POPULARITY
Categories
272 episodes with Medicare Advantage
264 episodes with Medicare Advantage
144 episodes with Medicare Advantage
144 episodes with Medicare Advantage
102 episodes with Medicare Advantage
72 episodes with Medicare Advantage
62 episodes with Medicare Advantage
58 episodes with Medicare Advantage
68 episodes with Medicare Advantage
33 episodes with Medicare Advantage
22 episodes with Medicare Advantage
26 episodes with Medicare Advantage
31 episodes with Medicare Advantage
23 episodes with Medicare Advantage
34 episodes with Medicare Advantage
48 episodes with Medicare Advantage
20 episodes with Medicare Advantage
18 episodes with Medicare Advantage
23 episodes with Medicare Advantage
30 episodes with Medicare Advantage
15 episodes with Medicare Advantage
9 episodes with Medicare Advantage
15 episodes with Medicare Advantage
26 episodes with Medicare Advantage
11 episodes with Medicare Advantage
13 episodes with Medicare Advantage
12 episodes with Medicare Advantage
19 episodes with Medicare Advantage
9 episodes with Medicare Advantage
7 episodes with Medicare Advantage
12 episodes with Medicare Advantage
12 episodes with Medicare Advantage
10 episodes with Medicare Advantage
12 episodes with Medicare Advantage
11 episodes with Medicare Advantage
10 episodes with Medicare Advantage
11 episodes with Medicare Advantage
18 episodes with Medicare Advantage
9 episodes with Medicare Advantage
10 episodes with Medicare Advantage
13 episodes with Medicare Advantage
9 episodes with Medicare Advantage
6 episodes with Medicare Advantage
15 episodes with Medicare Advantage
8 episodes with Medicare Advantage
8 episodes with Medicare Advantage
5 episodes with Medicare Advantage
6 episodes with Medicare Advantage
7 episodes with Medicare Advantage
5 episodes with Medicare Advantage
6 episodes with Medicare Advantage
7 episodes with Medicare Advantage
7 episodes with Medicare Advantage
4 episodes with Medicare Advantage
For this episode of Disrupt, we caught up with Ken Albert, the President and CEO of Andwell Health Partners. During the conversation, Albert discusses how nonprofit organizations can cope with Medicare Advantage, which he says is rapidly becoming a “failed policy,” home-based care delivery innovation and the need for health care reform. Listen to this episode of Disrupt to learn: – How nonprofit home-based care providers are faring in the age of private equity – The service lines that Andwell Health Partners plans to branch into – The home-based care trends Albert has his eyes on, including technological innovation and serious illness management – And more! Subscribe to Disrupt to be notified when new episodes are released. Listen today!
Today on Raise the Line, we bring you the unlikely and inspiring story of a woman who was afraid of blood as a child but became an accomplished nurse; who struggled with learning disabilities but became an effective educator; and who, despite lacking business experience or knowledge of graphics, built a successful company that produces visually rich educational materials for nurses and other providers. “I think the theme of my life has been I have struggled with learning, and I didn't want other people to struggle,” says Jennifer Zahourek, RN, the founder and CEO of RekMed which has developed a sequential, interactive learning system that includes illustrated planners, books, and videos used by millions of students and providers. The initial focus was to provide nurses with everything they needed to know from “the basics to the bedside” but RekMed now offers content for medics, respiratory therapists, medical assistants, and veterinarians as well. Driven by her belief in the power of visual learning and her “just freakin' do it” attitude, Jennifer overcame her fear of launching a business and quickly realized just how well nursing had prepared her for the hard work and unpredictability of entrepreneurship. “Nursing teaches you how to just be resilient, to pivot, to delegate, to work on a team and to handle high stress. I think nurses could literally be some of the best entrepreneurs on the planet,” she tells host Lindsey Smith. Tune in to this lively and valuable conversation as Jennifer shares lessons from bootstrapping a publishing company, insights on the evolving landscape of healthcare education, and advice on embracing change in nursing, especially with the expanding role of AI. Mentioned in this episode:RekMed If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
What does the “long tail” of AI really look like in a highly regulated industry? In this episode, Dave Wollenberg, VP of Enterprise Data & Analytics at Scan, breaks it down. From cautious experimentation to enabling non-technical users to build AI-driven POCs, Dave shares a grounded, practical perspective on AI adoption inside a Medicare Advantage organization.You'll hear why the real transformation isn't just technical—it's cultural. We talk about how to shift employee mindsets, educate business teams, and unlock self-service analytics while staying compliant. If you're a tech or data leader trying to separate hype from real value, this one's for you.Key Takeaways:The long tail of AI means rethinking roles—not just automating tasksReal AI enablement starts with data quality, governance, and semantic clarityNon-technical employees can (and should) build AI proof-of-conceptsChange management will make or break your AI strategyIn regulated industries, open source and secure deployment models matterTimestamped Highlights:00:55 – What Scan Health Plan does and why AI matters in healthcare03:10 – From machine learning to generative AI: how use cases have evolved08:15 – Three types of business users and how to upskill them for AI12:40 – Shifting expectations: stakeholders want AI-powered insights, now15:20 – Why self-service BI still falls short without a solid data foundation18:35 – AI adoption isn't just IT's job—business users need to lead too22:15 – Navigating AI in regulated industries: risks, rules, and realitiesQuote of the Episode:“It's not as if there's a certain amount of work in the world, and if AI takes some, there's nothing left to do. When you make people more powerful, they add more value—and you want more of them, not fewer.”Pro Tips:Host internal hackathons to build excitement and break down resistanceUse sandbox environments to safely encourage experimentationDon't wait for technical users—give your business teams the tools to tryCall to Action:Like what you heard? Share this episode with someone exploring AI adoption in their org. Subscribe to The Tech Trek for more candid conversations with tech leaders on building, scaling, and leading through change.
It's a Medicaid Madness mess.For many years, Medicaid has been providing support for America's most vulnerable populations. But now, Medicaid finds itself as a pawn, being manipulated for political gain between two opposing forces: those who view the program as a means to an end to reduce government spending, and those who hold the opposite point of view.Who will be the winners and losers? During the next live edition of the venerated Monitor Mondays, senior healthcare consultant Dennis Jones will report on how hospitals can save money in the face of the inevitable Medicaid cuts.Jones, senior director of revenue cycle at Jefferson Health, was among the first of hand-picked subject-matter experts heard nearly 14 years ago on the weekly Internet broadcast produced by RACmonitor.The Monday's broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Sitting in for healthcare attorney David Glaser will be attorney Marguarite Ahman, a shareholder in the law offices of Fredrikson & Byron.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
Rounding out NIC Chats' value-based care series, Lynne Katzmann, founder and CEO of Juniper Communities, joins host Lisa McCracken for an insightful discussion on one operator's journey successfully implementing outcomes-driven care models in senior living. Juniper's experience with integrated care offers actionable lessons for other senior living providers seeking to improve outcomes, resident satisfaction, and operational efficiency.Listen to learn:The fundamentals of value-based care and its impact on resident outcomes, satisfaction, and cost management, based on firsthand operator experience.Practical advice for senior living operators considering value-based care, including essential partnerships, technology investments, and foundational best practices.How Juniper's "Connect4Life" program and operator-owned Medicare Advantage plan are transforming care transitions and reimbursement models.The importance of data, communication, and a values-driven approach in achieving success under value-based care arrangements.The benefits of being part of an operator-owned Medicare Advantage plan.Whether you're a senior living operator, provider, or industry enthusiast, this episode offers actionable insights and inspiration for navigating the evolving landscape of senior care.Want to join the conversation? Follow NIC on LinkedIn.We want to hear from you! Let us know what you think of NIC Chats by giving us a review on Apple Podcasts, Spotify, or wherever you listen.
The One Big Beautiful Bill Act could upend healthcare for millions. In this must-hear conversation, Jae Oh, CFP® and Medicare expert, unpacks how Medicaid work rules, Medicare Advantage cost shifts, and ACA premium spikes could impact retirees, workers, and families.In This Video00:00:00 Medicaid Ejections Are Happening Now00:01:15 Should Retirees Worry About Medicare Changes?00:03:00 New Medicaid Work Requirements Explained00:04:30 Why Everyone on Medicaid Must Verify Monthly00:05:45 Medicare Savings Program Disruption Risks00:07:10 Could Part B Costs Rise? The Budget Battle Impact00:08:45 ACA Marketplace Chaos and Premium Uncertainty00:11:00 Enhanced APTC Ending? What It Means for You00:13:00 Employer Open Enrollment: Don't Just “Check the Box”00:20:00 COBRA vs ACA After Layoffs: Planning Under Pressure
In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down key developments in the payer world including a deepening DOJ investigation into UnitedHealth Group's Medicare Advantage billing and the far-reaching implications of the newly passed One Big Beautiful Bill.
“Very often, doctors try to suppress what they feel or don't even have the vocabulary to describe their emotions,” says Professor Alicja Galazka of the University of Silesia, an observation based on decades of work with physicians to enhance their emotional intelligence and resilience. Galazka, a psychotherapist, psychologist, lecturer and coach, believes this deficit is rooted in part in a lack of instruction in the internal and external psychological dimensions of being a medical provider. “There is not enough space created in medical school for teaching and training students about how to deal with their own stress and all of the skills connected to building relationships with patients,” she tells host Michael Carrese. Those same skills are also critical to working effectively as a member of a care team, which is an increasingly common arrangement in hospitals and clinics. Galazka employs simulations, dramatic role-playing, mindfulness, Acceptance and Commitment Therapy and other methods in her work with an eye on increasing the emotional agility and sensitivity of her trainees and clients. Tune in to this thoughtful episode of Raise the Line to hear Galazka's ideas on how to reshape medical training, why she is a proponent of narrative medicine, and the merits of embedding psychologists on care teams as a resource for both patients and providers. Mentioned in this episode:University of SilesiaInternational Association of Coaching Institutes If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
Agent Boost Podcast: Major Announcement! Agent Boost Marketing Joins AmeriLifeWelcome to a special edition of the Agent Boost Podcast!
For this week's episode I'm bringing you something a little different, but of such importance that I had to share it with my Off the Record audience: The massive audit expansion of Medicare Advantage announced by CMS. In case you missed it, CMS in May rocked the mid-revenue cycle industry with the unveiling of a startling mandate. It will hire 2000 medical coders, beef up its audit technology, and expand its current limited auditing scope from 60 Medicare Advantage Plans to some 550 plans nationwide in an attempt to check widespread allegations of HCC upcoding. My colleague Jason Jobes has been closely following the news and presented this topic in June—the most attended webinar Norwood has ever hosted. This is a replay of that very well-received show. It covers: The evolving risk adjustment landscape and the rise of Medicare Advantage CMS broad and bold audit scope and strategy Best practice techniques to survive in risk adjustment and avoid potential risks Jason refers to several slides during the presentation, which you don't necessarily need, but if you'd like to follow along or see the exact references and data we've posted them to the Norwood website with a link in the show notes. Enjoy the show! Show notes and resources View the webinar slides here (free; requires registration) Read the full CMS audit announcement.
We've got the breakdown of all the Medicare and Medicare Advantage enrollment periods that beginner agents need to know. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Resources: 10 Essential Tools for Beginner Insurance Agents: https://ritterim.com/blog/10-essential-tools-for-beginner-insurance-agents/ Apps for Comparing Healthcare & Prescriptions: https://lnk.to/ASGA85 Medicare Advantage Open Enrollment Do's and Don'ts: https://ritterim.com/blog/medicare-advantage-open-enrollment-dos-and-donts/ Self-Guided Training with Knight School: https://ritterim.com/knight-school/ The Difference Between Medicare & Medicaid: https://lnk.to/ASGAE01 What is AHIP Certification and How Do I Get It? https://lnk.to/asg672 References: Franchina, Chris. “AEP vs. OEP: Understanding the Differences for Medicare.” Policy Engineer, 11 Jan. 2025, https://policyengineer.com/aep-vs-oep-understanding-the-differences-for-medicare/. “Get Ready to Buy.” Medicare.Gov, https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy. Accessed 17 June 2025. “Joining a Plan.” Medicare, “Joining a Plan.” Medicare, www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan. Accessed 10 June 2025. Worstell, Christian. “Medicare AEP vs. OEP: Know Your Enrollment Periods.” Medicare AEP vs. OEP | How to Enroll or Change Your Medicare Plan | MedicareAdvantage.Com, MedicareAdvantage.com, 18 Mar. 2025, https://www.medicareadvantage.com/enrollment/medicare-aep-vs-oep. “Medicare Open Enrollment.” CMS.Gov, https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources. Accessed 10 June 2025. “Medicare Open Enrollment Fact Sheet 2025.” CMS.Gov, Centers for Medicare & Medicaid Services, https://www.cms.gov/files/document/2024-medicare-open-enrollment-fact-sheet.pdf. Accessed 10 June 2025. “Special Enrollment Periods.” Medicare, Medicare.gov, https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods. Accessed 10 June 2025. “What Is the Medicare Annual Enrollment Period? | News & Articles | UnitedHealthcare.” UHC.Com, UnitedHealthcare, https://www.uhc.com/news-articles/medicare-articles/what-is-the-medicare-annual-enrollment-period. Accessed 10 June 2025. “What If I Missed My Initial Enrollment Period? | News & Articles | UnitedHealthcare.” UHC.Com, UnitedHealthcare, https://www.uhc.com/news-articles/medicare-articles/what-if-i-missed-my-initial-enrollment-period. Accessed 10 June 2025. “What Is the Medicare General Enrollment Period?” NOCA.Org, National Counsel of Aging, https://www.ncoa.org/article/a-closer-look-at-the-medicare-general-enrollment-period/. Accessed 10 June 2025. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency.
In our "Medicare Advantage Minute" we learn about Humana's "cautious defense" of Medicare advantage plans. In a refreshing change of pace, Humana seems to be willing to admit that MA plans have room for improvement. In a related conversation we touched on the ongoing legal action of the 250,000 retirees from New York City who have been engaged in a llawsuit against the city since 2021. They do not want the crappy Medicare Advantage retiree plan that the city says will save $600 million per year. On a lighter note, we spend the "Your Medicare Benefits 2025" segment learning all about how Medicare would cover medical nutrition therapy services. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
Send us a textIn this episode of Healthcare Trailblazers, host speaks with Dr. Boris Vabson, head of Medicare Advantage policy at CMMI (Center for Medicare & Medicaid Innovation). Dr. Vabson shares his fascinating journey from being born in the Soviet Union to becoming a Harvard health economist focused on dysfunctional healthcare systems. The conversation explores Medicare Advantage's evolution since 1965, current challenges including cost inefficiencies and prior authorization burdens, and CMMI's ambitious plans to transform the program. Dr. Vabson discusses the ongoing debate about Medicare Advantage overpayments, risk adjustment auditing using AI technology, and how CMMI plans to leverage its statutory flexibility to test innovative reforms that could be scaled nationwide. With recent leadership changes under Dr. Mehmet Oz at CMS, this timely discussion provides crucial insights into the future direction of Medicare Advantage policy affecting over 30 million Americans.Timestamps: 00:00:00 - Introduction and Dr. Vabson's Background 00:05:35 - Healthcare System Problems and Technology Solutions 00:09:42 - Medicare Advantage Overview and Current Challenges 00:18:25 - Policy Debates and Reform Efforts 00:32:44 - CMMI's Future Plans for Medicare Advantage Transformation
The Transparency in Coverage (TiC) Final Rule represents one of the most significant regulatory shifts in healthcare pricing since the implementation of the Patient Protection and Affordable Care Act.During the next live edition of Monitor Mondays, senior healthcare analyst Frank Cohen will walk you and your team through the comprehensive labyrinth of changes.Recent enforcement developments, including President Trump's Executive Order 14221, directing actual hospital price disclosure within 90 days, also signal an intensified regulatory environment requiring proactive compliance strategies.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Moesha Baptiste, intern regulatory analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
Looking back and looking ahead, we must reckon with a major shift in America's judicial landscape: the elimination of the so-called Chevron Deference. Last year, at about this same time, physician and attorney Dr. John K. Hall was the special guest here on Monitor Mondays, and he began his segment explaining the legal concept.Now, more than a year after the U.S. Supreme Court's landmark decision overturning 40 years of judicial precedent and upending statutory construction and enforcement, we must ask, has anything really changed?Dr. Hall will return to examine the changes – or maybe lack of changes – and what we might still expect regarding legal challenges to executive actions.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior regulatory affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
Medicare may feel overwhelming, but this fast-paced episode breaks down what you really need to know in just 10 minutes. In this episode, Nick and Jake walk you through the basics: when you're eligible, how enrollment works, and what each part (A, B, C, D) actually covers. They also explain the difference between Medicare Advantage and Original Medicare with supplements, how your income can impact premiums, and why certain medical expenses like long-term care and alternative treatments might not be covered. Get tips on how Medicare fits into your broader retirement plan and the importance of working with an independent Medicare agent. Here's what we discuss in this episode:
In episode 207, Coffey talks with Nicole Morgan about what HR professionals need to know about Medicare to help employees navigate the transition from employer-provided health insurance to Medicare coverage. They discuss the four main parts of Medicare (A, B, C, and D) and how they work together; the differences between Medicare Advantage plans (Part C) and traditional Medicare with supplemental coverage; how creditable coverage determinations affect employees who continue working past age 65; the coordination of benefits between employer group health plans and Medicare based on company size; timing considerations for Medicare enrollment and the importance of planning three months before turning 65; why brokers may have financial incentives to sell Medicare Advantage plans over traditional Medicare; the risks and benefits of different Medicare options including network limitations and out-of-pocket maximums; and the role HR should play in connecting employees with qualified Medicare experts rather than providing specific coverage advice. Good Morning, HR is brought to you by Imperative—Bulletproof Background Checks. For more information about our commitment to quality and excellent customer service, visit us at https://imperativeinfo.com. If you are an HRCI or SHRM-certified professional, this episode of Good Morning, HR has been pre-approved for half a recertification credit. To obtain the recertification information for this episode, visit https://goodmorninghr.com. About our Guest: Nicole A. Morgan is a seasoned healthcare professional with over two decades of experience, seamlessly blending her clinical expertise as a Registered Occupational Therapist with her proficiency as a Licensed Independent Insurance Agent. As the founder of Morgan Medicare Solutions, LLC, based in Sherman, Texas, Nicole is dedicated to guiding individuals through the complexities of Medicare, ensuring they make informed decisions tailored to their unique needs. Her extensive background encompasses various healthcare settings, including inpatient and outpatient rehabilitation, acute care, skilled nursing, home health, and community-based services. This diverse experience has equipped her with a deep understanding of the challenges seniors face, particularly in navigating the transition to Medicare. Nicole holds multiple certifications, such as Certified Senior Advisor (CSA), Certified Long-Term Care (CLTC®), and Certified Living in Place Professional (CLIPP), underscoring her commitment to senior care and wellness. Beyond her professional endeavors, Nicole is deeply rooted in her community. A native of Sherman, she has been married to her husband, Brad, for nearly 30 years and is a proud mother of three young adults. Her passion for service extends to active involvement in her church and local initiatives, reflecting her dedication to making a positive impact both personally and professionally. At Morgan Medicare Solutions, Nicole offers personalized consultations, educational workshops, and ongoing support, ensuring clients feel confident and secure in their Medicare choices. Her holistic approach, grounded in compassion and expertise, has made her a trusted advisor for many navigating the intricacies of healthcare in their retirement years. Nicole Morgan can be reached athttps://www.morganmedicaresolutions.comhttps://www.linkedin.com/in/nicole-a-morganotr/https://www.facebook.com/morganmedicare/ About Mike Coffey: Mike Coffey is an entrepreneur, licensed private investigator, business strategist, HR consultant, and registered yoga teacher.In 1999, he founded Imperative, a background investigations and due diligence firm helping risk-averse clients make well-informed decisions about the people they involve in their business.Imperative delivers in-depth employment background investigations, know-your-customer and anti-money laundering compliance, and due diligence investigations to more than 300 risk-averse corporate clients across the US, and, through its PFC Caregiver & Household Screening brand, many more private estates, family offices, and personal service agencies.Imperative has been named a Best Places to Work, the Texas Association of Business' small business of the year, and is accredited by the Professional Background Screening Association. Mike shares his insight from 25+ years of HR-entrepreneurship on the Good Morning, HR podcast, where each week he talks to business leaders about bringing people together to create value for customers, shareholders, and community.Mike has been recognized as an Entrepreneur of Excellence by FW, Inc. and has twice been recognized as the North Texas HR Professional of the Year. Mike serves as a board member of a number of organizations, including the Texas State Council, where he serves Texas' 31 SHRM chapters as State Director-Elect; Workforce Solutions for Tarrant County; the Texas Association of Business; and the Fort Worth Chamber of Commerce, where he is chair of the Talent Committee.Mike is a certified Senior Professional in Human Resources (SPHR) through the HR Certification Institute and a SHRM Senior Certified Professional (SHRM-SCP). He is also a Yoga Alliance registered yoga teacher (RYT-200) and teaches multiple times each week. Mike and his very patient wife of 28 years are empty nesters in Fort Worth. Learning Objectives: 1. Understand the basic structure of Medicare parts A, B, C, and D to provide foundational guidance when employees ask about Medicare options and transitions.2. Recognize when employer group health plans have creditable coverage for prescription drugs and ensure proper notification letters are sent to Medicare-eligible employees by October 15th annually.3. Establish relationships with trusted Medicare brokers and implement processes to proactively reach out to employees approaching age 65 to ensure proper planning and coordination of benefits.
Health plans continue to face operational delays due to fragmented systems and an over-reliance on manual reporting cycles. While data analysts work across multiple platforms to produce static reports, the insights often arrive too late to support real-time decisions. This episode explores why traditional models are no longer sustainable and how self-service dashboards, powered by a connected data ecosystem, are transforming operational agility. Listeners will hear how prebuilt metrics provide immediate visibility across functions such as claims, call center performance, and ID card fulfillment, enabling teams to respond faster, stay compliant, and enhance member outcomes. The discussion also covers adoption strategies, ROI considerations, and the organizational shift toward on-demand, decision-ready data.Listen now to discover how leading health plans are moving from reactive operations to real-time insight, without relying on analysts.About Our Guest: Michael Waxman is a health plan operations leader with over 20 years of experience as a health payer consultant at PwC and EY. He recently served as the Director of Business Operations for the post-implementation operations of HealthProof's technology ecosystem for a Medicare Advantage client. Using HealthProof's self-service dashboard, he ensured operational alignment for the health plan's provider data, claims, credentialing, cross-functional alignment for call center, disputes, utilization management, and more. Today, Waxman is a member of the Advisory Services team at HealthProof.
Navigating the Future of ACA & Medicare: Key Insights from Industry Experts.Discover crucial updates on ACA, Medicare, and Medicaid insurance landscapes with our hosts as they cover the latest from Humana's Broker Advisory Council, Agent Boost's elite training events, and exclusive insights from a major CMS event in Washington, DC. Key discussions include the future of AHIP, the impact of the $5 SEP rule, the push for integrity in healthcare enrollment, and AI's role in the industry. Stay informed about the imminent changes in Medicaid, broker guidelines, and the proposed healthcare bill. Ideal for brokers and agents looking to stay ahead in the ever-evolving insurance market.Need to take your AHIP certification to sell Medicare Advantage plans? Use our official Agent Boost link to get started today. It's accepted by all major carriers and includes the $50 discount—bringing your cost down to just $125.
In this episode of Quality Talks With Peggy O'Kane, NCQA President Peggy O'Kane has an energizing, constructive conversation with Dr. Will Shrank, a Venture Partner at Andreessen Horowitz.Will shares his vision for a more cohesive health care system that works based on aligned incentives, meaningful measurement of patient outcomes and savvy implementation of value-based care.Peggy and Will discuss:The ‘Systemness' Solution: Will emphasizes that while American health care has the right components—technology, talent and intent—it lacks the integration to make them work together. Systemness means aligning care delivery, data and incentives to function as a cohesive whole.Measurement Makeover: Current quality metrics often miss what matters most to patients and providers. Will calls for fewer measures that are focused on outcomes, not just process checks. Digital measurement can help, but fragmented data remains a challenge.Reimagined Reimbursement Prioritizes Primary Care: Will envisions a future where primary care providers take on meaningful financial risk for the cost and quality of care. This approach could help simplify incentives, foster collaboration with specialists and drive better outcomes.From Waste to Wellness: Health care wastes billions of dollars on administrative complexity. Meanwhile, prevention—arguably the most cost-effective strategy—struggles to gain traction due to delayed ROI. Will argues that aligning incentives around long-term health is essential to reducing waste and improving outcomes.Will concludes by assessing Medicare Advantage as a model of high-value care. Listen to the whole conversation for a warm, witty tour of quality's accomplishments and prospects.Key Quote:We just have to make this simpler. We've got to make it easy for doctors to do the right thing and to create the right relationships and to set the right paths.I think most people would agree a model where primary care docs have some meaningful accountability for the populations they serve would be better than what we have today.And if we as a system decided that's the direction we're going to go and make that the North Star, I think we in a much shorter time could get efficient, higher quality, and deliver better outcomes at lower cost, and deliver more equitable care for all Americans.”Will Shrank, MD Time Stamps:(01:06) A Systematic Approach to a Better Future(04:12) Challenges in Quality Measurement(09:24) Payment Models and Primary Care (13:55) Addressing Waste (24:49) Medicare Advantage and Value-Based Care(28:43) Peggy's Final Thoughts Links:Studies by Will Shrank (Google Scholar)Connect with Will
In the Medicare Advantage Minute we learn how MA plans use prior authorization requirements to help balance the books. This at the expense of patients who are in need of medical treatment for the best opportunity to regain health! Nebraska is taking the lead in the war to make MA plans better for their members. In the Your Medicare Benefits segment we learn how Medicare is likely to cover lymphedema compression treatment items. Do you like to get stabbed? We cover a list of vaccinations recommended for adults. Finally, an advisor known only as "Rusty" takes a question from a couple who are shocked to have been caught by the "Success Penalty" known as IRMAA. IRMAA casts a wide net but there is an appeal process that has shown success in the past. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
On this episode of The Ty Brady Way, Ty is joined by Neil Reich, a veteran insurance professional with over 27 years of experience. Neil recounts his career journey, beginning at a small P&C agency and advancing to a leadership role at Humana, where he was instrumental in launching the national broker channel and collaborating with major FMOs in the Medicare Advantage sector. After years in corporate leadership, Neil transitioned to entrepreneurship by founding his own agency, CareConnect, where he applied his expertise to scale operations and build a thriving business. Neil discusses the unique challenges of starting CareConnect, including adapting to the shift from field to virtual sales and responding to evolving consumer behaviors. He notes that phone enrollments are becoming increasingly common and highlights the importance of meeting clients where they are. Despite industry headwinds, his agency generated nearly $6 million in its first year. He also shares insights into managing client communication, setting clear expectations, and maintaining trust through prompt, supportive service. Looking ahead, Neil outlines strategies to keep his virtual sales team productive, especially in a market impacted by changes to SEP rules and lead quality. He emphasizes the importance of cross-selling products like final expense and cancer policies to boost retention and value. As the healthcare landscape evolves, Neil and Ty stress the need for agents to become trusted advisors rather than just salespeople. Their conversation underscores the enduring value of education, strong client relationships, and diversification in building a resilient, modern agency As always, we would like to hear from you! Email us at thetybradyway@gmail.com Or DM us on Instagram @thetybradyway https://www.instagram.com/thetybradyway/
Some Medicare Advantage plans stop cold when you cross state lines. Original Medicare travels, but uncovered costs can pile up fast. Healthline breaks it down with the help of CMS.gov, and Medicare.org, a trusted resource for dual-state retirees. David Bynon City: Prescott Address: 101 W Goodwin St # 2487 Website: https://davidbynon.com
Enhancing Payment Integrity in Health Systems: An In-depth Discussion with Kimberly Carleson. In Episode 481 of Relentless Health Value, host Stacey Richter speaks with Kimberly Carleson, CEO of US Beacon, about payment integrity within health systems. They delve into strategies some hospitals use to maximize revenue without raising rates and discuss the importance of accurate billing. Key takeaways include the high prevalence of billing errors, which can lead to significant overcharges for plan sponsors, often due to documentation gaps and complex coding systems. Kimberly provides actionable advice for both healthcare providers and plan sponsors on how to mitigate billing inaccuracies and enhance transparency. Emphasized points include the necessity of third-party claim audits, understanding legal rights under various acts, and the importance of maintaining clear communication and compliance with legal billing standards. === LINKS ===
"Older adults have this special clarity about who they are and what they want, which is incredibly inspiring," says Dr. Julia Hiner, explaining, in part, why she loves her work as a geriatrician in Houston, Texas. She also enjoys the challenge of the medical complexity these patients present and the opportunity it creates to see the patient as a whole person. In fact, as you'll hear in this upbeat conversation with Raise the Line host Lindsey Smith, there's almost nothing about geriatrics that Dr. Hiner does not enjoy, which explains her passion for teaching the subject at McGovern Medical School at the University of Texas Health Science Center in Houston and trying to convince more students to pursue it as their specialty. The need is great, given that there are only 8,000 geriatricians in the US despite a rapidly growing senior population. Tune in to learn why Dr. Hiner thinks clinicians avoid the field and the steps that can be taken to improve the situation, including requiring courses in geriatrics. You'll also learn about the importance of capacity assessments, the troubling, and under-reported, problem of elder mistreatment, ageism among health professionals and much more in this super informative episode. Mentioned in this episode:University of Texas Health Science Center at Houston McGovern Medical School If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/raisethelinepodcast
Howie and Harlan are joined by Stephen Waxman, a leading neurology researcher, to discuss the promise of new methods developed by his lab to treat the ravages of pain. Harlan talks about the importance of ratings for Medicare Advantage plans; Howie assesses two sobering new reports on the solvency of Medicare. Links: Harlan's Section Slides from Humana's Investor Day "Humana's cautious defense of Medicare Advantage" "What Are the Medicare Star Ratings?" "Early analysis: How health plans fared in the 2025 Medicare Advantage star ratings" Interview with Dr. Waxman "F.D.A. Approves Drug to Treat Pain Without Opioid Effects" "A brief historical perspective: Hodgkin and Huxley" "A quantitative description of membrane current and its application to conduction and excitation in nerve" Nobel Prize: “Speed read: Signal to charge" "Sodium channels and pain" "Targeting a Peripheral Sodium Channel to Treat Pain" Girl with the Dragon Tattoo: "Ronald Niedermann" "Peripheral Sodium Channel Blocker Could Revolutionize Treatment for Nerve Pain" "Interplay of Nav1.8 and Nav1.7 channels drives neuronal hyperexcitability in neuropathic pain" "Pharmacotherapy for Pain in a Family With Inherited Erythromelalgia Guided by Genomic Analysis and Functional Profiling" "Neuropathic Pain" "A historical perspective on the discovery of statins" "Erythromelalgia" "The Two Sides of NaV1.7: Painful and Painless Channelopathies" "Dr. Stephen Waxman awarded Sharpey-Schafer Prize for pain research" Nobel Prize: "Robert Edwards" "Gain-of-function mutation in Nav1.7 in familial erythromelalgia induces bursting of sensory neurons" "Scientists Identify Method to Study Resilience to Pain" "Chasing the genes behind pain" "Stephen Waxman: pioneer in axons, their disorders, and pain" "I Feel Like I'm Burning Alive. It's Hard for People to Believe Me" "‘How badly does it hurt?' Challenges of measuring pain in clinical trials" Howie's Section "2025 Medicare Trustees Report" "Analysis of the 2025 Medicare Trustees' Report" "Medicare gets a big (unofficial) surprise: a 17-year extension on when it'll run dry" "Evan Sussman: Expanding Access to Fertility Drugs" "Trump gives major lift to 2026 Medicare Advantage payments" "June 2025 Report to the Congress: Medicare and the Health Care Delivery System" "Medicare Advantage's supplemental benefits will cost taxpayers $86 billion this year, with little transparency" "How UnitedHealth turned a questionable artery-screening program into a gold mine" "From boom to bitcoin: A device maker's surprising pivot amid a Medicare crackdown" Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.
This just in: CMS 2026 maximum broker commissions for Medicare Advantage and Medicare Part D. Listen to learn more about commission structure and the caps writing MA and PDP business in your market for the upcoming 2026 plan year. Read the text version Resources: AHIP 2026 Certification Dates: https://lnk.to/asgf20250516 Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. FAQs About NABIP Medicare Certification: https://ritterim.com/blog/faqs-about-nabip-medicare-certification/ How to Avoid Using Elderspeak: https://lnk.to/asgf20250530 Reach out to the team at Ritter Insurance Marketing: https://ritterim.com/meet-your-sales-team/ Reassuring Your Clients During Difficult Times: https://lnk.to/asg671 What is AHIP Certification and How Do I Get It? https://lnk.to/asg672 References: “2026 Medicare Advantage and Part D Rate Announcement.” CMS.Gov, CMS, 7 Apr. 2025, www.cms.gov/newsroom/fact-sheets/2026-medicare-advantage-and-part-d-rate-announcement. Agent Broker Compensation and Training and Testing Requirements CY2026: https://ritterim.com/documents/cms-memos/memo-agent-broker-compensation-and-training-and-testing-requirements-cy2026.pdf Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency.
On this Ropes & Gray podcast, health care partner Michael Lampert and counsel Sam Perrone are joined by litigation & enforcement partner Andrew O'Connor for a two-part discussion, with this first episode focused on recent enforcement activity and broker arrangements in the Medicare Advantage (“MA”) space. They delve into the Oak Street settlement, the Office of Inspector General's (“OIG”) Special Fraud Alert, and a recent Department of Justice (“DOJ”) False Claims Act (“FCA”) suit against major Medicare Advantage plans and brokers. The conversation covers the complex regulatory framework governing broker arrangements, the implications of recent enforcement actions, and practical takeaways for providers. Listen in for an insightful analysis of these critical issues affecting the health care industry, and stay tuned for part two, where the focus will shift to enforcement in the patient assistance program space.
As you approach age 65, one of the most important—and often confusing—financial decisions you face is how to structure your Medicare coverage. Understanding the differences between Original Medicare and Medicare Advantage plans is essential for making an informed decision that aligns with your healthcare needs, financial situation, and lifestyle.
Join Sarah and Tina as they review frequently asked questions about NABIP Medicare Certification. Don't miss out on resources to help you get ready-to-sell! Read the text version NABIP Official Website: https://www.nabiptraining.org/ Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Resources: 4 Ways PlanEnroll Will Make This Your Best AEP Yet: https://lnk.to/cdV0H1 Making Your Own Luck ft. Michael Krantz: https://lnk.to/krantz2025 Survive AEP with Ritter Insurance Marketing: https://ritterim.com/aep/ The Survivor's AEP Checklist: https://ritterim.com/blog/the-survivors-aep-checklist/ What is AHIP Certification and How Do I Get It? https://lnk.to/asg672 References: “Approved Carriers for 2025.” NABIP.Org, https://www.nabiptraining.org/nabip/carriers. Accessed 5 June 2025. “Corporate Partnership.” NABIP, https://nabip.org/membership/corporate-partnership. Accessed 5 June 2025. “Course Credit Details.” NABIP.Org, https://www.nabiptraining.org/site/courseDetails/1777. Accessed 5 June 2025. “Medicare + Fraud, Waste, and Abuse (MFWA) Online Course.” Ahipmedicaretraining.Com, https://www.ahipmedicaretraining.com/. Accessed 5 June 2025. “Medicare, Medicare Advantage, and Compliance Requirements User Guide” NABIP.Org, https://nabip.org/media/8564/nabip-ma-user-guide.pdf . Accessed 5 June 2025. “State Rules for Insurance Continuing Education.” NABIP.Org, https://www.nabiptraining.org/site/staterules. Accessed 5 June 2025. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency.
Medicare Advantage Minute was the source of an interesting and welcome news report of the likely agenda items to be pushed by Dr, Oz. As the new Administrator of the CMS he has some ambitious goals, including intensive auditing and collection efforts aimed at each Medicare Advantage plan. In the "Your Medicare Benefits 2025" segment we learned how Medicare might cover Long Term Care expenses. Finally, in the largest Medicaid fraud scheme known to mankind, crooks used the identities of dead patients in order to bilk billions from government coffers. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.
This episode recorded live at the Becker's Hospital Review 15th Annual Meeting features Tiffany Miller, Chief Executive Officer, Yoakum Community Hospital. Tiffany shares how her team is cultivating a vibrant organizational culture through leadership development while navigating challenges like Medicare Advantage reimbursement and preparing a compassionate, resilient workforce for the future.
In this episode of the Heartland Daily Podcast, AnneMarie Schieber and economist Devon Herrick break down the latest health care debates in Washington. They discuss how promised reforms like Medicaid work requirements and health savings account expansions are being stripped from President Trump's health care package, and what that means for patients and taxpayers. The conversation covers efforts to close costly Medicare Advantage loopholes, the push for site-neutral payments, and Minnesota's controversial plan to incentivize Medicaid-funded home births. They also examine Robert F. Kennedy Jr.'s overhaul of the federal vaccine advisory committee and the growing concern about political bias in mental health counseling. Finally, Devon explains why age — more than lifestyle choices — is the biggest risk factor for cancer.Get a clear, free-market perspective on these vital health care issues. Visit Health Care News and the Goodman Institute Health Blog for more insights. In The Tank broadcasts LIVE every Thursday at 12pm CT on on The Heartland Institute YouTube channel. Tune in to have your comments addressed live by the In The Tank Crew. Be sure to subscribe and never miss an episode. See you there!Climate Change Roundtable is LIVE every Friday at 12pm CT on The Heartland Institute YouTube channel. Have a topic you want addressed? Join the live show and leave a comment for our panelists and we'll cover it during the live show!
In this episode, we dive into the growing trend of non-commissionable Medicare Advantage plans and what it means for agents and the industry. Josh Slattery, Executive VP of The Brokerage Inc. and a seasoned expert in the Medicare space, explains that carriers are labeling certain plans as non-commissionable primarily to curb financial losses, often driven by low profitability, plan redundancy, or rising costs. A major talking point is UnitedHealthcare's decision to make 15% of its PPO portfolio non-commissionable, impacting over 100 plans nationwide. The episode also explores the financial strain caused by the V28 risk adjustment model, the Inflation Reduction Act (IRA), and unfavorable post-COVID utilization trends. Despite these headwinds, agents are encouraged to: Stay informed on carrier changes Leverage technology to improve efficiency Prioritize client retention to build long-term value Consider cross-selling ancillary products to offset lost commissions The episode emphasizes that field agents remain critical in navigating local markets and client relationships, even amid shifting compensation structures. 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/
Learn more about the NABIP Medicare Advantage Certification (MMACR), an alternative program for agents looking to satisfy their Medicare & Fraud, Waste, and Abuse training requirements from CMS. Read the text version Resources: 4 Ancillary Cross-Sales to Show Clients You Care: https://lnk.to/asg670 AHIP 2026 Certification Dates: https://lnk.to/asgf20250516 Reassuring Your Clients During Difficult Times: https://lnk.to/asg671 Takeaways on Social Media Marketing in 2025: https://lnk.to/asgf20250523 What Is AHIP Certification and How Do I Get It? https://lnk.to/asg672 References: “NABIP Approved Carriers .” NABIP.Org, NABIP, https://www.nabiptraining.org/nabip/carriers. Accessed 2 June 2025. “NABIP Medicare Advantage Certification.” NABIP.Org, NABIP, https://www.nabiptraining.org/nabip/medicare. Accessed 2 June 2025. “NABIP Official Site.” Nabip.Org, NABIP, nabip.org/. Accessed 2 June 2025. “NABIP Professional Development.” Nabip.Org, NABIP, nabip.org/professional-development. Accessed 2 June 2025. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.
Unlocking Medicare & ACA Success: Dalton Miller's Retireflo Revolution!Welcome to another episode of our podcast with your host and special guest, Dalton Miller, president, and founder of Retireflo . In this episode, Dalton shares his journey from being a Medicare agent to creating a revolutionary tool designed to streamline agent-client interactions in the Medicare and ACA markets. Tune in to learn how Retireflo can help agents collect crucial client information, improve efficiency, and enhance customer satisfaction. Whether you're curious about the origins of Dalton's business, the impact of recent healthcare changes, or practical strategies for the upcoming AEP, this episode has it all.
A comprehensive discussion on Medicare, led by Steve Gurney from Positive Aging Community, with insights from panelists Michelle Thomas and Don Oellerich, Ph.D. The session covers essential information for retirees about Medicare, including eligibility, enrollment periods, costs, and the interaction between Medicare and job-based or retiree coverage. The panelists explain the four parts of Medicare: Part A (hospital insurance), Part B (medical insurance), Part D (prescription drug plans), and Part C (Medicare Advantage plans). They highlight the importance of understanding Medicare's coverage limitations, such as the lack of long-term care and routine dental or vision care, and discuss options like Medigap policies to supplement coverage. The session also addresses enrollment strategies, penalties for late enrollment, and the nuances of Medicare Advantage plans. The panelists encourage attendees to utilize resources like the Medicare Plan Finder and local State Health Insurance Assistance Programs (SHIP) for personalized counseling. The discussion concludes with a Q&A session, addressing specific concerns about federal retiree benefits, TRICARE, and in-home care services under Medicare.Don Oellerich, Ph.D. Medicare Counselor, Arlington County's State Health Insurance Assistance Program Michelle Thomas, MPA Program Coordinator, Arlington Virginia Insurance Counseling and Assistance ProgramSlidedeck External-Transportation-FAQ.pdfFlyer Arlington VICAP Medicare FEHB Fact Sheet - June 2025.pdfView recording at https://www.retirementlivingsourcebook.com/videos/what-we-should-all-know-about-medicare
In this episode of the Heartland Daily Podcast, AnneMarie Schieber and economist Devon Herrick break down the latest health care debates in Washington. They discuss how promised reforms like Medicaid work requirements and health savings account expansions are being stripped from President Trump's health care package, and what that means for patients and taxpayers. The conversation covers efforts to close costly Medicare Advantage loopholes, the push for site-neutral payments, and Minnesota's controversial plan to incentivize Medicaid-funded home births. They also examine Robert F. Kennedy Jr.'s overhaul of the federal vaccine advisory committee and the growing concern about political bias in mental health counseling. Finally, Devon explains why age — more than lifestyle choices — is the biggest risk factor for cancer.Get a clear, free-market perspective on these vital health care issues. Visit Health Care News and the Goodman Institute Health Blog for more insights.
Keep track of your AEP prep to-do checklist with help from Ritter's certification center and Ritter Blog weekly roundups. Listen to find out how to access carrier AHIP, NABIP, MA and PDP certification, product training details, and more! Read the text version Resources: eBooks & Guides for Insurance Agents: https://ritterim.com/guides/ FAQs About NABIP Medicare Certification: https://ritterim.com/blog/faqs-about-nabip-medicare-certification/ Ritter Insurance Marketing Certification Center: https://docs.ritterim.com/products/certification/ What Is AHIP Certification and How Do I Get It? https://lnk.to/asg672 References: “Medicare Advantage Certification.” NABIP.Org, NABIP, www.nabiptraining.org/nabip/medicare. Accessed 30 May 2025. “Medicare + Fraud, Waste, and Abuse Training.” Ahip.Org, AHIP, www.ahip.org/courses/medicare-fraud-waste-and-abuse-training. Accessed 30 May 2025. “Miramar:Agent.” Miramar-Agent.Com, Miramar, miramar-agent.com/KnowledgeBase/Article?kb=5. Accessed 30 May 2025. “Medicare Certification System.” Pinpointglobal.Com, Pinpoint Global, www.pinpointglobal.com/medicare-certification-system. Accessed 30 May 2025. Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/ Not affiliated with or endorsed by Medicare or any government agency. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.
Call it a trifecta, triumvirate, or the Triple Crown of 2025.“Fraud, waste, and abuse” is the current triple-negative buzzword in America's lexicon. And it's being used to describe lots of things. But when that phrase is used by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), what does it actually mean?You'll learn during the next live edition of Monitor Mondays.That's when senior healthcare consultant Dr. Drew Updike – the broadcast's special guest – will report on how the Acting HHS Inspector General (IG) Juliet Hodgkins used that phrase when she recently posted an online promotion in support of the OIG Spring Semiannual report to Congress.The venerable broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.
In the "Medicare Advantage Minute" we learn about an enterprising gentleman who built a Medicare empire. He provided services for which he was able to bill the government over $174 million. Then the police came calling. On to "Your Medicare Benefits 2025" where we learned how Medicare is likely to cover Long Term Care. How might the "Big Beautiful Bill" affect Medicare? Some areas of concern involve Medicare Advantage and the upcoding that so many MA plans are wont to do. Finally, we discussed some of the locations on a list of "12 Great Places to Retire in the Midwest". Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.
The Medicare Advantage fraud, a bait and switch, is affecting many unionized retirees all over the country -- many times unbeknownst to them.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE
NY forced retirees to Medicare Advantage. Netanyahu flattened Gaza, bombed and un-alived Iranian scientists. Who are the arch terrorists? Watch Charlie Kirk disrespect women.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE
A professor advocates for social democracy as a means to resist fascism. New York is forcing Medicare Advantage on retirees. 72% of say the rich 'have too much' as GOP gives them handouts.Subscribe to our Newsletter:https://politicsdoneright.com/newsletterPurchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make AmericaUtopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And BeFit Now: https://amzn.to/3xiQK3K Tribulations of anAfro-Latino Caribbean man: https://amzn.to/4c09rbE
Thank you to everyone who tuned into my live video! Join me for my next live video in the app.* Netanyahu flattened Gaza, bombed and un-alived Iranian scientists. Who are the arch terrorists?: Benjamin Netanyahu believes the world is blind. As he illegally bomb civilians in Gaza and Iran claiming they are human shields, he complains because Iran retaliate… To hear more, visit egberto.substack.com
Thank you john king (MY HUMBLE OPINION), Deborah J., Leslie Teyssier, Marc Van Rafelghem, and many others for tuning into my live video! Join me for my next live video in the app.* Anthony David Vernon advocates for social democracy as a tool of rebellion against fascism: Adjunct Professor Anthony David Vernon discusses fascism and the use of social democracy as a tool of rebellion against fascism. [More]* New York is forcing M… To hear more, visit egberto.substack.com
Why UnitedHealth's Criminal Investigation Is Fueling the Cash Practice Movement In this episode, Danny, founder of PT Biz, exposes the major criminal investigation into UnitedHealth and breaks down how their alleged Medicare Advantage fraud is creating the perfect storm for the rise of cash-based healthcare. With the Department of Justice involved and billions of taxpayer dollars at stake, this could be one of the biggest health insurance scandals of our time. More importantly, Danny explains how this chaos is a massive opportunity for providers who want to ditch the insurance system and build profitable, transparent, patient-first practices outside the traditional model. Topics Covered Why UnitedHealth is being criminally investigated by the DOJ How Medicare Advantage "upcoding" works—and why it's fraud Why more people are abandoning traditional insurance plans The connection between high deductibles and patient behavior How cash-based and out-of-network clinics are thriving in the mess The mindset shift from sick care to proactive health investment Why this is the best time to start or scale a cash-based clinic Common fears about market saturation—and why they're unfounded Key Quote “People used to think I was a jackass for not taking insurance. Now they're looking for clinics like this on purpose.” Resources & Links Visit PT Biz – See how we help cash-based and hybrid practices grow Book a Free Strategy Call – Speak with our team and get clear on your next steps Subscribe on YouTube – Get breakdowns, insights, and client case studies Read the PT Biz Book – Learn how to build your own cash-based practice Final Thought The system is broken—and people know it. With trust in insurance companies at an all-time low, more patients are seeking alternatives that put their health and dollars first. If you've ever considered going cash-based or out-of-network, there's never been a better time to start.
Dr. John Sweetenham and Dr. Erika Hamilton highlight key abstracts that were presented at ASCO25, including advances in breast and pancreatic cancers as well as remarkable data from the use of structured exercise programs in cancer care. Transcript Dr. Sweetenham: Hello, and welcome to the ASCO Daily News Podcast. I'm your host, Dr. John Sweetenham. Today, we'll be discussing some of the key advances and novel approaches in cancer care that were presented at the 2025 ASCO Annual Meeting. I'm delighted to be joined again by the chair of the Meeting's Scientific Program, Dr. Erika Hamilton. She is a medical oncologist and director of breast cancer and gynecologic cancer research at the Sarah Cannon Research Institute in Nashville, Tennessee. Our full disclosures are available in the transcript of this episode. Dr. Hamilton, congratulations on a fantastic meeting. From the practice-changing science to the world-renowned speakers at this year's Meeting, ASCO25 really reflected the amazing progress we're seeing in oncology today and the enormous opportunities that lie ahead of us. And thanks for coming back on to the podcast today to discuss some of these advances. Dr. Hamilton: Thanks, Dr. Sweetenham. I'm happy to join you today. It really was an impactful ASCO Annual Meeting. I probably am biased, but some great research was presented this year, and I heard lots of great conversations happening while we were there. Dr. Sweetenham: Yeah, absolutely. There was a lot of buzz, as well as a lot of media buzz around the meeting this year, and I think that's probably a good place to start. So I'd like to dive into abstract number LBA3510. This was the CHALLENGE trial, which created a lot of buzz at the meeting and subsequently in the media. This is the study that was led by the NCI Canada Clinical Trials Group, which was the first randomized phase 3 trial in patients with stage III and high-risk stage II colon cancer, which demonstrated that a post-treatment structured exercise program is both feasible and effective in improving disease-free survival in this patient group. The study was performed over a long period of time and in many respects is quite remarkable. So, I wonder if you could give us your thoughts about this study and whether you think that this means that our futures are going to be full of structured exercise programs for those patients who may benefit. Dr. Hamilton: It's a fantastic question. I think that this abstract did create a lot of buzz. We were very excited when we read it. It was highlighted in one of the Clinical Science Symposium sessions. But briefly, this was a phase 3 randomized trial. It was conducted at 55 centers, so really a broad experience, and patients that had resected colon cancer who completed adjuvant therapy were allowed to participate. There were essentially 2 groups: a structured exercise program, called ‘the exercise group,' or health education materials alone, so that was called just ‘the health education group.' And this was a 3-year intervention, so very high quality. The primary end point, as you mentioned, was disease-free survival. This actually accrued from 2009 to 2024, so quite a lift, and almost 900 patients underwent randomization to the exercise group or the health education group. And at almost 8 years of follow-up, we saw that the disease-free survival was significantly longer in the exercise group than the health education group. This was essentially 80.3% of patients were disease-free in exercise and 73.9% in the health education group. So a difference of over 6 percentage points, which, you know, at least in the breast cancer world, we make decisions about whether to do chemotherapy or not based on these kind of data. We also looked at overall survival in the exercise group and health education group, and the 8-year overall survival was 90.3% in the exercise group and 83.2% in the health education group. So this was a difference of 7.1%. Still statistically significant. I think this was really a fantastic effort over more than a decade at over 50 institutions with almost 900 patients, really done in a very systematic, high-intervention way that showed a fantastic result. Absolutely generalizable for patients with colon cancer. We have hints in other cancers that this is beneficial, and frankly, for our patients for other comorbidities, such as cardiovascular, etc., I really think that this is an abstract that deserved the press that it received. Dr. Sweetenham: Yeah, absolutely, and it is going to be very interesting, I think, over the next 2 or 3 years to see how much impact this particular study might have on programs across the country and across the world actually, in terms of what they do in this kind of adjuvant setting for structured exercise. Dr. Hamilton: Absolutely. So let's move on to Abstract 3006. This was an NCI-led effort comparing genomic testing using ctDNA and tissue from patients with less common cancers who were enrolled in but not eligible for a treatment arm of the NCI-MATCH trial. Tell us about your takeaways from this study. Dr. Sweetenham: Yeah, so I thought this was a really interesting study based, as you said, on NCI-MATCH. And many of the listeners will probably remember that the original NCI-MATCH study screened almost 6,000 patients to assess eligibility for those who had an actionable mutation. And it turned out that about 60% of the patients who went on to the study had less common tumors, which were defined as anything other than colon, rectum, breast, non–small cell lung cancer, or prostate cancer. And most of those patients lacked an eligible mutation of interest and so didn't get onto a trial therapy. But with a great deal of foresight, the study group had actually collected plasma samples from these patients so that they would have the opportunity to look at circulating tumor DNA profiles with the potential being that this might be another way for testing for clinically relevant mutations in some of these less common cancer types. So initially, they tested more than 2,000 patients, and to make a somewhat complicated story short, there was a subset of five histologies with a larger representation in terms of sample size. And these were cholangiocarcinoma, small cell lung cancer, esophageal cancer, pancreatic, and salivary gland cancer. And in those particular tumors, when they compared the ctDNA sequencing with the original tumor, there was a concordance there of around 84%, 85%. And in the presentation, the investigators go on to list the specific mutated genes that were identified in each of those tumors. But I think that the other compelling part of this study from my perspective was not just that concordance, which suggests that there's an opportunity there for the use of ctDNA instead of tumor biopsies in some of these situations, but what was also interesting was the fact that there were several clinically relevant mutations which were detected only in the circulating tumor DNA. And a couple of examples of those included IDH1 for cholangiocarcinoma, BRAF and p53 in several histologies, and microsatellite instability was most prevalent in small cell lung cancer in the ctDNA. So I think that what this demonstrates is that liquid biopsy is certainly a viable screening option for patients who are being assessed for matching for targeted therapies in clinical trials. The fact that some of these mutations were only seen in the ctDNA and not in the primary tumor specimen certainly suggests that there's some tumor heterogeneity. But I think that for me, the most compelling part of this study was the fact that many of these mutations were only picked up in the plasma. And so, as the authors concluded, they believe that a comprehensive gene profiling with circulating tumor DNA probably should be included as a primary screening modality in future trials of targeted therapy of this type. Dr. Hamilton: Yeah, I think that that's really interesting and mirrors a lot of data that we've been seeing. At least in breast cancer, you know, we still do a biopsy up front to make sure that our markers, we're still treating the right disease that we think we are. But it really speaks to the utility of using ctDNA for serial monitoring and the emergence of mutations. Dr. Sweetenham: Absolutely. And you mentioned breast cancer, and so I'd like to dwell on that for a moment here because obviously, there was a huge amount of exciting breast cancer data presented at the meeting this year. And in particular, I'd like to ask you about LBA1008, the DESTINY-Breast09 clinical trial, which I think has the potential to establish a new first-line standard of care for metastatic HER2+ breast cancer. And that's an area where we haven't seen a whole lot of innovation for around a decade now. So can you give us some of the highlights of this trial and what your thinking is, having seen the results? Dr. Hamilton: Yeah, absolutely. So this was a trial in the first-line metastatic HER2 setting. So this was looking at trastuzumab deruxtecan. We certainly have had no shortage of reports around this drug, initially approved for later lines. DESTINY-Breast03 brought it into our second-line setting for HER2+ disease and we're now looking at DESTINY-Breast09 in first-line. So this actually was a 3-arm trial where patients were randomized 1:1:1 against standard taxane/trastuzumab/pertuzumab in one arm; trastuzumab deruxtecan with pertuzumab in another arm; and then a third arm, trastuzumab deruxtecan alone. And what we did not see reported was that trastuzumab deruxtecan-alone arm. But we did have reports from the trastuzumab deruxtecan plus pertuzumab versus the chemo/trastuzumab/pertuzumab. And what we saw was a statistically significant improvement in median progression-free survival, 26.9 months up to 40.7, so an improvement of 13.8 months, over a year in PFS. Not to mention that we're now in the 40-month range for PFS in first-line disease. Really, across all subgroups, we really weren't able to pick out a subset of patients that did not benefit. We did see about a 12% ILD rate with trastuzumab deruxtecan. That really is on par with what we've seen in other studies, around 10%-15%. I think that this is going to become a new standard of care in the first-line. I think it did leave some unanswered questions. We saw some data from the PATINA trial this past San Antonio Breast, looking at the addition of endocrine therapy with or without a CDK4/6 inhibitor, palbociclib, for those patients that also have ER+ disease, after taxane has dropped out in the first-line setting. So how we're going to kind of merge all this together is, I suspect that there are going to be patients that we or they just don't have the appetite to continue 3 to 4 years of trastuzumab deruxtecan. And so we're probably going to be looking at a maintenance-type strategy for them, maybe integrating the PATINA data there. But how we really put this into practice in the first-line setting and if or when we think about de-escalating down from trastuzumab deruxtecan to antibody therapy are some lingering questions. Dr. Sweetenham: Okay, so certainly is going to influence practice, but watch this space for a little bit longer, it sounds as though that's what you're saying. Dr. Hamilton: Absolutely. So let's move on to GI cancer. Abstract 4006 reported preliminary results from the randomized phase 2 study of elraglusib in combination with gemcitabine/nab-paclitaxel versus the chemo gemcitabine/nab-paclitaxel alone in patients with previously untreated metastatic pancreatic cancer. Can you tell us more about this study? Dr. Sweetenham: Yeah, absolutely. As you mentioned, elraglusib is actually a first-in-class inhibitor of GSK3-beta, which has multiple potential actions in pancreatic cancer. But the drug itself may be involved in mediating drug resistance as well as in some tumor immune response modulation. Some of that's not clearly understood, I believe, right now. But certainly, preclinical data suggests that the drug may be effective in preclinical models and may also be effective in combination with chemotherapy and potentially with immune-modulating agents as well. So this particular study, as you said, was an open-label, randomized phase 2 study in which patients with pancreatic cancer were randomized 2:1 in favor of the elraglusib plus GMP—gemcitabine and nab-paclitaxel—versus the chemotherapy alone. And upon completion of the study, which is not right now, median overall survival was the primary end point, but there are a number of other end points which I'll talk about in just a moment. But the sample size was planned to be around 207 patients. The primary analysis included 155 patients in the combination arm versus 78 patients in the gemcitabine/nab-paclitaxel arm. Overall, the 1-year overall survival rate was 44.1% for the patients in the elraglusib-containing arm versus 23.0% in the patients receiving gemcitabine/nab-paclitaxel only. When they look at the median overall survival, it was 9.3 months for the experimental arm versus 7.2 months for chemotherapy alone. So put another way, there's around a 37% reduction in the risk of death with the use of this combination arm. The treatment was overall well-tolerated. There were some issues with grade 1 to 2 transient visual impairment in a large proportion of the patients. The most common treatment-related adverse effects with the elraglusib/GMP combination was transient visual impairment, which affected around 60% of the patients. Most of the more serious treatment-related adverse events included neutropenia, anemia, and fatigue in 50%, 25%, and 16% of the patients, respectively. So the early results from this study show a significant benefit for 1-year overall survival and for median overall survival with, as I mentioned above, a significant reduction in the risk of death. The authors went on to mention that the median overall survival for the control arm in this study is somewhat lower than in other comparable trials, but they think that this may be related to a more advanced disease burden in this particular study. Of interest to me was that right now: there is no apparent difference in progression-free survival between the 2 arms of this study. The authors described this as potentially indicating that this may be related in some way to immune modulation and immune effects on the tumor, which, if I'm completely honest, I don't totally understand. And so, the improvement in overall survival, as far as I can see at the moment, is not matched by an improvement in progression-free survival. So I think we probably need to wait for more time to elapse to see what happens with the study. And so, I think it certainly is an interesting study, and the results are intriguing, but I think it's probably a little early for it to actually shift the treatment paradigm in this disease. Dr. Hamilton: Fantastic. I think we've been waiting for advances in pancreatic cancer for a long time, but this, not unlike others, we learn more and then learn more we don't realize, so. Dr. Sweetenham: Right. Let's shift gears at this point and talk about a couple of other abstracts in kind of a very different space. Let's start out with symptom management for older adults with cancer. We know that undertreated symptoms are common among the older patient population, and Abstract 11002 reported on a randomized trial that demonstrated the effects of remote monitoring for older patients with cancer in terms of kind of symptoms and so on. Can you tell us a little bit about this study and whether you think this approach will potentially improve care for older patients? Dr. Hamilton: Yeah, I really liked this abstract. It was conducted through the Veterans Affairs, and it was based in California, which I'm telling you that because it's going to have a little bit of an implication later on. But essentially, adults that were 75 years or older who were Medicare Advantage beneficiaries were eligible to participate. Forty-three clinics in Southern California and Arizona, and patients were randomized either into a control group of usual clinic care alone, or an intervention group, which was usual care plus a lay health worker-led proactive telephone-based weekly symptom assessment, and this was for 12 months using the validated Edmonton Symptom Assessment System. So, there was a planned enrollment of at least 200 patients in each group. They successfully met that. And this lay health worker reviewed assessments with a physician assistant, who conducted follow-up for symptoms that changed by 2 points from a prior assessment or were rated 4 or greater. So almost a triage system to figure out who needed to be reached out to and to kind of work on symptoms. What I thought was fantastic about this was it was very representative of where it enrolled. There were actually about 50% of patients enrolled here that were Hispanic or Latinos. So some of our underserved populations and really across a wide variety of tumor types. They found that the intervention group had 53% lower odds of emergency room use, 68% lower odds of hospital use than the control group. And when they translated this to actual total cost of care, this was a savings of about $12,000 U.S. per participant and 75% lower odds of a death in an acute care facility. So I thought this was really interesting for a variety of reasons. One, certainly health care utilization and cost, but even more so, I think any of our patients would want to prevent hospitalizations and ER visits. Normally, that's not a fantastic experience having to feel poorly enough that you're in the emergency room or the hospital. And really showing in kind of concrete metrics that we were able to decrease this with this intervention. In terms of sustainability and scalability, I think the question is really the workforce to do this. Obviously, you know, this is going to take dedicated employees to have the ability to reach out to these patients, etc., but I think in value-based care, there's definitely a possibility of having reimbursement and having the funds to institute a program like this. So, definitely thought-provoking, and I hope it leads to more interventions. Dr. Sweetenham: Yeah, we've seen, over several years now, many of these studies which have looked at remote symptom monitoring and so on in this patient population, and many of them do show benefits for that in kinds of end points, not the least in this study being hospitalization and emergency room avoidance. But I think the scalability and personnel issue is a huge one, and I do wonder at some level whether we may see some AI-based platforms coming along that could actually help with this and provide interactions with these patients outside of actual real people, or at least in combination with real people. Dr. Hamilton: Yeah, that's a fantastic point. So let's talk a little bit about clinical trials. So eligibility assessment for oncology clinical trials, or prescreening, really relies on manual review of unstructured clinical notes. It's time-consuming, it's prone to errors, and Abstract 1508 reported on the final analysis of a randomized trial that looked at the effect of human-AI teams prescreening for clinical trial eligibility versus human-only or AI-only prescreening. So give us more good news about AI. What did the study find? Dr. Sweetenham: Yeah, this is a really, a really interesting study. And of course, any of us who have ever been involved in clinical trials will know that accrual is always a problem. And I think most centers have attempted, and some quite successfully managed to develop prescreening programs so that patients are screened by a health care provider or health care worker prior to being seen in the clinic, and the clinical investigator will then already know whether they're going to be eligible for a trial or not. But as you've already said, it's a slow process. It's typically somewhat inefficient and requires a lot of time on the part of the health care workers to actually do this in a successful way. And so, this was a study from Emory University where they took three models of ways in which they could assess the accuracy of the prescreening of charts for patients who are going to be considered for clinical trials. One of these was essentially the regular way of having two research coordinators physically abstract the charts. The second one was an AI platform which would extract longitudinal EHR data. And then the third one was a combination of the two. So the AI would be augmented by the research coordinator or the other way around. As a gold standard, they had three independent oncology reviewers who went through all of these charts to provide what they regarded as being the benchmark for accuracy. In a way, it's not a surprise to me because I think that a number of other systems which have used this combination of human verification of AI-based tools, it actually ultimately concluded that the combination of the two in terms of chart accuracy was for the most part better than either one individually, either the research coordinator or the AI alone. So I'll give you just a few examples of where specifically that mattered. The human plus AI platform was more accurate in terms of tumor staging, in terms of identifying biomarker testing and biomarker results, as well as biomarker interpretation, and was also superior in terms of listing medications. There are one or two other areas where either the AI alone was somewhat more accurate, but the significant differences were very much in favor of a combination of human + AI screening of these patient charts. So, in full disclosure, this didn't save time, but what the authors reported was that there were definite efficiency gains, and presumably this would actually become even more improved once the research coordinators were somewhat more comfortable and at home with the AI tool. So, I thought it was an interesting way of trying to enhance clinical trial accrual up front by this combination of humans and technology, and I think it's going to be interesting to see if this gets adopted at other centers in the future. Dr. Hamilton: Yeah, I think it's really fascinating, all the different places that we can be using AI, and I love the takeaway that AI and humans together are better than either individually. Dr. Sweetenham: Absolutely. Thanks once again, Dr. Hamilton, for sharing your insights with us today and for all of the incredible work you did to build a robust program. And also, congratulations on what was, I think, a really remarkable ASCO this year, one of the most exciting for some time, I think. So thank you again for that. Dr. Hamilton: Thanks so much. It was really a pleasure to work on ASCO 2025 this year. Dr. Sweetenham: And thank you to our listeners for joining us today. You'll find links to all the abstracts we discussed today in the transcript of this episode. Be sure to catch up on all of our coverage from the Annual Meeting. You can catch up on my daily reports that were published each day of the Annual Meeting, featuring the key science and innovations presented. And we'll have wrap-up episodes publishing in June, covering the full spectrum of malignancies from ASCO25. If you value the insights you hear on the ASCO Daily News Podcast, please remember to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. More on today's speakers: Dr. John Sweetenham Dr. Erika Hamilton @erikahamilton9 Follow ASCO on social media: @ASCO on Twitter ASCO on Bluesky ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. John Sweetenham: No relationships to disclose Dr. Erika Hamilton: Consulting or Advisory Role (Inst): Pfizer, Genentech/Roche, Lilly, Daiichi Sankyo, Mersana, AstraZeneca, Novartis, Ellipses Pharma, Olema Pharmaceuticals, Stemline Therapeutics, Tubulis, Verascity Science, Theratechnologies, Accutar Biotechnology, Entos, Fosun Pharma, Gilead Sciences, Jazz Pharmaceuticals, Medical Pharma Services, Hosun Pharma, Zentalis Pharmaceuticals, Jefferies, Tempus Labs, Arvinas, Circle Pharma, Janssen, Johnson and Johnson Research Funding (Inst): AstraZeneca, Hutchison MediPharma, OncoMed, MedImmune, Stem CentRx, Genentech/Roche, Curis, Verastem, Zymeworks, Syndax, Lycera, Rgenix, Novartis, Millenium, TapImmune, Inc., Lilly, Pfizer, Lilly, Pfizer, Tesaro, Boehringer Ingelheim, H3 Biomedicine, Radius Health, Acerta Pharma, Macrogenics, Abbvie, Immunomedics, Fujifilm, eFFECTOR Therapeutics, Merus, Nucana, Regeneron, Leap Therapeutics, Taiho Pharmaceuticals, EMD Serono, Daiichi Sankyo, ArQule, Syros Pharmaceuticals, Clovis Oncology, CytomX Therapeutics, InventisBio, Deciphera, Sermonix Pharmaceuticals, Zenith Epigentics, Arvinas, Harpoon, Black Diamond, Orinove, Molecular Templates, Seattle Genetics, Compugen, GI Therapeutics, Karyopharm Therapeutics, Dana-Farber Cancer Hospital, Shattuck Labs, PharmaMar, Olema Pharmaceuticals, Immunogen, Plexxikon, Amgen, Akesobio Australia, ADC Therapeutics, AtlasMedx, Aravive, Ellipses Pharma, Incyte, MabSpace Biosciences, ORIC Pharmaceuticals, Pieris Pharmaceuticals, Pieris Pharmaceuticals, Pionyr, Repetoire Immune Medicines, Treadwell Therapeutics, Accutar Biotech, Artios, Bliss Biopharmaceutical, Cascadian Therapeutics, Dantari, Duality Biologics, Elucida Oncology, Infinity Pharmaceuticals, Relay Therapeutics, Tolmar, Torque, BeiGene, Context Therapeutics, K-Group Beta, Kind Pharmaceuticals, Loxo Oncology, Oncothyreon, Orum Therapeutics, Prelude Therapeutics, Profound Bio, Cullinan Oncology, Bristol-Myers Squib, Eisai, Fochon Pharmaceuticals, Gilead Sciences, Inspirna, Myriad Genetics, Silverback Therapeutics, Stemline Therapeutics
Some of the sickest Medicare Advantage patients ran into problems getting end-of-life care. Ultimately many patients switched to traditional Medicare, costing taxpayers billions, according to an investigation by the Wall Street Journal. This is one of many Medicare Advantage practices that is now under government scrutiny. Both Congress and Medicare agency head Dr. Mehmet Oz are pushing for reforms to curb tactics that can boost federal payments to private insurers. The Department of Justice is also investigating major private insurance companies UnitedHealth, Aetna, Elevance Health and Humana. Jessica Mendoza discusses the investigations with WSJ's Anna Wilde Mathews. Further Listening: -Medicare, Inc. Part 1: How Insurers Make Billions From Medicare -A Life-or-Death Insurance Denial Sign up for WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices
Medicare Advantage was designed to save the government money. But a Wall Street Journal investigation found that private insurers used the program to generate extra payments through questionable diagnoses. The investigation uncovered instances of potentially deadly illnesses like AIDS, where patients received no follow-up care, as well as diagnoses that were medically impossible. This happened in part when insurers sent nurse practitioners into Medicare Advantage recipients' homes. Jessica Mendoza discusses the investigation with WSJ's Christopher Weaver as well as a nurse who participated in the program. Further Listening: -A Life-or-Death Insurance Denial -Even Doctors Are Frustrated With Health Insurance Sign up for WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices
© 2020-2025 Ivy Podcast Discovery LLC
