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"I'd already finished my cardiovascular unit. I'd finished my pulmonary unit. I had never heard about this in any of my classes." That was Dr. Joel Bervell's reaction to discovering that a device used every day in hospitals -- the pulse oximeter -- reads less accurately on darker skin tones. He posted a 30-second video about this consequential discrepancy that, to his utter surprise, gained over 500,000 views by the next morning. That video launched Dr. Bervell into orbit as a social media presence and created his identity as The Medical Mythbuster. In just a few years, he's built a following of two million people, earned a Peabody Award and was named to the inaugural Time 100 Creators list, all while finishing his residency. On this episode of Raise the Line, host Lindsey Smith welcomes Dr. Bervell to explore the roots of this kind of bias and the real world impact of drawing attention to it. “The most impactful biases in medicine exist because no one stops to ask who was included in the original data and who was left out,” Dr. Bervell explains. Stay tuned to also learn about: His YouTube animated series The Doctor is In which helps kids understand how their bodies work, as well as providing medical role models; How to build trust with marginalized communities; His forthcoming book, The Default Body which examines who medicine was actually designed for. Mentioned in this episode:Dr. Bervell on InstagramTikTok ChannelFacebook"The Doctor Is In" Show 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
We are almost at two months since the tragic death of Nolan Wells. Ben Crump has been representing the family since early on, along with his team of attorneys. Now, a Jackson County defense attorney named Ahmad Smith has joined. Join Don to break down this story and everything else going on today.
In this episode, Neil Machhar, Chief Executive Officer, Greenbrook Medical, discusses Greenbrook's high-touch primary care model for seniors, its growing partnership with Tampa General Hospital, and plans for expansion. He also shares insights on Medicare Advantage headwinds, sustainable growth, and building a team-first culture.
Health Affairs Publishing's Rob Lott speaks to Grace Mackleby of the University of Southern California about her recent paper that explores how vertically integrated Medicare Advantage plans and hospital systems set prices, finding that most affiliated and unaffiliated plans pay similar rates, with notable variation in certain markets. Order the August 2026 issue of Health Affairs.Sign up for our free Health Affairs newsletters to stay up to date on health policy news and analysis.
Caregiving can feel like a private struggle, but the numbers and the lived reality say it's a hidden crisis. We sit down with Diane, a nurse with 53 years of experience and the founder of CaregiverRelief.com, to talk about what dementia caregiving really does to families and why so many caregivers feel like they're carrying the whole load alone.Diane traces her “why” back to her grandmother's Alzheimer's journey and the kind of moment every family hopes for: connection that still breaks through the fog. From there, we get honest about the long arc of caregiving, including how early grief and responsibility shape a caregiver's life, why burnout is more than “being tired,” and how relationships can wither when your world becomes meds, meals, safety, and constant vigilance.Then we go straight at the system. Diane explains the gaps she sees in dementia care support, why navigating hospitals, rehab, and long-term care can overwhelm anyone without a medical background, and what scares her about cost-sharing and Medicare Advantage co-pays tied to skilled nursing and rehab. Most importantly, she gives practical tools you can use right now: build a caregiver relief group, assign people to check on the caregiver, and put a family caregiver contract in place so time off and support are clear and fair.If you're caring for a parent with Alzheimer's or supporting someone who is, hit play, share this with your village, and then subscribe, leave a review, and tell us what kind of help would actually make your week easier.Make sure to visit caregivingrelief.com to learn more about Diane and listen to her podcast. Exec. Producer/Host: J Smiles Comedy Producer: Mia Hall Editor: Annelise Udoye Support the show"Alzheimer's is heavy but we ain't gotta be!"IG: https://www.instagram.com/parentingupFB: https://www.facebook.com/parentingupYT: https://www.youtube.com/@parentingupTEXT 'PODCAST" to +1 404 737 1449 - to give J topic ideas, feedback, say hi!Be sure to leave us a review!
There's a number attached to every patient's chart that quietly shapes the resources they receive, the care they're offered, and whether their health conditions are fully seen — and most providers don't fully understand it. In this episode, Jamie sits down with Ericka Bauman, Director of Quality Assurance at Your Health, to break down the Risk Adjustment Factor — better known as the RAF score. Ericka has spent years traveling across Georgia and South Carolina, walking into provider offices, sitting with care teams, and doing the work of turning confusing data into meaningful patient outcomes. What you'll hear in this episode: What the RAF score actually is — explained the way Erica explains it to every team she visits, from providers to front desk staff Why most RAF scores are too low — and how underdocumenting a patient's conditions leaves them exposed to missed care, hospitalizations, and unmet needs The biggest misconception providers have about RAF (hint: it's not another box to check) How RAF and quality measurement are really asking the same question from two different angles — and why treating them separately is a mistake What changes for patients when care teams show up prepared, proactive, and looking at the whole person — not just the reason for today's visit The numbers will follow when you take care of the patient. This episode will show you how. www.YourHealth.Org
What are the biggest Social Security and retirement mistakes retirees make? Toby Mathis and Erin Moriarity break down when to claim Social Security, Social Security taxes, Roth conversions, Medicare and IRMAA surcharges, the 4% rule, retirement income strategies, long-term care costs, and how to avoid running out of money in retirement. Learn how smarter Social Security planning, Medicare planning, tax strategies, and retirement withdrawal decisions can help you build a more secure retirement. Check out Erin's Channel
In this episode, Jakob Emerson, Associate News Director, Becker's Healthcare, discusses the latest Medicare Advantage trends, including SCAN's new partnership with Costco, insurer market exits, tighter margins, and fewer plan options for seniors. He also explores how changes to Part D subsidies could influence Medicare Advantage enrollment.
Health Affairs Publishing's Jeff Byers welcomes Erica Socker of Georgetown University to the pod to discuss her recent Forefront article that explores how the Medicare Advantage quality bonus program is working in the wake of a Clover Health-CMS lawsuit over star ratings. They discuss the court's ruling, CMS's policy response, and why the case could become a catalyst for broader reforms to a program that now distributes billions of dollars annually. Related Links:Medicare Advantage Quality Bonus Program: Court Decisions Spotlight Flaws (Health Affairs Forefront)Sign up for Health Affairs' free newsletter to catch up on our new articles, podcasts, and events.
Hour 4 (8.19) Tim finds a saved voicemail from his dad, Tim Conway, plus Costco getting into the Medicare business and a very big night for a very underfunded candidate in Florida. The hour opens on the City Council's 10-3 vote to remove 12 designated enforcement zones under the city's 41.18 anti-camping law — supporters say it lets the city focus on outreach and housing; opponents warn about public safety and quality of life. Crozier offers his own L.A. housing history: he slept on a branch in a tree when he first moved here. Then Conway on going to Agua Caliente with his dad and everything that track gave racing — the Pick 6, which started there as the "5-10," along with the starting gate and safety helmets, and Anna Lee Aldred, the first American woman licensed to ride, who got that license at Caliente. Plus, the Coast Guard on pulling a jet skier out of the ocean. Then the Florida Democratic Senate primary, where progressive state Rep. Angie Nixon upset former National Security Council aide Alex Vindman, and what that would have paid on Poly-market and Kalshi. And to close it out: Costco and nonprofit insurer SCAN Health Plan are partnering on Medicare Advantage products in two states and a Medicare supplement in a third, pending regulatory approval — the retailer's first entry into the Medicare market — and then Tim, going through his phone, finds his father's voice waiting on it. See omnystudio.com/listener for privacy information.
Hour 3 (8.19) A Long Beach man spends the night alone in the ocean and lives, four 40-story towers for seniors are headed for Warner Center, and Tim finds a saved voicemail from his dad. The hour opens on prediction markets and what the Florida upset would have paid out, then Costco and nonprofit insurer SCAN Health Plan partnering on Medicare Advantage products in two states and a Medicare supplement in a third, pending regulatory approval — the retailer's first entry into the Medicare market. Then Tim, scrolling his phone, finds his father's voice still on it. From there: Paul Carbullido Jr., 53, was found 16 hours after he was reported missing — a husband and father of four on a personal watercraft for the first time in his life. He can't swim. Coast Guard crews found him floating nearly three miles south of the Seal Beach Pier around 10:45 a.m., body temperature down to 86 degrees, and he says his life vest is what let him paddle all night. Plus the Viva project headed for Warner Center: four towers, roughly 40 floors, more than 3,000 units of affordable senior housing, part of a much wider redevelopment. Councilmember Bob Blumenfield calls it the future of senior housing — "kind of like Golden Girls on steroids." And the crew closes out on Harry and Meghan, their post-royal business record, and whether the American public has moved on. See omnystudio.com/listener for privacy information.
Despite gains in recent years, Black, Hispanic, and Asian communities are still under-represented in the U.S. nursing workforce. We're going to explore that gap and how to close it on this episode of Raise the Line from Elsevier with Dr. Ernest Grant, Vice Dean for Diversity, Equity, Inclusion and Belonging at the Duke University School of Nursing. "You get a patient who is more compliant when they see someone who looks like them, who is from their culture and who can advocate on their behalf," he tells host Lindsey Smith. Dr. Grant bases that and other insights on a rich professional background that includes 50 years in nursing, being a leading advocate for his profession and breaking down barriers himself as a male nurse of color and the first man elected president of the American Nurses Association. In this thoughtful conversation, Dr. Grant reflects on what it took to earn credibility in leadership roles, how he's navigating the political climate on DEI initiatives, and the causes and solutions to the persistent shortage in nursing faculty, among other pressing issues. Tune in for a uniquely-informed look at what it will take to build a stronger, more representative nursing profession. Mentioned in this episode: Duke University School of Nursing American Nurses Association 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
Costco to launch its own Medicare Advantage plan. E-bike and e-scooter injuries keep climbing, Harborview says. Jim with innovations in helmet technology. Seattle’s “No Right on Red” Revolution // Nikola Tesla STEM High near Redmond in Top 10 in U.S. News ranking. These kids are learning without technology in Seattle Public Schools // Portland’s bus-riding goats go national, get their own TriMet merch
Costco to launch its own Medicare Advantage plan. E-bike and e-scooter injuries keep climbing, Harborview says. Jim with innovations in helmet technology. Seattle’s “No Right on Red” Revolution // Nikola Tesla STEM High near Redmond in Top 10 in U.S. News ranking. These kids are learning without technology in Seattle Public Schools // Portland’s bus-riding goats go national, get their own TriMet merch
Today we celebrate the life of Nolan Wells on what would have been his 19th birthday. The National Action Network held a virtual prayer vigil today and a separate celebration of his life will be held tonight at 7pm in Biloxi. Also, journalist, lawyer, and friend of the show Katie Phang has been successfully suing the DOJ to release more Epstein files. She joins us to discuss this process.
Plus: BHP annual profit rises on record copper prices. And a tech selloff that began on Wall Street Monday, gathers steam. Luke Vargas hosts. Sign up for WSJ's free What's News newsletter. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Direct Primary Care no longer disqualifies patients from HSA eligibility. As of January 1, 2026, DPC membership fees are a qualified HSA expense at or below $150 per month for one person and $300 for a family. Above $150 you are not in violation. You are in the same gray zone DPC lived in for a decade, and the tax position belongs to the patient and their accountant, not to you.Dr. Phil Eskew (DO, JD, MBA) of DPC Frontier joins Dr. Maryal Concepcion to break down what changed and what it means for your practice, then walks through the Medicare opt-out calendar most physicians discover too late.KEY NUMBERS AND DATES $150/month per person, $300 family. Effective January 1, 2026. Opt-outs take effect only on January 1, April 1, July 1, October 1. Affidavit must be filed at least 30 days before the effective date. File by roughly December 1, 2026 to be opted out January 1, 2027. 90-day reversal window, but you must refund every membership dollar collected.QUESTIONS ANSWEREDCan patients use an HSA to pay for direct primary care? Yes, as of January 2026. Both old IRS objections were fixed: whether the fee is a medical expense, and whether membership disqualifies HSA contributions.Should I put "HSA eligible" on my website? No. Write "We accept HSA cards." Promising eligibility in your marketing or agreement takes on a tax position on your patient's behalf.How do I get under $150 without losing revenue? Enrollment fees are not compensation for care. Blood draws, injections, EKGs, and dispensed medications can price separately.What does the rule exclude? Prescription drugs other than vaccines, and lab services not typically done in an ambulatory primary care setting.If I opt out, can I still order labs and referrals? Yes. Opting out is not disenrollment. You stay credentialed and Medicare pays for labs, imaging, referrals, DME, and prescriptions you order.Where can I still work while opted out? VA, Indian Health Service, corrections, and hospice administrative work. Precepting usually requires participation. TRICARE requires Medicare participation. Medicaid uses ORP/OPR status, prohibited in Kentucky and Colorado.Does opt-out apply to Medicare Advantage? Yes. Opt-out applies to all Medicare programs nationwide. You cannot opt out selectively.MENTIONED DPC Frontier · McCarran-Ferguson Act (1945) · ACA primary care carve-out · bronze and catastrophic plans as HSA-compatible · capacity vs. competency · durable power of attorney · prior authorization escalation strategyHAVE A QUESTION? WE ANSWER THEM ON AIR. Leave a voicemail at mydpcstory.com/contact with your name, state, and question.NEXT EPISODE: ILLINOIS, timed to the Illinois DPC Summit, October 2 and 3, NIU Naperville. Subscribe to the My DPC Story newsletter at mydpcstory.com to know when it drops.Educational only. Not legal or tax advice. Dr. Eskew is not your attorney.Stand With Dr. Nyasha Spears and the Future of Patient-Centered Healthcare. Get the MEDICARE & MEDICARE ADVANTAGE OPEN ENROLLMENT SURVIVAL GUIDE at mydpcstory.com/shop! Get your copy of the Physician Owner's Planner today at mydpcstory.com/library Start using the done-for-you patient emails, scripts etc. in our 2027 Edition of the MEDICARE & MEDICARE ADVANTAGE OPEN ENROLLMENT SURVIVAL GUIDE at mydpcstory.com/shop!Support the showGET your FREE MONTHLY BUSINESS TOOL DOWNLOADBecome A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube
In this episode, Jakob Emerson, Associate News Director, Becker's Healthcare, discusses UnitedHealth's $3 billion acquisition of Allegis, the evolving Medicare Advantage and Medicaid landscape, and how insurers are approaching AI investments. He also explores the growing focus on measurable AI returns, proprietary data and the challenges of using AI in healthcare.
What does it take to compete on the world's biggest stage and then pivot to one of the most demanding training paths in professional life? Today's guest, Samantha "Sammy" Kolowrat, has done both, and she has some fascinating insights into the commonalities of those two worlds on this episode of Raise the Line. “Something that really drew me to medicine is the team atmosphere that's there as you work towards a common goal, and there's this level of intensity that's very reminiscent of the experiences I had as a professional athlete.” Originally from Prague, Kolowrat represented Czechia at six IIHF Women's World Championships and the 2022 Beijing Olympics, and also captained the Division I women's hockey team at the University of Vermont while earning degrees in biology and pharmacology. As she starts an anesthesiology residency at Vanderbilt University, she credits her athletic career with shaping how she handles pressure, feedback, and teamwork in medicine. "The more I improve, the more knowledge I acquire, the more skills I hone, the better care my patients get," she tells host Lindsey Smith, describing what drew her to a field that rewards the same relentless fine-tuning as elite sports. This engaging conversation also explores: How crippling performance anxiety as a Division I athlete ended up preparing Kolowrat for the operating room; Why she was drawn to anesthesiology's "well-oiled machine" atmosphere; The mentorship gap she's working to close for the next generation of athlete-physicians. Mentioned in this episode: Vanderbilt University Anesthesiology Residency Program 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
Drs. Akshay Thomas and Sarwar Zahid join for a journal club discussion of three recent articles in the ophthalmology literature. Retinal Laser Prophylaxis for Lattice Degeneration (https://www.ophthalmologyretina.org/article/S2468-6530(26)00308-8/abstract) Anti-VEGF Access Medicare Advantage versus Fee-for-service (https://www.aaojournal.org/article/S0161-6420(26)00453-7/abstract) Conversion to Wet Macular Degeneration after Cataract Surgery (https://www.aaojournal.org/article/S0161-6420(26)00420-3/abstract)
Livestream Notice: The stream was unfortunately cut off at the very end due to a network connection issue. We apologize for the abrupt ending and appreciate your understanding. AEP is coming fast, and if you wait you'll miss out—so take advantage of Lead Heroes' 15% off preset Medicare appointments when you pre-order by August 31 and secure your spot before the program sells out. https://leadheroes.com/ In this episode of the Seven Figures Or Bust Podcast, Christian Brindle and Glen Shelton break down the massive Medicare Advantage plan terminations and Service Area Reductions expected for the upcoming AEP. With an estimated 1.8 million members potentially impacted, they discuss what these changes mean for agents, why market disruption can create major opportunities, and how smart agents can position themselves for a stronger AEP.
MEDICARE ADVANTAGE MINUTE: THE MEDICARE ADVANTAGE COVERAGE GAP THAT COSTS RETIREES THOUSANDS AFTER JOINT REPLACEMENT! MEDICARE PAYS FOR AN AMBULANCE ONLY WHEN OTHER TRANSPORTATION THREATENS YOUR HEALTH. ANALYSIS OF RATE INCREASE REPORTS ILLUSTRATES ONCE AGAIN THAT HDG HAS THE SMALLEST INCREASES. CONSUMPTION OF COFFEE MAY LOWER HEART DISEASE RISK. EVEN MASS QUANTITIES? FINALLY, WE READ A LIST OF THE PLACES THAT MAKE TRAVELERS THE HAPPIEST. THE LIST WAS COMPILED BY USA TODAY SO DON'T EXPECT IT TO MAKE ANY SENSE! Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE ENROLLMENT GUIDE" - DOWNLOAD FREE "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" ....AND A PODCAST! @ DBJ@M4TLM.com W medicareforthelazyman.com T (630) 878-5055 Review Us On Google For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
The recent $14.1 million False Claims Act settlement against Complete Health Partners Holdings, a management services organization operating provider groups in Florida, Alabama, and Colorado, brings to light the role coders can play in False Claims Act cases.In this instance, it was alleged that Complete Health Partners Holdings directed physicians to add high-value, risk-adjusting codes for Drug and Alcohol Dependence and Major Depressive, Bipolar, and Paranoid Disorders to the medical records of Medicare Advantage patients when those codes were not indicated.So, listen and learn when special guest Liz Soltan, counsel for Whistleblower Partners, will discuss the role of coders in these cases.The popular weekly Internet broadcast will also feature these additional instantly recognizable panelists, who will report more news during their segments:• POV: Penny Jefferson, Manager of Coding & Clinical Documentation Integrity Services for the University of California-Davis Medical Center, will share her point of view during the broadcast.• CDI Report: Cheryl Ericson will provide an update on all things clinical documentation integrity (CDI).• SDoH Report: Tiffany Ferguson will report on news happening at the intersection of compliance and medical record coding.• The Coding Report: Christine Geiger will report on the latest coding news.• Talk Ten Tuesday News Desk: Timothy Powell, will deliver the latest news from the Talk Ten Tuesday News Desk.
Socially vulnerable Medicare patients see dramatically better outcomes—such as fewer emergency department visits, fewer preventable hospital admissions, and 23.4% to 30% less use of high-risk medications—when their physicians take on full financial risk for their care compared with those in traditional fee-for-service Medicare. That's the core finding of a new study published in the June issue of Population Health, Equity & Outcomes, and the subject of this conversation between Ken Cohen, MD, chief medical officer for Optum Health, and host Sophia Humphreys, PharmD, vice president of health system strategy and innovation at The American Journal of Managed Care.
We're on summer break and replaying one of our favorite episodes. This episode originally aired on September 22, 2025.A wearable can collect endless data, but it only matters if people trust it enough to change their behavior.In this replay, Oura CEO Tom Hale joins Steve and Michael to explain how the company combines clinical-grade accuracy with a consumer-friendly product. They discuss why the ring's form factor makes overnight tracking so powerful, how Oura turns physiological signals into useful guidance, and why the company is being pulled faster than expected into traditional healthcare.We cover:Why sleep data can reveal changes in the body before symptoms appearHow Oura designed a health product that supports users without judging or nagging themWhy accuracy is the foundation for trust, predictions, and behavior changeHow Oura navigates the boundary between wellness products and regulated medical devicesThe company's expansion into Medicare Advantage, women's health, metabolic health, and clinical care—About our guest:Tom Hale is the Chief Executive Officer at ŌURA and a member of its board. As the CEO he sets the company's business strategy and vision to make health a daily practice for members all over the world. He has over 30 years of experience across the technology and consumer product industry.Before joining ŌURA, Hale was president of Momentive where he drove B2B strategy and led product growth. During his time there he was instrumental in taking the company public in 2018, leading the team in key acquisitions, and driving the evolution and rebranding of the company into a multiple SAAS business. Previously, he held leadership roles at HomeAway and Linden Lab as the Chief Operating Officer and Chief Product Officer, respectively, and held executive roles at Macromedia and Adobe.Hale has a Bachelor of Arts from Harvard University and sits on the boards of Cars.com, RocketReach, and NoiseAware.—If you're enjoying the show, we would so appreciate it if you left us a review!—
Patient out-of-pocket costs can have implications for care access. Jabre Millon, MD, discusses the AJR article by Billig et al. comparing patient cost-sharing for advanced diagnostic imaging in Medicare Advantage plans between 2018 and 2026. Full article: Patient Cost-Sharing for Advanced Diagnostic Imaging in Medicare Advantage Plans Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social
An 11-year-old boy in rural Zambia once told Dr. Genesis Mwamba that he was about to attend school wearing shoes for the first time in his life. That moment, Dr. Mwamba says, crystallized why he started the Lead Me Back Foundation to provide school supplies and other support to marginalized communities in his native country. As you'll learn in this inspiring installment in our NextGen Journeys series, Dr. Mwamba started the foundation in 2021while still a medical student because he had experienced the power of education as an “equalizer” in his own life, taking him from humble roots to a career in medicine. He and his colleagues have grown the bootstrapped organization to a point where it now provides hundreds of thousands of people across the country with educational access, climate education and community health clinics. “I've always been drawn to opportunities and initiatives that bring help to humankind,” he tells Raise the Line host Dr. Parsa Mohri. This episode also explores: What building "with" a community rather than "for" it looks like in practice; The storytelling strategy that attracted donors and partners; How his mother's untimely death inspired his commitment to preventive medicine. Mentioned in this episode: Lead Me Back Foundation If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
If you're thinking about becoming an insurance agent, you may be thinking about what can come along with the career change? What are some of the perks you might discover, and what downsides could sneak up on you? in this episode of The Agent Survival Guide Podcast, we help you weigh the good of becoming an insurance agent against the bad. Read the text version Get Connected:
In this episode, Laura Dyrda, Vice President, Editor-in-Chief, Becker's Healthcare, discusses the latest CMS inpatient payment rule, rising ACA marketplace premiums, and the evolving Medicare Advantage landscape, along with what these changes mean for hospitals, health systems, and patient access to care.
The Nolan Wells case has taken another dramatic turn. Tonight, Don is joined by Jeanetta Brantley, the audio expert who first isolated key audio from the Sea Tow distress call that sparked nationwide discussion. Since sharing her analysis, Jeanetta says she has faced a wave of threats and harassment. She joins us live to discuss her findings, respond to the criticism, and explain why she believes the focus should remain on uncovering the truth in Nolan's case. This episode is sponsored by BetterHelp. See the reviews, see what stands out, and see if BetterHelp is right for you. Visit BetterHelp.com/DonLemon. This episode is brought to you by MSI. Text "LEMON" to 511511 or go online to msiunitedstates.org to learn more and to donate and help the women in Afghanistan receive healthcare. This episode is brought to you by Upwork. Visit Upwork.com right now and post your job for free This episode is brought to you by Lean. Visit https://TAKELEAN.com and enter LEMON for your 20% discount and free rush shipping 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.
For years, regional health plans benefited from powerful tailwinds: Medicare Advantage growth, Medicaid expansion, and a prospering ACA marketplace. But many of those growth engines have stalled, just as new pressures emerged: rising utilization, runaway spend, pricing uncertainty and more scrutiny from patients and policy makers. The result is a dramatically different financial reality for health plans. In 2024, only eight of 33 Blues plans reported positive operating margins. In this episode, host Rae Woods sits down with Jared Landis, Vice President of Advisory Board's Health Plan Research practice, to unpack how regional plans got here and the three-year turnaround strategy regional and Blues plans are now pursuing. Together, they explore the market forces that upended the payer playbook, the operational and pricing changes plans are making to stabilize performance, and how AI-enabled transformation could reshape the future of the insurance business. Stay tuned to the end of the episode for an update on the Rural Health Transformation Program, including a key deadline this fall. We're here to help: Episode | Ep. 257: Paul Markovich on new builds, breakups, and bold healthcare bets Episode | 305: “The work isn't easy, but it's clear”: How healthcare leaders are responding to the market Episode | 302: CMS announced the 2027 MA final rate. What do payers and providers need to know? Playlist | Radio Advisory Provider Strategy and Financial Outlook playlist Expert Insight | Can health plans turn their MA business around this year? Research | Health plan strategy Report | Rural health transformation funds: Where they're really going Ready-to-Use Slides | Health Plan Market Explorer Webinar | Understanding health plan decision-makers Sponsor link: Precision in motion: How digital tools support diabetes care providers A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.
On this episode of Diabetes Connections In the news… Sanofi acknowledges an insulin shortage, a new oral therapy for type 1 moves along in research, could there be an actual, accurate, non-invasive CGM in the works, ADA conflict continues and a new documentary about Girl Scout cookies shines a spotlight on T1D. Don't miss our upcoming events! Moms' Night Out in Detroit and Seattle, Club 1921 in Charlotte and Phoenix: https://diabetes-connections.com/events/ Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com Transcript: (Stacey Track) On this episode of Diabetes Connections In the news… Sanofi acknowledges an insulin shortage, a new oral therapy for type 1 moves along in research, could there be an actual, accurate, non-invasive CGM in the works, ADA conflict continues and I can't wait to tell you about Cookie Queens.. that's coming up right after this. (AD BREAK) Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bring you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. We are still looking for your community commercials. These are 30–60 second audio spots created by members of the diabetes community to share: Events you're organizing: a fundraiser, walk, or local meetup Products you've created: maybe you've written a book, have a Substack, designed a T1D-friendly gadget, or launched a small business Helpful projects or resources: things you think others in our community should know about It's your chance to share what you're doing and help others get connected! Full instructions are on the website. While you're there please check out our events. We're turning toward fall and we have a lot going on – MNO and Club 1921. Okay.. our top story this week: XX I want to talk about Cookie Queens! It might not sound like a hard news story.. but It's my show and I can't wait to watch this. This move follows four Girl Scouts ages 5-12 during cookie season. One of the girls has type 1 – they don't mention it in the trailer, but you can see her omnipod. Here's a clip: Start the very beginning and stop after "I want to be a supreme court justice." (stop after the "oh..laughter" https://www.youtube.com/watch?v=nnSQS43Eil8 Viewers meet Ara from San Diego, CA (5), Shannon Elizabeth from El Paso, TX (8), Nikki from Chino, CA (9), and Olive from Charlotte, NC (12). Ara has Type 1 diabetes and is shown taking insulin, refilling her pump before bed, and determining with her dad how to sample the cookies she's selling while keeping her blood sugar levels safe. Thumbs down to the Hollywood reporter dot com. In their review they say.. "if this film were itself a baked good, Ara would need to be careful because one bite could cause hyperglycemia or even diabetic ketoacidosis. It's just that sweet." Cookie Queens comes out this month. https://www.hollywoodreporter.com/movies/movie-reviews/cookie-queens-review-prince-harry-meghan-markle-girl-scouts-1236484555/ trailer: XX Supply issues for Lantus SoloStar pens being acknowledged by Sanofi. The company says it's experiencing "a period of intermittent supply due to increased demand. The company said the increase in demand is being driven by "broader market dynamics," but did not provide additional details. Sanofi said the situation is temporary and is expected to improve over the coming weeks. The company said Lantus U-100 vials and Toujeo U-300, which contain the same active ingredient, remain available. https://www.wral.com/news/local/common-insulin-pen-faces-supply-issues-amid-rising-demand-july-23-2026/ XX The University of Alabama at Birmingham startup TIXiMED Inc. has launched the next phase of clinical testing for a novel oral therapy for Type 1. For now called TIX100, a small-molecule drug designed to inhibit a protein linked to pancreatic beta-cell loss and diabetes progression. The new double-blind, randomized, placebo-controlled study will evaluate the drug's safety, tolerability and pharmacokinetics. Researchers will enroll 18 healthy participants across three dose cohorts at a single United States study site. Participants will receive either TIX100 or a placebo twice daily for 28 days, followed by a seven-day follow-up period. Six participants making up the first cohort have been successfully enrolled thus far. In addition to its potential use in Type 1 diabetes, TIX100 may have applications in Type 2 diabetes and obesity. A recent study found that the drug prevented weight regain and preserved lean muscle mass after discontinuation of GLP-1 therapies in preclinical models. https://www.uab.edu/news/research-innovation/startup-advances-novel-oral-type-1-diabetes-therapy-to-next-phase-of-human-testing XX Researchers at the University of California San Diego say they have developed and validated a Continuous Health Analyzing Ring Module (CHARM), a compact, fully integrated wearable smart ring capable of continuous real-time monitoring of multiple biomarkers in sweat. The wearable device can simultaneously measure up to four biomarkers, including glucose, ketone, uric acid, lactate, ascorbic acid, and alcohol, to provide real-time insights into metabolic health. The study is published in Nature Communications. They say CHARM device contains all necessary biomarker sensors, low-power electronics, and a flexible battery. The left compartment of the device is designed to draw sweat passively using an osmotic hydrogel, a soft polymer that creates a pressure gradient to pull fluid from the skin painlessly. The sweat is then analyzed by multiplexed electrochemical sensor arrays within the same compartment, leading to simultaneous and real-time tracking of four biomarkers at a time. The right compartment of the device contains a flexible zinc-silver oxide rechargeable battery that supplies power for up to 12 hours of operation between charges. Biomarker information generated through sensors is wirelessly transferred to a connected Bluetooth-enabled device for real-time display The findings indicated that the device performed well in initial temperature, cytotoxicity, and on-body compatibility tests. It also demonstrated high analytical accuracy in preliminary studies involving healthy participants and individuals with type 1 diabetes, highlighting its potential for non-invasive metabolic monitoring. The calculated estimated sweat-based blood glucose concentration showed a mean absolute relative difference of approximately 13.7% against its corresponding blood concentration values. The device needs further validation in diverse clinical settings and across large diabetic cohorts. https://www.news-medical.net/news/20260727/Prototype-smart-ring-tracks-multiple-sweat-biomarkers.aspx XX Hotter weather and rising temps appear to increase the short term risk for low blood sugar in adults with type 1. An analysis of more than 32 million continuous glucose monitor (CGM) readings from nearly 700 adults with T1D in the UK showed a 26% greater risk for hypoglycemia at a temperature of 25 °C (77 °F) than at 13 °C (55.4 °F). Hypoglycemia was defined as a glucose level < 3.9 mmol/L (70 mg/dL). The study included 679 individuals with T1D and 32,966,282 CGM readings collected between February 23, 2017, and August 8, 2024. Participants had a mean age of 46.4 years and a mean T1D duration of 23.7 years. The researchers observed strong seasonal patterns, with lower odds of hypoglycemia in late winter and early spring, followed by a peak during the summer. The lowest risk occurred on Mondays. The odds then increased over the course of the week and peaked toward the weekend, with a significant odds ratio of 1.14 on Saturdays compared with Mondays. Increases in hypoglycemia were observed during both hot and cold weather, but the association was stronger for heat. The net odds ratio was 1.26 at 25 °C compared with 13 °C. https://www.medscape.com/viewarticle/when-temperatures-climb-hypoglycemia-risk-rises-type-1-2026a1000q4r XX Seven weeks after the expulsion of five diabetes experts from the American Diabetes Association conference, controversy continues. More than 200 members now calling for two ADA leaders to resign. In response, the ADA delivered its own message Tuesday, expressing appreciation for members' patience while a report is prepared. The resignation demand, sent last week in an open letter to the ADA board of directors, calls for the removal of CEO Charles Henderson and chief scientific and medical officer Rita Kalyani. It also urges "an independent investigation into the events of the 2026 Scientific Sessions in New Orleans, a full apology to the five colleagues removed from the meeting, and the restoration of editorial independence at Diabetes Care," an ADA scientific journal. https://www.statnews.com/2026/07/28/american-diabetes-association-fallout-researchers-expulsion/ XX XX Still to come, , a new link between diabetes and dementia, device updates, and why you might want to start rooting for the Red Sox.. XX New study says that people diagnosed with type 1 diabetes (T1D) before the age of 10 years had a 37% higher risk of developing all-cause dementia later in life than those diagnosed between ages of 18 and 30 years. These researchers used a Swedish national register of 43,440 individuals with T1D (mean age at cohort entry, 33 years; 44% women) Worth noting a couple of things.. the mean age in this study was 33 – so the people who were diagnosed under the age of ten would not have had access to current technology – no CGMs or AID systems. And while the study says it's 37% higher for the younger group, the actual rate was still very low. As always, I'll link to the study so you can learn more. My obvious bias here to look for a silver lining because I have a son who diagnosed with T1D at age 2. https://www.medscape.com/viewarticle/type-1-diabetes-onset-before-age-10-tied-higher-risk-2026a1000pir XX Researchers have developed a machine learning model that uses routine clinical information to detect diabetes and distinguish between type 1, type 2, prediabetes, and diabetes caused by pancreatic disease. The model performed well in early testing, but researchers say it still needs to be validated in independent patient groups before it could be considered for use in diabetes screening or clinical care. It did not assess clinical utility, patient outcomes, or quality of life. https://www.news-medical.net/news/20260729/Researchers-train-AI-to-detect-diabetes-and-assign-four-diagnostic-labels.aspx XX Trinity Biotech and Latch Medical are teaming up to explore combining CGM with precision drug delivery technology for diabetes, obesity, and other metabolic conditions. The companies hope real-time glucose data from Trinity's CGM+ sensor could eventually help guide more personalized treatment decisions and medication delivery. Trinity's CGM+ is still in development, with a pivotal clinical trial planned for later this year. https://www.drugdeliverybusiness.com/trinity-biotech-collab-cgm-drug-delivery/ XX The FDA selects Dexcom as the first participant in a new digital health pilot that will exempt certain digital health devices from FDA premarket authorization requirements while collecting real world data through a complementary Medicare program. Dexcom, plans to implement an artificial intelligence-enabled glucose health program through the pilot. The program is intended to help screen for prediabetes and Type 2 diabetes. The company plans to integrate data from its sensors, including its prescription G7 CGM and its over-the-counter Stelo device, along with contextual health information such as nutrition, physical activity, sleep and stress. The FDA announced plans for the Technology-Enabled Meaningful Patient Outcomes, or TEMPO, pilot last year amid a broader push for adoption of digital health and wearables. It coincides with a new program by the CMS to fund the use of digital technologies for managing chronic conditions. https://www.healthcaredive.com/news/fda-names-dexcom-as-first-participant-in-digital-health-pilot/826215/ XX Medicare and Medicare Advantage beneficiaries now have access to the new MiniMed Flex insulin pump. Beneficiaries can now access the MiniMed Flex and its latest sensor portfolio, which currently includes the Simplera Sync sensor, a disposable, all-in-one sensor with easy two-step insertion. The company plans to roll it out with the Instinct sensor, made by Abbott, later this summer. It also added Abbott's dual glucose-ketone sensor (still investigational in the U.S.) to its portfolio this year. Flex picked up FDA clearance in March and the company announced the initial commercial rollout of the pump last month. https://www.drugdeliverybusiness.com/minimed-flex-pump-now-available-medicare/ XX Eli Lilly expands it's partnership with Resilience – the makers of the KwikPen device. Through the investment, Resilience will significantly increase U.S. production of Lilly's KwikPen injectable device for diabetes and obesity medicines. In February, Lilly won FDA approval for Zepbound in a multidose KwikPen device. The product includes four doses of the GLP-1/GIP receptor agonist, providing a month of treatment for obesity or overweight in one device. Resilience expects the KwikPen capacity expansion to create at least 400 jobs in the Cincinnati area. https://www.biospace.com/deals/lilly-and-resilience-invest-750m-in-diabetes-and-obesity-drug-device-supply XX Alex Cooper – the host of the top podcast Call her Daddy – announced she's been diagnosed with gestational diabetes. "When I got this diagnosis, the first couple days, I was really hard on myself," the 31-year-old admitted. "It felt very isolating, like, as much as my family and my husband and everyone was there for me I just felt like, it's me on an island." She says she found an online community that's been helping. In sharing her experience, she hoped it would alleviate the stress. https://www.eonline.com/news/1434556/pregnant-alex-cooper-shares-isolating-gestational-diabetes-diagnosis XX Several amazing diabetes non profits are vying for big charity dollars from the Boston Red Sox. The IMPACT Awards provide Red Sox fans with the chance to nominate their favorite, most impactful nonprofit organization serving New England for their opportunity to win a grant from the Red Sox Foundation. In 2026, the IMPACT Awards will focus on organizations that are supporting research and providing awareness, advocacy, and services to people with diabetes. Check out all the charities and vote for your favorites – you've heard of so many of these I promise – at the link in the episode show notes, . https://www.mlb.com/redsox/community/red-sox-foundation/impact-awards?partnerId=redirect-bos-impact
In this episode, Scott Becker highlights the latest U.S. News and Forbes hospital rankings, the continued insurer pullback from Medicare Advantage, and more.
The new Medicare speech therapy CPT codes are coming, and adult SLPs need to prepare.In this episode, Jeanette Benigas, PhD/SLP, is joined by Katie Brown, SLP of Neuro Speech Solutions (@neurospeechsolutions), to discuss how the new code family replacing 92507 could impact adult speech-language pathology across Medicare Part B, skilled nursing, outpatient, home health, hospital outpatient, and private practice.They discuss how the new codes may affect reimbursement, scheduling, productivity, documentation, cognition treatment, Medicare Advantage, commercial insurance, and ethical billing. They also explore why accurate utilization data will be critical to future advocacy for higher reimbursement rates.Whether you own a private practice, work in a SNF, outpatient clinic, hospital, or even pediatrics, this conversation will help you understand what's changing, what questions remain unanswered, and how to start preparing now.Topics include:• The new adult SLP CPT codes• Replacing 92507• Medicare Part B billing• Cognition reimbursement• Documentation changes• Productivity concerns• Private practice and SNF implications• Ethical billing and future advocacyResources Mentioned
Chapters: :00 - 17:00 - 2027 AEP Overview 17:00 - 41:00 - HealthSpring 41:00- 1:05:00 - Aetna The 2027 AEP season is here, and with it comes significant changes that every Medicare agent needs to understand. In the first episode of a special two-part Carrier Rollout Series, co-hosts Josh Slattery and David Ireland break down the latest carrier announcements, industry trends, and regulatory updates shaping the upcoming Annual Enrollment Period. The discussion begins with the continued impact of the Inflation Reduction Act on the Medicare Advantage market. As plan revenues struggle to keep pace with rising healthcare costs, carriers are making strategic adjustments to benefits, networks, and product offerings. Josh and David explain what these market pressures mean for agents and how they may influence client conversations during AEP. The episode also explores key carrier updates, including HealthSpring's transition to the HCSC brand and its continued focus on HMO products and Dual Special Needs Plan (DSNP) expansion. The hosts discuss Aetna's strategy centered on network efficiency and product enhancements, noting that approximately 60% of members are expected to experience stable or improved benefits despite ongoing market challenges. Beyond carrier-specific news, the conversation covers important regulatory updates, changes to the SSBCI qualification process, and why ancillary products will continue to play a vital role in helping clients address coverage gaps. Josh and David also preview additional carrier releases, market expansions, and emerging opportunities that agents should be watching as the rollout season continues. Whether you're preparing for your first client appointment or refining your AEP strategy, this episode provides the insights needed to stay informed and confident heading into the 2027 selling season. Be sure to tune in for Part 2, coming later this August, as Josh and David continue their analysis of the latest carrier rollouts and what they mean for your business. Learn more about partnering with The Brokerage Inc. by visiting our website, www.thebrokerageinc.com. Remember to like, share, and subscribe to our show! New episodes are available every Tuesday. Join our Community! LinkedIn: https://www.linkedin.com/company/the-brokerage-inc-/ Facebook: https://www.facebook.com/thebrokerageinc/ Instagram: https://www.instagram.com/thebrokerageinc/ YouTube: https://www.youtube.com/@TheBrokerageIncTexas Website: https://thebrokerageinc.com/
Humana will reduce its Medicare Advantage footprint again in 2027. The Centers for Medicare & Medicaid Services will end a Medicare Part D premium stabilization program. And the American Red Cross has declared a national blood supply crisis. Listen to the latest episode of The Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
Two conversations that cut to the heart of what workers and retirees are navigating right now — one about what happens when an employer decides union members are expendable, and one about finding the right healthcare coverage when the landscape keeps shifting. The University of Maryland, College Park, laid off more than 80 workers earlier this summer. More than 80% were union members. The university's nearly billion-dollar endowment went untouched. So did the president's $1 million-plus annual salary and the multi-million-dollar coaching contracts for coaches with losing records. And almost immediately after the layoffs were announced, the university lifted its hiring freeze. AFSCME Local 1072 President Todd Holden, union steward Sarah Eppley and laid-off member Sarah Grun describe what happened, why the local filed 40 grievances covering workers laid off while on FMLA, pursuing grievances or active in union organizing and how to sign the AFSCME toolkit letter to the University System of Maryland at afscmemd.org. Then, BCBS NLO Executive Director Merrilee Logue and BCBS Association Medicare market analyst Duncan Lawson discuss a Medicare Advantage landscape that has become more complicated for union retirees to navigate. For the second consecutive year, more than 2 million Medicare Advantage consumers had their plans terminated and even more saw their benefits reduced. Logue and Lawson explain which plans and regions have been most affected, why Medicare Advantage remains the most popular retiree coverage option despite the changes and what union members approaching 65 need to know to find coverage that fits — including how to work with a broker, check union fund coverage and take advantage of special enrollment periods. Visit afscmemd.org for more on the AFSCME Local 1072 fight and bcbs.com/MedicareAdvantage for Medicare Advantage resources. Follow @BlueLabor on LinkedIn and X for updates from the BCBS National Labor Office.
Build your pipeline with Lead Heroes' call-verified, exclusive insurance leads and take advantage of the Freedom Sale before it's gone. https://leadheroes.com/ In this episode of Seven Figures Or Bust, Christian Brindle and Glen Shelton separate fact from fiction surrounding the 2027 Medicare Part D subsidy changes and the headlines claiming Part D is ending. They explain what the subsidy actually did, why misinformation has spread so quickly, and what Medicare agents and beneficiaries should really expect heading into AEP. Plus, they break down Humana's announcement that up to 600,000 Medicare Advantage members could be affected by market exits, discuss what it means for the industry, and share their predictions for the 2027 enrollment season. If you want the facts behind the headlines and practical insights for navigating the changes ahead, this episode is one you won't want to miss.
Episode 653: Medicare Advantage and original Medicare work very differently. Learn how to compare the tradeoffs before deciding which path is right for you. Then, Ryan and Steve explain how emotions, timing, and buying the latest winners can cause investors to miss out on the returns their investments actually earn.
Dr. Oz's proposed 2027 CMS rules dropped, and I've been waiting all week to get into them. The push toward value-based care and Accountable Care Organizations continues, but the headline for anyone in private practice is the multiple procedure cut: if you bill an E&M code and a procedure on the same day, Medicare now pays 100% for the more expensive service and only 50% for the other, regardless of modifiers, regardless of whether they're for two totally separate problems. That is a direct assault on independent practices, and every commercial insurer will follow Medicare's lead. There's one small win. Mandating real-time electronic prior authorization across Medicare Advantage, Medicaid, and ACA marketplace plans One head-scratcher...Medicaid work requirements of 80 hours per month starting January 2027, which I suspect will land squarely on physicians' documentation burden. Also, everyone say it with me: physician compensation is 10% of U.S. healthcare expenditure. After the break, medical malpractice for ophthalmologists. A colleague just came out of a settlement, and it got me looking at the top drivers of ophthalmology lawsuits: cataract surgery complications, missed or delayed retinal detachments, glaucoma management failures, and post-op infections. The uncomfortable truth: the only way to avoid surgical complications is to not operate, and sometimes even perfect communication and documentation don't stop a lawsuit. But they help. Takeaways: The proposed 2027 CMS rules would pay only 50% for a second same-day service when an E&M visit is billed alongside a procedure, regardless of modifier, effectively a major reimbursement cut that will hit independent private practices hardest and be adopted by commercial insurers Physician compensation accounts for just 10% of total U.S. healthcare expenditure, yet Medicare physician reimbursement is cut nearly every year while hospital and insurer reimbursement continues to rise The 2027 rules push physicians further toward Accountable Care Organizations and value-based care, favoring large health systems and insurers over independent physician-owned practices, with one bright spot: mandatory real-time electronic prior authorization across Medicare Advantage, Medicaid, and ACA plans The top ophthalmology malpractice risks are cataract surgery complications (posterior capsule tears, retained lens fragments, unfulfilled patient expectations), missed or delayed retinal detachment diagnosis, glaucoma management failures (insufficient IOP monitoring), and post-op infections Per OMIC, the three biggest drivers of ophthalmology claims are documentation deficiencies, communication gaps, and technical performance, about 60% of claims involve surgical execution errors, and diligent documentation, brutally honest informed consent, and strong physician-patient rapport are the biggest mitigators To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit http://www.EyelidCheck.com for more information. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices
"We have an untapped army of 200,000 PAs that really could step up and drive some change in the healthcare system if we weren't restricted,” says Dr. Jennifer Kolb, capturing her motivation for pushing to update practice regulations for physician associates that date back more than 50 years. As Chief Medical Officer and Senior Vice President of Clinical Affairs at the American Academy of Physician Associates, Dr. Kolb has been in the middle of the fight at the state and federal level to grant PAs more independence from physicians, full billing rights, and the increased ability to practice across state lines, among other changes. In this pertinent conversation with Raise the Line host Lindsey Smith, Dr. Kolb explains how these updates could help close huge gaps in access to healthcare, better manage the fight against chronic diseases and improve patient outcomes. Dr. Kolb also addresses: Why the name shift from "assistant" to "associate" took her years to fully appreciate; How a 10-year gap in life expectancy across Chicago zip codes shapes her view of health equity; Why PA's shouldn't wait for permission to start making change in their communities. Mentioned in this episode:American Academy of Physician Associates 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
Wednesday, July 29, 2026 Today, Senator Cornyn says he won't vote to advance Todd Blanche's nomination without a written rescission of the Slush Fund and tax immunity; Governor Beshear has written another letter to Mitch McConnell demanding he prove he's fit to serve or resign; the Knight Institute and American Oversight have filed reply briefs with the 11th Circuit in the case of Volume II of Jack Smith's final report; Rep. Max Miller has been credibly accused of assaulting his ex-wife and holding a gun to her head; the Trump administration is trying to get a hold of our personal emergency room medical records while simultaneously ending Medicare drug plan subsidies; new polling shows people don't like Trump's tax bill; Senate Democrats are pressing Todd Blanche on the New York Times subpoenas; newly uncovered grand jury testimony in the Davey Hearn case has led to his legal team demanding the grand jury materials; plus Allison delivers your Good News. 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Plus: Oil prices jump after Iran launched a surprise attack on U.S. forces. And Ford shares rallies after raising outlook. Imani Moise hosts. Sign up for WSJ's free What's News newsletter. An artificial-intelligence tool assisted in the making of this episode by creating summaries that were based on Wall Street Journal reporting and reviewed and adapted by an editor. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
In this episode, Jakob Emerson, Associate News Director, Becker's Healthcare, breaks down the latest hospital and payer earnings, examining how expiring ACA subsidies, Medicare Advantage margin recovery, and shifting reimbursement dynamics are reshaping financial performance and strategy across the healthcare industry.
The Nolan Wells investigation continues to raise difficult questions. This morning, Don takes another deep dive into the explosive distress call audio and what it may reveal about Nolan's final moments. Joined by Funky Dineva, Reecie Colbert, and Clay Cane, we'll break down the latest developments, examine what's still not adding up, and discuss where the investigation goes from here. This episode is brought to you by Byron Publishing. 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 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 brought to you by Lean. Visit https://TAKELEAN.com and enter LEMON for your 20% discount and free rush shipping 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.
Medicare Advantage enrollment continues to grow, but for many health systems, the administrative burden, prior authorization requirements, delayed care, and financial pressures are prompting leaders to reassess whether these plans continue to support their mission and patients.In this episode of Value-Based Care Insights, Daniel Marino sits down with Ivan Mitchell, CEO of Great Plains Health, to discuss why his organization made the difficult decision to terminate its Medicare Advantage contracts. Ivan shares the real-world experiences that shaped this decision, including prolonged prior authorization delays, denied rehabilitation services, increased administrative complexity, and the operational and financial challenges that ultimately affected both patients and providers.
Ep 158- Rethinking Medicare Advantage: One Health System's Decision Medicare Advantage enrollment continues to grow, but for many health systems, the administrative burden, prior authorization requirements, delayed care, and financial pressures are prompting leaders to reassess whether these plans continue to support their mission and patients. On this episode Dan sits down with Ivan Mitchell, CEO of Great Plains Health, to discuss why his organization made the difficult decision to terminate its Medicare Advantage contracts. Ivan shares the real-world experiences that shaped this decision, including prolonged prior authorization delays, denied rehabilitation services, increased administrative complexity, and the operational and financial challenges that ultimately affected both patients and providers. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen
New developments continue to emerge in the Nolan Wells investigation. Tonight, Don brings you the latest updates from the Cajun Navy as volunteers continue their efforts to uncover new evidence and help provide answers for Nolan's family. We'll break down what was found, what it could mean for the investigation, and where the search for truth goes from here. This episode is sponsored by BetterHelp. Don't let stigma stand in the way of support. Sign up and get 10% off at BetterHelp dot com slash DONLEMON. This episode is brought to you by Byron Publishing. 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. 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.
Welcome back to a special encore presentation of Turn on the Lights! As we continue our transition series, our new host, Dr. Philip, has selected one of our most impactful and widely listened-to conversations from the archives to revisit. He introduces this timely discussion with Chris Van Gorder, which explores how cost shifting, regulatory mandates, and Medicare Advantage risk transfer are pushing healthcare toward structural unaffordability. Summary: Leading a major health system today means juggling patient-first ethics with a financing model that keeps tightening the screws. In this episode, Chris Van Gorder, President and Chief Executive Officer of Scripps Health, explains why health care is becoming structurally unaffordable amid soaring premiums, uncompensated emergency care, and rising input costs. He describes how hospitals have become the default safety net as county systems disappear, while underpayment by Medicare and Medicaid forces cost shifting onto employers and commercially insured patients. Van Gorder also highlights California's seismic rebuilding mandates, which create massive capital pressure without matching reimbursement. He critiques managed care, value-based care, and Medicare Advantage for pushing risk onto providers through prior authorization and denials, recounting Scripps' difficult decision to exit several Medicare Advantage contracts after heavy losses and the downstream impact on patients. Tune in and learn how payment design, intermediaries, and regulation shape what hospitals can sustain and what patients can access. About Chris Van Gorder: Chris Van Gorder, MPA, FACHE, is the President and Chief Executive Officer of Scripps Health in San Diego, where he has led the organization since 2000 after serving as its Chief of Healthcare Operations and COO. A veteran healthcare executive with decades of experience across California hospital systems, he previously held CEO and senior leadership roles at Long Beach Memorial Medical Center, Anaheim Memorial Medical Center, and Little Company of Mary Hospital. Beyond health system leadership, he has served on multiple boards, including Prolacta Bioscience and previously Abiomed and Z-Medica, and he has been active in national and civic service as a commissioner for the U.S. National Commission for UNESCO. He also brings an uncommon public-safety background, including reserve service with the San Diego Sheriff's Department and long-running involvement with California's Emergency Medical Services Authority, earning a Distinguished Service Medal. An educator and author, he teaches at USC and wrote The Front-Line Leader (2014). Things You'll Learn: Healthcare executives are dealing with an unprecedented volume of simultaneous operational, financial, and workforce demands, raising the stakes of everyday decisions. Affordability isn't just a household problem; it's a system design problem that forces hospitals to cover the growing cost of unpaid care. Cost shifting is not a theory; it is the mechanism that pushes public underpayment onto commercial premiums. Regulatory and capital mandates can dramatically raise costs without generating new revenue, especially in California. Medicare Advantage often adds friction through narrow networks, prior authorization, and payment disputes, while shifting risk downhill. Walking away from bad contracts can stabilize a system financially, but it creates real disruption for patients and exposes policy gaps in switching coverage. Resources: Connect with and follow Chris Van Gorder on LinkedIn. Follow Scripps Health on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode, host Ross Frey, Senior Product Manager and resident MTM/CMR strategist, sits down with Cindy Henry, Director of Payer Products at Outcomes, to unpack one of the biggest changes hitting Medicare Advantage plans: CMS's intent to return the CMR completion rate to the Star Ratings program beginning in measure year 2027. Ross and Cindy explore how the industry reacted to the latest CMS Advance Notice, why the CMR measure's return matters, and how MTM strategy has quietly shifted during its two‑year placement on the display page. Together, they outline the pressures plans are feeling—from shrinking margins to rising expectations around clinical quality—and the renewed focus on the value of medication therapy management, total cost of care, and local pharmacy engagement. A key topic throughout the episode is the impact of CMS's expanded MTM eligibility criteria, which significantly increases denominators for 2025 and beyond. Cindy explains how this shift forces payers to rethink scale, budget, ROI, and operational models, while Ross shares Outcomes' cut‑point predictions and how performance is likely to redistribute once the measure becomes active again. The conversation also highlights Outcomes' strategy to support both health plans and community pharmacies as they prepare for 2027. Ross describes work underway to reduce documentation burden, streamline workflows, leverage new technology, and allow pharmacists to practice at the top of their license—ultimately helping MTM delivery scale without sacrificing quality. By the end of the episode, the message is clear: Plans that begin modeling, staffing, vendor alignment, and workflow modernization now will be best positioned when Star Ratings recalibrate in 2029. Listeners are encouraged to explore Outcomes' latest prediction models and analysis at outcomes.com
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