of a population that has some of the highest rates of preventable disability. That's not going away. We need to make sure that we're effecting change for this group to make sure that they have the best possible outcomes they can experience. Dr Monteith: So, any final messages for our listeners? Dr Ifejika: I look forward to hearing everyone's feedback about our issue. I am thankful for the opportunity to talk about, address, and write about this important topic, and look forward to everyone's feedback. Dr Monteith: Well, thank you so much for being on our podcast. It was a really wonderful summary and we had a very thorough conversation, but you didn't give away too much, so I think they're going to have to read the article. Dr Ifejika: You're going to have to read the article. And we want medical students, residents, fellows, faculty, all of our ancillary staff within the hospitals, please read this article. We really appreciate it. Dr Monteith: Again today, I've been interviewing Dr. Nneka Ifejika about her article on social determinants of health and their impacts on stroke prevention and outcomes. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.
CMS continues to pull on the levers it has at its disposal to rein in national healthcare spend, including rulemaking around Medicare Advantage. In April, CMS announced the final rate for MA plans for CY2027, after a controversial proposed rule generated animated pushback — and a fair bit of panic — among payers. In this episode, host Abby Burns speaks with Alex Balmes, Vice President of Actuarial Services at Optum, to unpack what did — and didn't — end up in the final rate announcement, and what that signals for the future of the Medicare Advantage program. Together, they explore the components of the final rate that are most important for payers and providers to pay attention to, respectively, and why. Also in the 2027 final announcement, but not discussed in this episode: four measures are being added or updated in Star ratings calculations (Colorectal Cancer Screening; Care for Older Adults – Functional Status Assessment; Concurrent Use of Opioids and Benzodiazepines (COB); Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)) and three are being removed (Care for Older Adults – Pain Assessment, Medication Reconciliation Post-Discharge, Medication Therapy Management (MTM) Program Completion Rate for Comprehensive Medication Review (CMR)) We're here to help: Read the 2027 CMS Announcement | 2027 | CMS Episode | 286: A Medicare Advantage reset — and what comes next Ready-to-Use Slides | Medicare Advantage market outlook Stay informed | Healthcare policy updates Tool | Policy Scenario Impact Calculator Connect with an Optum Advisory expert | Optum Learn more about Advisory Board's 2026 summit series. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.
Medicare Advantage covers more than half of seniors, and the debate over what it really costs is stuck in two camps. Timothy Bulat, a senior consulting actuary who spent nearly two decades leading Medicare Advantage analytics inside a major insurer, raises a question the loudest voices keep avoiding: who actually pays for the program, and is the value being shared fairly? This episode is based on his article "The truth about Medicare Advantage funding and costs," published on KevinMD. You will hear how plans simultaneously manage costs well and extract excess taxpayer dollars through coding intensity and favorable selection, why headlines about Medicare Advantage being "in retreat" are overblown, and which specific policy levers (risk adjustment reform, benchmarking, slowing annual payment growth) the Biden and Trump administrations have already started using. Listen for the distinction Timothy draws between a funding cut and a smaller increase, and why that distinction matters for every clinician dealing with prior auth. Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let's work together to tell your story. PARTNER WITH KEVINMD → https://kevinmd.com/influencer SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
What if your healthcare team already knew what happened during your hospital stay — before you even explained it? What if someone on your care team noticed you were struggling on a Saturday and simply showed up? In this episode, Jamie sits down with Christopher Laffey, Nurse Practitioner at Your Health, to break down what a truly connected, proactive model of care actually looks like when it's working. Christopher practices in North Charleston, SC, where his team — nurses, therapists, social workers, community health workers, and more — functions less like a traditional office practice and more like a living, breathing safety net woven around each patient's real life. What you'll hear in this episode: Why most patients are failing not because nobody cares, but because the system itself is fragmented — and what doing it differently actually looks like on a Tuesday morning The real difference between "patient-centered" as a marketing phrase and patient-centered as a daily practice (hint: it involves seeing the medication bottles on the kitchen table) A powerful real-life story of a bedbound patient whose caregiver suddenly disappeared — and how the team mobilized over a weekend, on their own time, to prevent a hospitalization The single mindset shift every clinician needs to make the transition from visit-based thinking to longitudinal care Why "value-based care" doesn't mean discounted care — it means the organization is accountable for your outcomes, not just your appointments If you've ever left a doctor's appointment feeling more confused than when you walked in, this episode will show you what healthcare can feel like when it's actually designed around you. www.YourHealth.Org
DC EKG with Joe GroganThe Economics of Ozempic and Other Weight Loss DrugsEpisode 136.5 (“Prescription Refill” – A replay from the archives)Original Air Date: May 2024In this episode, Joe Grogan welcomes Ben Ippolito, Senior Fellow in Economic Policy Studies at the American Enterprise Institute, to discuss the rapidly evolving economics of GLP-1 weight loss drugs like Ozempic and Wegovy.Ben explains the two main competitors in this market—Novo Nordisk's Ozempic and Wegovy versus Eli Lilly's Mounjaro and Zepbound. Revealing how insurance coverage decisions drive pharmaceutical marketing strategy.The conversation reveals a critical irrationality in Medicare policy: the statutory prohibition on covering weight loss drugs despite their profound clinical and quality-of-life benefits. Yet these same drugs are covered for diabetes and cardiovascular risk reduction.Ben explores the surprising economics of drug pricing through gross-to-net pricing—the massive gap between list prices and what insurers actually pay through rebates and discounts.The episode examines critical implications of the Inflation Reduction Act's price negotiation provisions. Once Medicare negotiates Ozempic's price, that same price applies to all products using the same active ingredient. This creates cascading market effects: competitors must match those prices to remain on formularies, new entrants face lower pricing power even if clinically superior, and pharmaceutical companies may abandon promising programs due to regulatory uncertainty.Ben argues Congress doesn't need to act immediately to expand Medicare coverage, but likely will within a few years.Joe and Ben discuss unintended consequences of government price regulation, including effects on innovation and drug development pipelines. They explore how price controls announced before elections affect pharmaceutical strategy and development timelines.Concluding with Ben's research on Medicare Advantage and why both Democrats and Republicans scrutinize this private alternative to traditional Medicare. With over 50 percent of seniors enrolled in Medicare Advantage plans, bipartisan interest in reform is reshaping healthcare policy conversations on Capitol Hill.Key TopicsGLP-1 drugs, Ozempic, Wegovy, Mounjaro, Zepbound, weight loss medications, obesity treatment, Medicare coverage, drug pricing, Inflation Reduction Act, pharmaceutical competition, rebates, gross-to-net pricing, health economics, cardiovascular benefits, diabetes treatment, Medicare Advantage, healthcare policy, innovation incentivesKey Timestamps00:00 Cold Open: "Turned Up to 11"00:24 Welcome to DC EKG00:46 Meet Ben Ippolito (AEI)03:48 The GLP-1 Landscape: Ozempic, Wegovy, and the Field05:04 One Drug, Two Names06:45 Medicare's Weight-Loss Coverage Ban07:21 Blockbusters and Big Effect Sizes09:32 Why Isn't Congress Acting?10:17 Why It Costs Less Than You Think12:34 The Coverage Irrationality14:05 Quality of Life as a Real Benefit15:17 Beyond Weight: Cravings and Addiction18:21 Devil's Advocate: Why Cover It At All?19:48 Gross-to-Net and the Rebate Problem22:41 Why Can't You Just Pay Cash?25:43 The IRA and the Ozempic Price Cut27:32 One Ingredient, One Price30:10 Unintended Consequences in Part D34:01 New Competitors and Killed Programs38:03 What's Next: Medicare Advantage42:04 Wrap-Up and CreditsAbout the Guest(As of May 2024) Ben Ippolito is a Senior Fellow in Economic Policy Studies at the American Enterprise Institute. He holds a PhD and Master's degree in Economics from the University of Wisconsin-Madison and a Bachelor's degree in Mathematics and Economics from Emory University. Ben examines drug pricing policy, Medicare Advantage, and healthcare innovation economics with regular engagement with Congress.Podcast: DC EKG with Joe GroganGuest: Ben IppolitoSponsor: Survivors for SolutionsProducer: Stay on Course StudiosExecutive Producer: John CZ Czwartacki, DC EKG Podcast
Recent legislative coverage proposals may cause many seniors to lose access to certain benefits or care programs. Darren Grubb is a spokesperson for Medicare Advantage Majority (MAM), a nonprofit nonpartisan program advocating for senior medical benefits. He joins JMNID to share some common health care concerns that Medicare Advantage Majority addresses, and breaks down the difference between Medicare, Medicare Advantage, and Medicaid programs, for those who don't know or understand the distinction., and give information for seniors to consider as they review and enroll in their care options.
It was 3 o'clock in the morning when Scott Middleton finally signed the papers. The merger was official. And within days, he was already on the road — visiting facilities, riding along with providers, and spotting the same gap everywhere he went: brilliant clinicians doing real work that was completely invisible to the system. In this episode of The Disrupted Podcast, Jamie sits down with Scott Middleton, calling in from Boston, to unpack what he's discovering on the ground in the newly merged Your Health organization — and why tracking your time isn't about paperwork. It's about protection, proof, and getting paid for every minute of care you're already delivering. What you'll hear in this episode: The Dr. Jeeve story: a high-producing doc who managed a nursing home crisis by phone, saved a patient from an unnecessary ER visit — and never billed for it, leaving Medicare with no record of his intervention Why not documenting a visit before a hospitalization doesn't just cost you revenue — it makes you look like a bad provider, even when you did everything right How insurance companies like United Healthcare boldly take 15% off the top of every healthcare dollar — and why that math means providers can't afford to give their time away for free The TCPA pattern Scott keeps seeing: 15,000–18,000 visits a month, almost entirely in nursing homes, with zero follow-up once patients go home The new post-discharge standard: every patient leaving a nursing home gets a telehealth visit within 48 hours, then weekly follow-up for four weeks — no one gets left in the gap This episode is a masterclass in understanding that documentation isn't bureaucracy — it's how you tell your story, protect your reputation, and keep the care you've already given from disappearing. www.YourHealth.Org
Turning 65 opens a new season of life—and with it comes some of the most important financial and healthcare decisions you'll ever make. In this episode of Finishing Well, Certified Financial Planner Hans Scheil and co-host Robbie Dilmore continue their Financial Plan Series by exploring Medicare, IRMAA (Income-Related Monthly Adjustment Amount), and how these choices fit into a comprehensive retirement strategy. Hans walks through the key Medicare decisions every retiree faces, including the differences between Original Medicare and Medicare Advantage plans, the importance of Medicare Supplement coverage, and why your initial enrollment period can create opportunities that may never come again. Using the real-life financial planning case of Tom and Susan, listeners will learn how Medicare decisions affect healthcare costs, retirement income planning, tax strategies, and long-term financial security. The discussion also covers Medicare Part D prescription drug plans, common enrollment mistakes, and strategies for managing or potentially reducing costly IRMAA surcharges. Through personal experiences and practical examples, Hans and Robbie highlight how choosing the right Medicare coverage can protect both your health and your retirement savings. Whether you're approaching age 65, already enrolled in Medicare, or helping a loved one navigate retirement healthcare decisions, this episode provides valuable insights to help you make informed choices and avoid costly mistakes. Topics Covered: Original Medicare vs. Medicare Advantage Medicare Supplement (Plan G) coverage Open enrollment opportunities and deadlines Medicare Part D prescription drug plans Understanding IRMAA and Medicare premiums Healthcare planning as part of a complete retirement strategy Real-world retirement planning case study Learn how thoughtful Medicare planning can help you finish well in retirement.
The Friday Five for June 5, 2026: Certification Reminder Pod Rec: Before Breakfast TRICARE Resources for Agents Clover Health Star Ratings 2027 MA and Part D Max Commissions Get Connected:
The fallout continues after the firing of CBS icon Scott Pelley, with many questioning what it means for the future of 60 Minutes and the credibility of CBS itself. Is this the beginning of the end for one of journalism's most respected institutions?
As concerns escalate about the deadly Ebola virus outbreak in Africa, we bring you the unique insights of Dr. Peter Piot, a renowned microbiologist who co-discovered the virus 50 years ago during the first recorded outbreak of the disease. His on-the-ground account of that crisis was provided to us in April before the current outbreak was declared, but it contains valuable historical perspective and shares lessons learned that he carried forward in his consequential career. “What I saw from the beginning is the most important thing is to listen to people and that you need to act fast to save lives, before you have the evidence you would like to have.” He followed his contributions on Ebola by diving into the fight against HIV/AIDS, eventually reshaping global response in leadership roles at the World Health Organization and United Nations. As he shares with host Lindsey Smith, the learnings in that case were more pragmatic than scientific. “We had to redefine HIV/AIDS not as a medical problem but as an economic and security problem in order to get it on the political agenda.” Tune in for a fascinating episode that takes you from the gritty frontlines of public health crises to the battles for funding and attention in the halls of power as Dr. Piot shares what it actually takes to move the world to respond effectively to health threats. Mentioned in this episode: London School of Hygiene & Tropical Medicine 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
SummaryThis episode features a detailed discussion on recent healthcare compliance issues, focusing on Medicare Advantage overpayments, the importance of proactive audits, and the evolving role of data analytics in fraud detection. Experts Terry Fletcher and Sean Weiss share insights on regulatory updates, best practices, and the need for strategic compliance in healthcare organizations.Key TopicsMedicare Advantage overpayment risksThe role of OIG alerts in complianceData analytics in fraud detectionBest practices for healthcare audits
MEDICARE ADVANTAGE VS ORIGINAL MEDICARE: KEY DIFFERENCES WATCH ON YOUTUBE Thad Ismart, CFP®, ChFEBC, CEPS Senior Financial Planner, BWFA Tessa Hall Media and Communications Specialist About This Episode Tessa speaks with BWFA's Thad about how to compare Medicare plans and what individuals should consider when evaluating coverage options. They explain the differences between Original Medicare and Medicare Advantage plans, along with how prescription coverage, Medigap policies, and supplemental benefits can affect overall costs. The conversation also covers travel coverage, plan comparisons, and why many individuals overpay simply because they do not review their options regularly. To better understand how Medicare planning fits into your broader retirement strategy, visit our Financial Planning services page. Read Full Description Choosing a Medicare plan involves more than comparing monthly premiums. Coverage, deductibles, prescriptions, and long-term healthcare needs can all impact which plan makes the most sense. In this episode of Healthy, Wealthy & Wise, Tessa speaks with BWFA's Thad about how to compare Medicare plans and evaluate different coverage options. They explain the differences between Original Medicare and Medicare Advantage plans, as well as how Medigap policies and prescription drug coverage fit into the overall picture. The discussion also highlights why many individuals overpay for Medicare. In many cases, people continue using the same plan year after year without reviewing costs or comparing alternatives. Travel coverage is another important consideration. Some Medicare Advantage plans may include coverage for healthcare outside the United States, while Original Medicare typically does not. The episode also explains why comparing plans regularly matters. Even when benefits remain similar, pricing can vary significantly between providers. Ultimately, Medicare planning requires balancing costs, flexibility, and healthcare needs. Understanding your options can help you make more informed decisions, avoid unnecessary expenses, and feel more confident about your healthcare coverage throughout retirement as healthcare needs and costs continue changing over time.
188 The Intersection of Hospice and Palliative Care: A Conversation with Dr. Jill Schwartz-Chevlin, MD, MBA, FACP Host Marie Betcher, RN and former hospice nurse, interviews Dr. Jill Schwartz-Chevlin, an internist and palliative physician with experience in home-based primary care, hospice leadership, and value-based care. Dr. Jill explains value-based medicine as aligning incentives with patient outcomes, especially for people with complex chronic illness, by anticipating needs, supporting symptom recognition, and preventing crisis-driven ER and hospital use that can lead to debility and loss of independence. She describes Vynca's home-based, tech-enabled, interdisciplinary palliative care model across California, Oregon, Washington, Utah, and Idaho, plus enhanced care management and a digital advance care planning platform used in 28 states. She discusses reimbursement challenges, noting Medicaid palliative care programs in California, Hawaii, and New Jersey and Medicare Advantage as current pathways, and explains transferring eligible patients to hospice when available while providing virtual hospice-like support in areas without access. Dr. Jill outlines practical ways to normalize advance care planning conversations and encourages patients and families to advocate for palliative services and proactive planning. 00:00 Welcome and Disclaimer 00:29 Meet Host and Guest 02:13 Dr Jill's Background 05:40 Value Based Care Explained 11:01 Patient Empowerment and Team Care 13:51 Vynca Locations and Services 15:07 Proactive Home Based Model 20:16 Access and Reimbursement Challenges 23:32 Hospice Transition and Rural Gaps 25:11 Advance Care Planning Tips 30:37 Final Takeaways and Closing https://www.vyncacare.com/ If you want to help, you can donate to help support Hospice Explained at the Buy me a Coffee link https://www.buymeacoffee.com/Hospice Hospice Explained Affiliates & Contact Information Buying from these Affilite links will help support this Podcast. Maire introduces a partnership with Suzanne Mayer RN inventor of the cloud9caresystem.com, When patients remain in the same position for extended periods, they are at high risk of developing pressure injuries, commonly known as bedsores. One of the biggest challenges caregivers face is the tendency for pillows and repositioning inserts to easily dislodge during care.(Suzanne is a former guest on Episode #119) When you order with Cloud 9 care system, please tell them you heard about them from Hospice Explained.(Thank You) Marie's Contact Marie@HospiceExplained.com www.HospiceExplained.com Finding a Hospice Agency 1. You can use Medicare.gov to help find a hospice agency, 2. choose Find provider 3. Choose Hospice 4. then add your zip code This should be a list of Hospice Agencies local to you or your loved one.
The Tenpenny Files – Twila Brase warns that Medicare Advantage is becoming a controlled healthcare system shaped by automatic enrollment, restricted networks, prior authorization, AI decision-making, and corporate cost containment. Her conversation with Dr. Sherri Tenpenny examines how seniors may lose access to doctors, specialists, cancer centers, and medical independence when it matters most...
This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Garfield Collins, Co-Founder and Chief Administrative and Partnership Officer, Zing Health. Garfield shares how Zing Health is balancing affordability with high-touch member engagement, leveraging technology and AI to support chronically ill populations, simplify care navigation, and build long-term trust with members.In collaboration with Hippocratic AI.
The Tenpenny Files – Twila Brase joins Dr. Sherri Tenpenny to expose how Medicare Advantage, prior authorization, AI-driven denials, and administrative controls reshape healthcare access. The discussion reveals how delays, appeals barriers, and corporate incentives ration care while doctors lose authority and patients face a system increasingly built on surveillance, dependency, and nationwide control...
In this episode, Dave DeHommel, Senior Vice President and General Manager of Payer Solutions at Reveleer, discusses how Medicare Advantage plans can reduce RADV audit exposure through stronger clinical data infrastructure, prospective risk adjustment strategies, and year-round documentation readiness. Visit reveleer.com/beckers-radv to learn more.
To mark PQA's 20th anniversary, PQS Managing Director Todd Sega sits down with Laura Cranston, the founding CEO who built PQA from a one-person shop into the most influential pharmacy quality measurement organization in the country.Laura traces PQA's origins to April 2006, just months after Medicare Part D launched, talks about the alliance's growth, the groundwork for what would eventually become the EQUIPP platform, and the broader pharmacy quality infrastructure in use today.The conversation turns to the seismic shift in the CY2027 Final Rule and what it means that pharmacy-accountable clinical measures now command roughly 50% of a Medicare Advantage plan's Star Rating. Laura calls it a game changer, arguing that health plans simply cannot navigate this new environment without doubling down on their partnerships with community pharmacy.The episode closes with a look ahead at where AI and technology are taking quality measurement from faster measure development to the shift from retrospective accountability toward proactive, near-real-time quality improvement.https://www.pqa.org/
The Real Hernando podcast, presented by Thrive Entertainment and produced by SRP Studios Podcasting, spotlights Angela Kidd of Angela Kidd Insurance, specializing in Medicare, under-65 health insurance/healthcare.gov plans, and life insurance. Angela discusses how her Southaven brick-and-mortar office (8830 Center Street, Suite 1) has helped clients—especially seniors—by providing trusted, in-person guidance, while still offering phone and home visits. She explains annual enrollment timelines (Medicare Oct 15–Dec 7; marketplace Nov 1–Dec 15), warns about carrier changes like Cigna leaving the marketplace in 2027, and describes how income updates can prevent subsidy payback at tax time. Angela shares stories of correcting Medicare Advantage network mistakes, navigating claims, avoiding Medicare enrollment penalties, and offering final expense and supplemental protections for costs insurance doesn't cover.The Real Hernando is on YouTube, Apple, Spotify, Facebook, Instagram and TikTokThis episode was recorded at SRP Studios and Produced by Shelby Row Productions LLCSRPStudiosLLC.com
In this episode, Dave DeHommel, Senior Vice President and General Manager of Payer Solutions at Reveleer, discusses how Medicare Advantage plans can reduce RADV audit exposure through stronger clinical data infrastructure, prospective risk adjustment strategies, and year-round documentation readiness. Visit https://www.reveleer.com/solutions/radv-audit?utm_source=beckers&utm_medium=podcast&utm_campaign=260402--radv-b2g1 to learn more.
Breaking developments tonight in Don Lemon's arrest case, and the implications could go far beyond one person. Free speech, press freedom, and political retaliation are all on the table. Founder of the Legal AF Podcast Michael Popok joins us to break it all down. You won't want to miss this! This episode is sponsored by Incogni. Go to https://incogni.com/donlemon and use code donlemon for 60% off. Incogni HELPS wipe yourself from the Internet — they can't harm you if they can't find you. Click the link below to claim your 60% off and get your personal data off the market! Erase yourself from the internet This episode is brought to you by Shopify. See less carts go abandoned and more sales go with Shopify and their Shop Pay button.Sign up for your one-dollar-per-month trial today at https://SHOPIFY.COM/lemon This episode is sponsored by Mars Men. For a limited time, our listeners get 50% off FOR LIFE, Free Shipping, AND 3 Free Gifts at Mars Men at https://Mengotomars.com This episode is brought to you by Helix. Go to https://helixsleep.com/DON for 27% Off Sitewide. Exclusive for listeners of The Don Lemon Show. For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit megaphone.fm/adchoices
This episode features an edited recording of our CMS Final Notice webinar, offering timely insights into 2027 Medicare Advantage and Part D changes. Hear from Via Benefits experts as they break down MA payment updates, funding pressures, and evolving plan design strategies. Learn how CMS policies, Inflation Reduction Act provisions, and rising healthcare costs are shaping both group and individual Medicare markets. The discussion also explores what these changes mean for plan sponsors evaluating retiree benefits and long-term cost management.
The ongoing outbreak of hantavirus infections that originated with passengers on the Dutch cruise ship MV Hondius in April has generated concerns across the globe. This very rare occurrence has led to a number of deaths, required quarantining of passengers and prompted emergency responses from public health authorities in multiple countries. On this episode of Raise the Line from Elsevier, we're tapping the expertise of a leading authority on the subject, Dr. Jamie Childs of Yale University, to provide you with a scientific understanding of hantaviruses and what level of threat is posed by this situation. In short, Dr. Childs believes this is not the start of a pandemic. “The Andes variant involved here is one of the most dangerous hantaviruses, but it is totally controllable with contact tracing.” This timely conversation with host Lindsey Smith is informed by Dr. Childs' decades of hantavirus research as well as learnings from his role leading the CDC's environmental investigation during the landmark 1993 hantavirus outbreak in the Four Corners region of the American Southwest. And be sure to stay tuned to hear his concerns about the factors complicating containment of the current Ebola outbreak in East Africa. Note: this conversation was recorded on May 19th, 2026. Mentioned in this episode: Yale School of Public Health Yale Institute for Global Health 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
In this episode of Econ 101 on the 9 Innings Podcast, Kevin Thompson, founder and CEO of 9i Capital Group, explores how artificial intelligence, privatization, and cost containment are quietly reshaping Medicare. He discusses growing concerns around AI driven systems like the WiSer platform and how increased prior authorizations, delays, and denials could impact seniors seeking care.Kevin also examines the broader shift toward profit driven healthcare models, declining physician participation due to reimbursement pressures, data privacy concerns, and the growing complexity of Medicare Advantage plans. He encourages retirees and caregivers to understand their rights, protect their personal medical information, and build strong support systems to help navigate an increasingly bureaucratic healthcare landscape.(00:00) Introduction to AI and Medicare (02:33) The WiSer System and AI Driven Denials (05:10) The Privatization Shift Inside Medicare (08:56) Why Doctors Are Leaving MedicareNEWSLETTER (WHAT NOW): https://substack.com/@9icapital?r=2ei... 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-... 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/9idiscl...
This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Rob Hitchcock, President and Chief Executive Officer, Select Health. Rob discusses the operational pressures facing payers today, including Medicare Advantage challenges and rising pharmaceutical costs, while sharing how Select Health is leveraging AI and end-to-end member insights to improve care coordination, trust, and the overall member experience.In collaboration with Hippocratic AI.
Heads up — this is Part 2 of Jamie's conversation with Jaclyn Taylor If you haven't heard Part 1 yet, go back and start there. It sets up everything we unpack today. Most healthcare teams are working hard. They're just not working together. And the patient is the one absorbing the cost. In this second half of the conversation, Jamie and Jaclyn move from the why into the how. What does it actually look like when a provider stops responding to today's schedule and starts managing an entire patient panel? How do you turn a community health worker, a pharmacist, a PT, and a social worker into one coordinated team instead of four parallel ones? And what's the difference between data that produces reports and data that produces decisions? You'll hear: Why "frequent touches" only work when they're connected — and how fragmented touches still land patients back in the hospital The quarterback model — what it actually means for a provider to own a patient's trajectory, not just their visit The shift from seeing patients to managing a population — and why most providers were never taught how Why we don't have a resource problem in healthcare — we have an orchestration opportunity How to use technology and data without drowning in either What "showing up" really means inside a system that isn't perfect yet This is the episode for anyone trying to lead change from inside a system that's still catching up. Press play. www.YourHealth.Org
Send us Fan MailHospice has always been about people, but the future of hospice will increasingly be shaped by data—and that shift is both exciting and unsettling.In Part Two of The Future of Hospice: How HOPE Will Transform Reimbursement & Care, Raianne Melton and Andrea Hale unpack how the HOPE tool could redefine hospice reimbursement, value-based care, and quality measurement across CMS, Medicare Advantage, and health systems. The conversation explores where hospice measurement may be heading—from symptom impact scoring and burdensome discharges to acuity tracking, HUV utilization, and the growing importance of consistent documentation and actionable clinical data.The episode also focuses on what hospice leaders can do now to prepare: improving point-of-care documentation, simplifying EMR workflows, leveraging real-time analytics, and exploring AI-powered ambient listening to reduce clinician burden while preserving compassionate care. Ultimately, this conversation is about helping hospice organizations prove their value with measurable outcomes while staying true to the mission that defines hospice care.This episode offers practical insights for hospice executives, nonprofit healthcare leaders, clinicians, and anyone navigating the evolving landscape of end-of-life care.Guest:Andrea Hale, CEO of Valley Hospice Raianne Melton, Director of Clinical Services of Professional Services for AxxessHost:Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy of LeadershipThe 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
Hospice has always been about people, but the future of hospice will increasingly be shaped by data—and that shift is both exciting and unsettling.In Part Two of The Future of Hospice: How HOPE Will Transform Reimbursement & Care, Raianne Melton and Andrea Hale unpack how the HOPE tool could redefine hospice reimbursement, value-based care, and quality measurement across CMS, Medicare Advantage, and health systems. The conversation explores where hospice measurement may be heading—from symptom impact scoring and burdensome discharges to acuity tracking, HUV utilization, and the growing importance of consistent documentation and actionable clinical data.The episode also focuses on what hospice leaders can do now to prepare: improving point-of-care documentation, simplifying EMR workflows, leveraging real-time analytics, and exploring AI-powered ambient listening to reduce clinician burden while preserving compassionate care. Ultimately, this conversation is about helping hospice organizations prove their value with measurable outcomes while staying true to the mission that defines hospice care.This episode offers practical insights for hospice executives, nonprofit healthcare leaders, clinicians, and anyone navigating the evolving landscape of end-of-life care.Guest:Andrea Hale, CEO of Valley Hospice Raianne Melton, Director of Clinical Services of Professional Services for AxxessHost:Chris Comeaux, President / CEO of TELEIOS and author of The Anatomy of LeadershipTeleios Collaborative Network / https://www.teleioscn.org/tcntalkspodcast
We mark National Mental Health Awareness Month on this episode by tapping the expertise of Dr. Steve Strakowski, an internationally recognized expert in bipolar disorder, who has spent decades studying the neurobiology and treatment of mood conditions while pushing just as hard on the structural barriers that keep effective treatments out of reach for more than half the people who need them. In this conversation with Raise the Line from Elsevier host Michael Carrese, Dr. Strakowski explains why access, not science, is now the biggest obstacle to improving mental health outcomes. He also addresses the heavy toll society pays for underfunding mental health prevention and treatment programs. “The money is spent eventually, but in the most expensive places like emergency rooms and prisons, and there is the human cost of suffering and suicides." This important discussion also covers: The persistent problem of Black patients presenting with mania being misdiagnosed with schizophrenia; Why he describes bipolar disorder as a reward-processing illness; The emerging therapies he finds encouraging. Mentioned in this episode:Indiana University School of Medicine 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
This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Damanjeet Chaubey, Vice President, Clinical Affairs, Clover Health. She discusses how Clover Health is using AI, clinical decision support, and home-based care models to improve member outcomes, reduce costs through proactive interventions, and support care teams without adding administrative burden.In collaboration with Hippocratic AI.
Medicare v. Medicare Advantage, what's included, enrollment, and how to decide. 50% of Floridians choose advantage plans, offering seniors a private alternative to original Medicare. Darren Grubb with Medicare Advantage Majority on what's now and what's next.
Tonight, we break down the growing fallout from Donald Trump's leadership, from rising economic anxiety to escalating global tensions and mounting questions about corruption and accountability. Gas prices are climbing, recession fears are spreading, and critics are sounding alarms over the massive $1.8 billion taxpayer-funded pool that could potentially benefit Trump allies and political loyalists. Add in the ongoing chaos surrounding Iran policy, and a lot of people are asking the same question: how much more instability can the country take? And then there's Trump himself. After another round of rambling public remarks today, concerns about his behavior and mental sharpness are once again dominating conversation online and across the political world. We are joined by Senator Catherine Cortez Masto and Keisha Lance Bottoms! This episode is sponsored by SelectQuote. Save more than fifty percent on term life insurance at https://selectquote.com/lemon TODAY to get started. This episode is sponsored by BetterHelp. BetterHelp makes it easy to get matched online with a qualified therapist. Sign up and get 10% off at https://BetterHelp.com/donlemon This episode is brought to you by Lean. Lean is having a Huge Memorial Day Sale and Lean is 25% off!! Visit https://TAKELEAN.com and enter THANK YOU 25 for 25% OFF. That's promo code THANK YOU 25 at https://TAKELEAN.com For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit megaphone.fm/adchoices
Part 1:We talk with Lynne Stuart Parramore, cultural historian, essayist, and Research Analyst at the Institute for New Economic Thinking.We discuss the consequences of AI installations and data centers. We examine the power and water requirements for these centers, and what the effects will be on people who live near them. In addition, we look at the costs associated with them. Who is getting rich from this technology? Who is losing out?Part 2 We talk with Joyce Frieden, who oversees the coverage that Medpage Today provides about Washington's Health Policy.We learn that policies about enrolling seniors into Medicare Advantage programs are changing. Under a new proposed policy, seniors will be auto-enrolled, with few options to opt out or leave enrollment. There are many disadvantages in these types of plans, and we discuss them.WNHNFM.ORG productionMusic: "That's how every empire falls," John Prine
What if every "non-compliant" patient was actually a signal that the system isn't working for them? In this episode, Jamie sits down with Jaclyn Taylor, Clinical Strategy Director at Your Health and a nurse practitioner who started her career as a home-based provider in 2020 — thrown straight into the fire of COVID, isolated patients, and a healthcare world rewriting itself in real time. What she saw inside patients' homes — medications scattered on tables, food insecurity, missing transportation — changed how she thinks about every chart she's ever read. You'll hear: Why a nurse-first pathway gives nurse practitioners a fundamentally different lens than a medical school pathway — and why patients feel it What working across home care, telehealth, trauma, and wellness teaches you about treating the whole human, not just the diagnosis Why trauma surgery turned Jacqueline into a believer in proactive, longitudinal care — and what gets missed when we only meet patients after something has already gone wrong The two words she uses to describe what's most broken in traditional healthcare: fragmentation and misalignment How empathy stops being a poster and starts being operational — built into the design of care itself If you've ever felt invisible inside the healthcare system, or if you're the one trying to fix it, this conversation reframes the whole game. Press play. www.YourHealth.Org
In this episode, Dr. Monica Lypson and Dr. Ahilan Sivaganesan join the conversation to dissect the complexities of value-based payment models and the "perverse incentives" that often follow. By examining the parallels between Medicare Advantage upcoding and sliding-scale bundled payments, Dr. Lypson and Dr. Sivaganesan provide a masterclass on the systemic friction between financial risk and clinical equity. Key Discussion Themes - The Upcoding/Downcoding Tug-of-War: An analysis of how Medicare Advantage plans and health systems navigate risk adjustment, and why current models often incentivize "grading your own homework." - The TDABC Solution: Dr. Sivaganesan explains why physicians cannot truly manage risk without Time-Driven Activity-Based Costing (TDABC) to identify condition-specific costs. - Selection Bias in Care: A deep dive into the "cherry picking" (selecting low-risk patients) and "lemon dropping" (avoiding high-risk patients) dilemmas that threaten healthcare's moral compass. - Equity vs. Efficiency: Dr. Lypson explores how value-based care can either bridge the gap for underserved populations or inadvertently widen disparities through structural barriers. - The Path Forward: Why "whole-person health"—including non-clinical factors like housing—is the ultimate cost-saver, and the necessity of neutral, third-party risk scoring. === LINKS ===
"When the workforce does not align with the population, your system is misaligned by design." That candid observation comes from Tina Loarte-Rodríguez, DP, RN who has spent much of her two decade career in patient safety, risk management, and systems leadership as the only Latina in the room, which she sees as a signal of a systemic failure that demands structural solutions. As we mark National Nurses Month, Dr. Loarte-Rodríguez joins Raise the Line from Elsevier host Lindsey Smith to explain why a culturally congruent workforce has important implications for access, trust and quality of care. This wide-ranging discussion also covers: What Dr. Loarte-Rodriguez means by "narrative infrastructure" and how a book series born during COVID is now shaping workforce conversations nationwide; The case for making mentorship a core institutional system; Why nursing burnout is not about a lack of resiliency. Mentioned in this episode: Latinas in NursingThe Connecticut Center for Nursing Workforce 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
Tonight, we break down the growing economic pain being felt across the country and the policies that are making it worse. Gas prices are soaring, recession fears are rising, and millions of Americans are struggling just to afford the basics. Yet Donald Trump told reporters he doesn't spend much time thinking about the financial situation of everyday Americans. Yeah…that's pretty obvious. Tonight, we'll share exclusive footage of lawmakers reacting to those comments and discussing the growing frustration boiling across the country. But the criticism goes beyond rhetoric. Trump is now reportedly pushing the DOJ toward a settlement tied to his IRS lawsuit, raising new questions about whether taxpayers could ultimately be left footing the bill. And then there's the White House ballroom project, which was initially pitched as something that wouldn't cost Americans anything, but now appears likely to come with a public price tag after all. At a moment when people are struggling to pay rent, buy groceries, and fill up their gas tanks, many Americans are asking the same question: whose interests are actually being prioritized right now? This episode is sponsored by Lean. Get started with 20% off and free rush shipping so you can add LEAN to you healthy diet and exercise plan. Visit https://takelean.com enter LEMON for your discount. This episode is brought to you by Incogni. Go to https://incogni.com/donlemon and use code donlemon for 60% off. Incogni HELPS wipe yourself from the Internet — they can't harm you if they can't find you. Click the link below to claim your 60% off and get your personal data off the market! Erase yourself from the internet This episode is sponsored by “Bullies, Parasites and Slaves.” Get your copy of “Bullies, Parasites and Slaves” at https://www.BPS.online or text the word, “BULLY” to 511511 and receive an immediate link to get the book – paperback, E-book or audio. Text Fees may apply. This episode is brought to you by Helix. Go to helixsleep.com/DON for 27% off sitewide. Make sure you enter our show name after checkout, so they know we sent you! For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit megaphone.fm/adchoices
In the second part of this conversation between 20-Minute Health Talk host Chethan Sathya, MD, and Mark Cuban, they discuss the twin forces reshaping healthcare: AI and price transparency. He argues that large language models can curb online health misinformation and even augment day-to-day clinical decisions. Cuban dives into policy, praising recent moves to rein in Medicare Advantage overpayments and explaining the drivers of branded drug costs in the U.S. He then unveils Cost Plus Wellness, a push to “open-source” direct contracts between self-insured employers and providers to reduce administrative waste and improve outcomes. Along the way, he makes the case that healthcare is surprisingly easy to disrupt when you understand costs and align incentives. Northwell is New York State's largest healthcare provider and private employer, with 28 hospitals, 890 outpatient facilities and more than 16,600 affiliated physicians. We're making breakthroughs in medicine at the Feinstein Institutes for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Nursing and Physician Assistant Studies. Get the latest news and insights from our experts in the Northwell Newsroom: Press releases Insights Podcasts Publications Interested in a career at Northwell Health? Visit our career site and explore our many opportunities. Watch episodes of 20-Minute Health Talk on YouTube. For information on our more than 100 medical specialties, visit Northwell.edu and follow us @NorthwellHealth on Facebook, Instagram, X and LinkedIn.
n this Bright Spots in Healthcare episode, host Eric Glazer brings together Medicare Advantage and operational leaders to explore a growing challenge facing health plans: why identifying risk is no longer enough to improve outcomes. As organizations invest heavily in HRAs, predictive analytics, and member insight platforms, many still struggle to convert those insights into timely, coordinated action. This discussion focuses on where execution is breaking down between identification and intervention, and what leading plans are doing differently to reduce friction, align teams, and engage members while the opportunity to act still exists. This is a candid discussion for executives navigating increasing pressure around Stars, affordability, member engagement, and operational efficiency, while trying to turn insight into measurable performance improvement. Our guests include: Vanita Pindolia, PharmD, MBA, Vice President, Stars Program, Blue Cross Blue Shield of Michigan Chuck Palermo, Vice President, Operations, Health Alliance Plan Linda Isham, Former Vice President, Operations & Clinical Support, Humana Cory Busse, Vice President, Strategic Solutions, Icario Together, they explore: Why insight without operational coordination often fails to improve outcomes How leading plans are identifying the small populations that disproportionately impact performance What changes when organizations shift from retrospective reporting to real time intervention How plans are reducing friction by coordinating Stars, quality, operations, and engagement efforts around a shared action plan Why understanding behavioral, social, and operational barriers is becoming critical to improving adherence, experience, and quality outcomes How organizations are designing outreach and engagement strategies that reflect real member behavior, not just clinical gaps This episode offers a practical look at how leading organizations are closing the gap between insight and action, and what it takes to operationalize engagement in a way that consistently improves quality, cost, and member experience. Panelist Bios: https://www.brightspotsinhealthcare.com/events/closing-the-gap-between-insight-and-action-data-informed-tech-enabled-strategies-for-health-plans/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/Final_May7_Episode_Guide.pdf Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/May_7_2026_KIS.docx.pdf Resources: Report: Health Plan Playbook for 2027, Part 1: From HRA Completion to Real Action This first report in Icario's Health Plan Playbook for 2027 series examines why Medicare Advantage plans need to rethink the HRA as more than a requirement or data collection exercise. The issue is not that plans lack information. It is that the handoff between what members report and what happens next is often too slow, fragmented, or manual to drive meaningful action. The report focuses on a core shift facing plans heading into 2027: completing an HRA is no longer the goal. Acting on it is. When a member is engaged, self reporting, and open, plans have a short window to intervene. If nothing happens in real time, that moment is lost. Drawing on practical examples, the report shows how real time intervention, automatic enrollment into barrier removal programs, and proactive identification of risk patterns can help plans reduce delays, support care teams, and close the gap between insight and action. Inside, you'll find insights on: Why HRAs should be treated as a moment of influence, not just a compliance requirement Where plans lose momentum between member reported needs and follow up action How automatic enrollment can reduce manual handoffs and connect members to support faster Why delayed intervention creates hidden costs across ED utilization, inpatient stays, Stars performance, and unresolved care gaps How plans can act on SDoH, ADL, and behavioral signals while members are still engaged What changes when real time decisioning is embedded directly into the member experience The broader lesson is operational: plans that improve performance are not just collecting better data. They are reducing the time between signal and action, removing broken handoffs, and helping members get to the right support while the opportunity still exists. To request your copy of the report, please contact show producer Nicole Roberts at nroberts@brightspotsventures.com. Thank You to Our Episode Partner, Icario: Icario is a healthcare engagement platform designed to help health plans move beyond disconnected outreach and fragmented member experiences toward more coordinated, action oriented engagement. By combining behavioral science, real time data, and personalized engagement strategies, Icario helps plans identify where members are most likely to disengage, what barriers may prevent action, and how to intervene at the right moment to drive meaningful outcomes. Rather than simply increasing touchpoints, the focus is on reducing friction, improving coordination across teams and programs, and helping members take the next best step. The result is stronger performance across quality, adherence, cost, and member experience. Schedule a Meeting with a Senior Leader at Icario: To explore how Icario is helping health plans improve engagement, reduce friction, and drive more coordinated action across the member journey, reach out to show producer Nicole Roberts at nroberts@brightspotsventures.com to schedule a conversation with a member of the Icario leadership team. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.
I came up with at least one way to tell the difference between making a fair profit and profiteering. If someone makes more money when the patients or members they serve are worse off, yeah, call that profiteering. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. For more on what is fair profit versus what is profiteering, I would recommend you go back and listen to the episodes on mission and margin with Ben Schwartz, MD, MBA (EP481) and then with Mick Connors, MD (EP495). But it's probably not an accident that I have started an episode about Medicare Advantage in this fashion. To this end, I am very much looking forward to hearing what's up with Medicare Advantage from the one and only Betsy Seals, who is back for her third appearance on Relentless Health Value. And her advice in a nutshell is this: Don't profiteer. There are ample ways to make a fair profit. Just go back to basics and do it the right way. I wanna kind of tick through the list of things that I think about when I think about Medicare Advantage and just how it is relevant to absolutely everybody. The first thing I think about when I think about Medicare Advantage—and this is very obvious—is what Medicare Advantage plans do or don't do are our tax dollars at work or not at work, as the case may be. Along these same lines, the second thing: How does this impact our elders, our family, our friends, our grandparents? These are our senior citizens, getting the care or not getting the care that they may need. Those two are obvious. Now let's talk about a few less obvious things. Here's the third point that I think about as I listen to conversations about Medicare Advantage: cost shifting. Right? It is a well-known fact how big, vertically integrated carriers—and when I say big, vertically integrated carriers, I mean ones that have a Medicare Advantage line of business—when negotiating with big, consolidated health systems, the release valve of those negotiations is commercial rates. These are the rates that the self-insured employers are paying. So, the carrier says, "Look, gimme the best Medicare Advantage rates. I want the best Medicare Advantage rates because I, the carrier, am paying for those." Savings from those lower rates accrues to the Medicare Advantage plan and its shareholders or investors or executives, right? So, the carrier with the Medicare Advantage plan is like, "Look, go as low as we can go on the Medicare Advantage rates, but it's okay, health system, if you make up the difference with the ASO commercial book of business." Because right … ASO means administrative services only. It's not the carrier who's paying those commercial rates at the end of the day. So, the carrier uses its full book of business to negotiate lower rates for itself while, at the same time, cost shifting to commercial members. In fact, there was some research that was cited. It was episode 436 with Elizabeth Mitchell, and I quoted Luke Prettol. But there was research that puts this markup at 4.7% above what employers would otherwise pay if they had an ASO that did not have a Medicare Advantage Plan. So, yeah … number three big thing that I think about when listening to MA insights like the ones that Betsy drops today, I think about will this accelerate or ameliorate or really have anything to do with what is going on around those negotiating tables with ASOs and health systems? Because let's not forget, health systems account for about 50% of most self-insured employers' total health spend. The fourth thing that I think about: Will MA carriers underpay independent practices, especially primary care practices? Will it pay indies less? And then if it pays 'em a lot less, would ultimately manage to put them out of business, ultimately raising the total cost of care for everybody. But if we're thinking about this strictly from Medicare Advantage financial perspective, a really great move here, these are big, vertically integrated companies, don't forget. Many of them own provider organizations. This is why the FTC tends to frown on vertical integration. So, will these Medicare Advantage organizations who own provider organizations pay the provider organizations they own more? By the way, it's the same thing that's going on on the pharmacy side of the house when a PBM pays pharmacies that they own more. Here's a LinkedIn post by Stanley Warren about this topic. And there are a lot of obvious, maybe less obvious reasons for why paying providers the carrier itself owns more is a great short-term move. One of them is intracompany eliminations. Listen to the episode with Preston Alexander (EP482). But here's another reason: Rate increases paid by the government for Medicare Advantage plans are based on fee-for-service benchmarks. So, if fee-for-service rates go up, then the Medicare Advantage plans can negotiate more money for themselves. If the MA plans own the providers that are charging said FFS rates, then this is, I don't know, a great strategy, especially given the lobbying budget that some of these entities have. So, look … on today's show, I get the distinct opportunity to speak with Betsy Seals, my guest today, as I mentioned earlier; and we go through her advice for MA plans and what they need to get busy with and ensure, make a fair profit, go back to basics, and do it the right way. That's her bottom-line advice. Don't be putting your hands in the cookie jar. Sooner or later, you're gonna get caught. Focus on the members that you're really good at serving. And lastly, when it comes to STARS or other quality measures, lift them the right way—like, actually through better member health and actually better member experience, not some engineered mechanism by which one can check a box that honestly doesn't deserve to get checked. Because now we're back to the beginning and you're gonna get caught with your hand in the cookie jar, and it's profiteering. Let's just get real about that. If somebody's checking boxes that they don't deserve to check, member health is not improving. Betsy Seals, my guest today, as I have said at least three times, co-founded Rebellis Group, which is a Medicare Advantage consultancy. She became CEO of its parent company, Alerion Advisors. Now she is a board member, and also she works with start-ups in our industry. This podcast is sponsored by Aventria Health Group with an assist today from Payerset to help us with the financial support that we need to stay on the air. And with that, here is my conversation with Betsy Seals. Also mentioned in this episode are Alerion Advisors; Rebellis Group; Benjamin Schwartz, MD, MBA; Mick Connors, MD; Elizabeth Mitchell; Luke Prettol; Luke Trocchio; LoVasco; Stanley Warren; Preston Alexander; Aventria Health Group; Payerset; Eric Bricker, MD; Scott Conard, MD; Bob Herman; and Vivian Ho, PhD. For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here. You can learn more by visiting the Rebellis Group blog and by connecting with Betsy on LinkedIn. You can also email her at bseals@rebellisgroup.com. Betsy Seals is the co-founder of Rebellis Group, former CEO of Rebellis Group and Alerion Advisors, and a current board member of the Alerion Advisors family of companies. With over 25 years of experience across Medicare and Medicaid programs, Betsy is a nationally recognized leader known for her regulatory expertise, strategic vision, and ability to deliver measurable results. Betsy's work spans mergers and acquisitions, compliance, enterprise strategy, sales and marketing, supplemental benefits, and innovative benefit design that optimizes health plan performance and improves health outcomes. Betsy brings a strong blend of executive leadership, business acumen, and deep regulatory knowledge, with a focus on driving operational excellence and meaningful member impact. 00:00 Introduction to this episode. 00:43 Past episodes on profiteering: EP481 with Benjamin Schwartz, MD, MBA, and EP495 with Mick Connors, MD. 01:25 How Medicare Advantage is relevant to everyone. 06:15 A preview of today's conversation. 07:49 The "state of the state" of Medicare Advantage plans. 08:49 Video by Eric Bricker, MD, on the financial performance of the U.S. healthcare system. 09:32 Does Medicare Advantage's losses matter to the patients? 10:29 A recap of Betsy's insights so far. 11:19 The underlying strategic through line that needs to be considered. 13:04 The impact of Goodhart's Law. 14:12 What the players that are succeeding right now are doing. 14:22 The first pillar of a back-to-basics strategy: Don't get caught with your hand in the cookie jar. 16:07 EP463 with Betsy Seals. 16:50 Why short-term strategies don't work. 18:26 Stats report on prior authorizations serving the beneficiary. 19:32 EP482 with Preston Alexander. 19:38 Why prior authorization needs change. 21:28 The better strategy to use. 21:43 EP462 with Scott Conard, MD. 23:17 The second pillar of a back-to-basics strategy: Focus on the beneficiaries you actually serve well. 24:37 What it looks like to implement this focus on the beneficiaries you serve well. 25:29 How special needs plans play into this. 27:43 The third pillar of a back-to-basics strategy: Think about how STARS in clinical programs improve health. 30:04 The ethical component to implementing a Medicare Advantage program. 31:04 Betsy's advice for independent practices dealing with prior authorizations. 33:37 STAT article by Bob Herman about the effectiveness of Medicare Advantage lobbying on policy. 34:08 Betsy's final notes for all players impacted by what's currently happening. @betsyseals discusses the impact of #medicareadvantage news on our #healthcarepodcast. #healthcare #podcast #financialhealth #commercialpayermarketplace #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Patrick Nelli; Lee Lewis; Stacey Richter with 15 experts (EP507); Jerry DiMaso; Dr Ahilan Sivaganesan; Ryan Jacobs; Stacey Richter (INBW46); Ryan Wells, Dr Leo Spector, and Adam Stavisky
In this episode, host Steve Chen sits down with Mark Miller — journalist, author, and retirement expert behind RetirementRevised.com — to unpack the biggest changes hitting Social Security and Medicare right now. Mark shares his personal experience claiming both programs, explains why “later is better” for most Social Security claimants, and breaks down the trust fund depletion risk without the fear-mongering. The conversation covers the real-world impact of DOGE-driven SSA staffing cuts, why traditional Medicare beats Medicare Advantage for most people, the landmark $2,000 Part D out-of-pocket cap, and the quiet Medicare Savings Program rollback buried in the “One Big Beautiful Bill.” Mark's no-nonsense take: understand the rules, claim strategically, and shop your Medicare coverage every single year.
The doctor is in....the box. That's one way to describe how patients are now encountering their physicians in what's being described as the future of telehealth. Imagine that instead of a cancer patient in a rural area driving hours for an appointment to see their specialist at an academic health center, they can go to their local clinic and see a life-size, real-time, 3-D projection of them in a seven foot tall light box. The doctor can see the patient through two-way video, and is assisted by a clinician in the exam room. The technology behind this remarkable scene is provided by a Los Angeles based start-up called Proto Hologram, whose founder and chairman, David Nussbaum, joins us on this episode of Raise the Line from Elsevier. "Our holograms start where Zoom ends and where physically being there begins," says Nussbaum, a TIME Healthcare100 honoree who has spent the last decade developing commercial and educational applications for holograms. In addition to clinical settings, Proto units are being used at medical schools and senior living facilities and are playing a role in public health campaigns about breast cancer and vaccines. Join host Lindsey Smith for a fascinating conversation that covers: The role of holograms in extending access to specialty care; How the technology could be used to combat loneliness among seniors; Nussbaum's philosophy of "commercializing the impossible". Mentioned in this episode: Proto Hologram 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
Tonight, we break down the latest developments in the Iran war as confusion continues around the ceasefire, the Strait of Hormuz, and what the administration's actual strategy is supposed to be. Then we turn to a series of legal and political battles raising major questions about power, accountability, and the state of American democracy. Donald Trump is again trying to avoid paying E. Jean Carroll, this time with help from a Justice Department argument now headed toward the courts. Meanwhile, the FBI raided the office of a Virginia lawmaker tied to a redistricting push, and Kash Patel is facing scrutiny after reports that the FBI is investigating The Atlantic. The growing use of government power for political pressure, personal grievances, and revenge is beyond concerning. So where is the line, and what happens when the institutions meant to protect democracy are increasingly used to destroy it? This episode is brought to you by Aura Frames. Exclusive $25-off Carver Mat at https://on.auraframes.com/DONLEMON. Promo Code DONLEMON This episode is sponsored by FFRF. Visit https://ffrf.us/don or text DON 511511 to join or learn more. Because freedom belongs to all of us. Text Fees May Apply This episode is sponsored by BetterHelp. BetterHelp makes it easy to get matched online with a qualified therapist. Sign up and get 10% off at https://BetterHelp.com/donlemon For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit megaphone.fm/adchoices
PODCAST LAS NOTICIAS CON CALLE DE 1 DE MAYO - Protestas en la milla de Oro y otras partes de San Juan como parte del día de la clase trabajadoraFiscal que archivó castigo contra Secretaria de Familialogra mejor puesto en gobierno - Noticel Se estremece el dólar tras Japón intervenir en el Yen para subirlo de valor, carros japoneses pudieran subir de precio, etc. - Bloomberg Republicanos le quitan poder al voto boricua en Florida con nuevo mapa electoral aprobado ayer en la Legislatura - Fox News No va eliminar la crudita de PR porque hay que conseguir los fondos si haces eso - Metro Emigran menos boricuas a USA, Texas sube como preferencia y New York baja - El Nuevo Día Ética va a evaluar denuncia contra jefa de Familia - El Nuevo Día Le suben fondo de Medicare Advantage a PR por encima de Estados Unidos - El Nuevo DíaEducación perdería casi 20% de sus estudiantes en 4 años - El Nuevo Día Presidenta UPR dice que va para los tribunales para reabrir la UPR - El Nuevo Día Se va Arby's de PR tras no funcionar su modelo - El Nuevo Día Detenido Amazon en PR por permiso de carreteras que ellos tienen que cumplir - El Nuevo Día Empresas de Taiwán consideran a PR para Pharma y microprocesadores - El Nuevo Día Regresa American Airlines a Venezuela - Miami Herald Trump dice que mantiene el bloqueo a Irán y vence hoy el plazo de 60 días de la War Powers Resolution. Trump asegura que la guerra ya "terminó”, por lo que no necesita permiso del Congreso "El plazo de 60 días para que la administración consiga aprobación del Congreso o termine las hostilidades no es una sugerencia; es un requisito." — Susan Collins, senadora republicana de Maine Encuentran cuerpo de hombre y mujer en Mayagüez, heridas de arma clanba y casquillos de bala en escena - Noticentro Comienza juicio contra Elvia Cabrera por YouTube Jay Fonseca PR Gasolina en 4.40 el galón, precios más caros en la historia Mañana es el 10k del Teodoro Moscoso, así que no hay acceso por el puente #lilly #mounjaro Incluye auspicio
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