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Humana will reduce its Medicare Advantage footprint again in 2027. The Centers for Medicare & Medicaid Services will end a Medicare Part D premium stabilization program. And the American Red Cross has declared a national blood supply crisis. Listen to the latest episode of The Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.
Two conversations that cut to the heart of what workers and retirees are navigating right now — one about what happens when an employer decides union members are expendable, and one about finding the right healthcare coverage when the landscape keeps shifting. The University of Maryland, College Park, laid off more than 80 workers earlier this summer. More than 80% were union members. The university's nearly billion-dollar endowment went untouched. So did the president's $1 million-plus annual salary and the multi-million-dollar coaching contracts for coaches with losing records. And almost immediately after the layoffs were announced, the university lifted its hiring freeze. AFSCME Local 1072 President Todd Holden, union steward Sarah Eppley and laid-off member Sarah Grun describe what happened, why the local filed 40 grievances covering workers laid off while on FMLA, pursuing grievances or active in union organizing and how to sign the AFSCME toolkit letter to the University System of Maryland at afscmemd.org. Then, BCBS NLO Executive Director Merrilee Logue and BCBS Association Medicare market analyst Duncan Lawson discuss a Medicare Advantage landscape that has become more complicated for union retirees to navigate. For the second consecutive year, more than 2 million Medicare Advantage consumers had their plans terminated and even more saw their benefits reduced. Logue and Lawson explain which plans and regions have been most affected, why Medicare Advantage remains the most popular retiree coverage option despite the changes and what union members approaching 65 need to know to find coverage that fits — including how to work with a broker, check union fund coverage and take advantage of special enrollment periods. Visit afscmemd.org for more on the AFSCME Local 1072 fight and bcbs.com/MedicareAdvantage for Medicare Advantage resources. Follow @BlueLabor on LinkedIn and X for updates from the BCBS National Labor Office.
Build your pipeline with Lead Heroes' call-verified, exclusive insurance leads and take advantage of the Freedom Sale before it's gone. https://leadheroes.com/ In this episode of Seven Figures Or Bust, Christian Brindle and Glen Shelton separate fact from fiction surrounding the 2027 Medicare Part D subsidy changes and the headlines claiming Part D is ending. They explain what the subsidy actually did, why misinformation has spread so quickly, and what Medicare agents and beneficiaries should really expect heading into AEP. Plus, they break down Humana's announcement that up to 600,000 Medicare Advantage members could be affected by market exits, discuss what it means for the industry, and share their predictions for the 2027 enrollment season. If you want the facts behind the headlines and practical insights for navigating the changes ahead, this episode is one you won't want to miss.
Episode 653: Medicare Advantage and original Medicare work very differently. Learn how to compare the tradeoffs before deciding which path is right for you. Then, Ryan and Steve explain how emotions, timing, and buying the latest winners can cause investors to miss out on the returns their investments actually earn.
D-SNPs are offered by private insurance companies (such as UnitedHealthcare, Humana, Aetna, and Centene) that contract with both Medicare and your state's Medicaid program. According to CMS data, D-SNP enrollment has grown by more than 150% over the past five years, making it the fastest-growing segment within Medicare Advantage
Dr. Oz's proposed 2027 CMS rules dropped, and I've been waiting all week to get into them. The push toward value-based care and Accountable Care Organizations continues, but the headline for anyone in private practice is the multiple procedure cut: if you bill an E&M code and a procedure on the same day, Medicare now pays 100% for the more expensive service and only 50% for the other, regardless of modifiers, regardless of whether they're for two totally separate problems. That is a direct assault on independent practices, and every commercial insurer will follow Medicare's lead. There's one small win. Mandating real-time electronic prior authorization across Medicare Advantage, Medicaid, and ACA marketplace plans One head-scratcher...Medicaid work requirements of 80 hours per month starting January 2027, which I suspect will land squarely on physicians' documentation burden. Also, everyone say it with me: physician compensation is 10% of U.S. healthcare expenditure. After the break, medical malpractice for ophthalmologists. A colleague just came out of a settlement, and it got me looking at the top drivers of ophthalmology lawsuits: cataract surgery complications, missed or delayed retinal detachments, glaucoma management failures, and post-op infections. The uncomfortable truth: the only way to avoid surgical complications is to not operate, and sometimes even perfect communication and documentation don't stop a lawsuit. But they help. Takeaways: The proposed 2027 CMS rules would pay only 50% for a second same-day service when an E&M visit is billed alongside a procedure, regardless of modifier, effectively a major reimbursement cut that will hit independent private practices hardest and be adopted by commercial insurers Physician compensation accounts for just 10% of total U.S. healthcare expenditure, yet Medicare physician reimbursement is cut nearly every year while hospital and insurer reimbursement continues to rise The 2027 rules push physicians further toward Accountable Care Organizations and value-based care, favoring large health systems and insurers over independent physician-owned practices, with one bright spot: mandatory real-time electronic prior authorization across Medicare Advantage, Medicaid, and ACA plans The top ophthalmology malpractice risks are cataract surgery complications (posterior capsule tears, retained lens fragments, unfulfilled patient expectations), missed or delayed retinal detachment diagnosis, glaucoma management failures (insufficient IOP monitoring), and post-op infections Per OMIC, the three biggest drivers of ophthalmology claims are documentation deficiencies, communication gaps, and technical performance, about 60% of claims involve surgical execution errors, and diligent documentation, brutally honest informed consent, and strong physician-patient rapport are the biggest mitigators To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact. For more information go to Anatomy Warehouse DOT com. Link: https://anatomywarehouse.com/?aff=14 Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit http://www.EyelidCheck.com for more information. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices
"We have an untapped army of 200,000 PAs that really could step up and drive some change in the healthcare system if we weren't restricted,” says Dr. Jennifer Kolb, capturing her motivation for pushing to update practice regulations for physician associates that date back more than 50 years. As Chief Medical Officer and Senior Vice President of Clinical Affairs at the American Academy of Physician Associates, Dr. Kolb has been in the middle of the fight at the state and federal level to grant PAs more independence from physicians, full billing rights, and the increased ability to practice across state lines, among other changes. In this pertinent conversation with Raise the Line host Lindsey Smith, Dr. Kolb explains how these updates could help close huge gaps in access to healthcare, better manage the fight against chronic diseases and improve patient outcomes. Dr. Kolb also addresses: Why the name shift from "assistant" to "associate" took her years to fully appreciate; How a 10-year gap in life expectancy across Chicago zip codes shapes her view of health equity; Why PA's shouldn't wait for permission to start making change in their communities. Mentioned in this episode:American Academy of Physician Associates If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
As a house call firm, Ennoble Care brings the most skilled clinicians to a patient's house to provide essentially a doctor's office inside, CEO Kush Das explained. That slowly progresses to more longitudinal care with nurses and social workers and care managers supporting patients. The company serves both Medicare and Medicare Advantage patients, depending on the market. About 1 of every 2 Medicare patients it serves is in the ACO REACH model, Das explained. He is proud of the work of the Complex Care Alliance, which has advocated for high-needs Medicare patients in accountable care. He is bullish on the LEAD model, which will take the place of the REACH Model starting in 2027. The latest physician fee schedule proposed rule reflects the work involved in operating a house call company, he said. The company, which doubled in the last 12 months, will continue on a similar growth trajectory, he said. The federal hospice moratorium — which he believes in — will hurt the company's efforts to grow hospice in the short term, he said. Follow us on social media: X: @McKHomeCare Facebook: McKnight's Home Care LinkedIn: McKnight's Home Care Instagram: mcknights_homecare Follow Ennoble Care on social media: Facebook: Ennoble Care LinkedIn: Ennoble Care Instagram: ennoblecare Show contributors:McKnight's Home Care Editor Liza Berger; Kush Das, CEO, Ennoble Care Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
Wednesday, July 29, 2026 Today, Senator Cornyn says he won't vote to advance Todd Blanche's nomination without a written rescission of the Slush Fund and tax immunity; Governor Beshear has written another letter to Mitch McConnell demanding he prove he's fit to serve or resign; the Knight Institute and American Oversight have filed reply briefs with the 11th Circuit in the case of Volume II of Jack Smith's final report; Rep. Max Miller has been credibly accused of assaulting his ex-wife and holding a gun to her head; the Trump administration is trying to get a hold of our personal emergency room medical records while simultaneously ending Medicare drug plan subsidies; new polling shows people don't like Trump's tax bill; Senate Democrats are pressing Todd Blanche on the New York Times subpoenas; newly uncovered grand jury testimony in the Davey Hearn case has led to his legal team demanding the grand jury materials; plus Allison delivers your Good News. 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Donate to The Trevor Project - Daily Beans Podcast The Latest Breakdown→ DOJ Must Hand Over Internal Emails About NYT Subpoenas StoriesTalarico leads Paxton by 5 points in new poll of Texas' U.S. Senate race | Texas Tribune Blanche vote could be postponed, Cornyn says - Live Updates | POLITICO Senate Democrats Press Blanche on Times Subpoenas | NYT Backlash surges over Trump judge's order to hide secret DOJ files | Alternet.org Kentucky governor tells Mitch McConnell: Prove you can serve or ‘resign' | NBC News MAGA Rep. Allegedly Assaulted Wife, Put Gun to Her Head. Republicans Don't Care | Rolling Stone Trump administration demands hospitals share emergency room records | CNN Trump Administration to End Medicare Drug Plan Subsidy | Wall Street Journal Poll: Even Trump voters aren't very impressed by the GOP's tax overhaul | POLITICO Witness in Reflecting Pool case conceded damage before canoeist touched water | NBC News Good TroubleImpeach Vought Good Trouble - Gov. 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Plus: Oil prices jump after Iran launched a surprise attack on U.S. forces. And Ford shares rallies after raising outlook. Imani Moise hosts. Sign up for WSJ's free What's News newsletter. An artificial-intelligence tool assisted in the making of this episode by creating summaries that were based on Wall Street Journal reporting and reviewed and adapted by an editor. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
In this episode, Jakob Emerson, Associate News Director, Becker's Healthcare, breaks down the latest hospital and payer earnings, examining how expiring ACA subsidies, Medicare Advantage margin recovery, and shifting reimbursement dynamics are reshaping financial performance and strategy across the healthcare industry.
Medicare Advantage enrollment continues to grow, but for many health systems, the administrative burden, prior authorization requirements, delayed care, and financial pressures are prompting leaders to reassess whether these plans continue to support their mission and patients.In this episode of Value-Based Care Insights, Daniel Marino sits down with Ivan Mitchell, CEO of Great Plains Health, to discuss why his organization made the difficult decision to terminate its Medicare Advantage contracts. Ivan shares the real-world experiences that shaped this decision, including prolonged prior authorization delays, denied rehabilitation services, increased administrative complexity, and the operational and financial challenges that ultimately affected both patients and providers.
In this episode of Healthcare Beans, James speaks with Ryan Polselli, MD, founder and CEO of MammoLink, about why breast cancer screening remains underused despite decades of awareness, established clinical guidance, and broad insurance coverage. Ryan argues that the core problem is not simply awareness. Screening often conflicts with work, family responsibilities, appointment availability, financial uncertainty, and the natural tendency to postpone preventive care when no symptoms are present. He explains how MammoLink brings mammography and ultrasound directly to workplaces, schools, government sites, and rural communities through patient-centered mobile imaging units. The conversation also explores price transparency, payer quality incentives, direct-pay demand, rural health infrastructure, employer-sponsored screening, nationwide expansion, and the role of data and emerging technologies in the future of breast cancer detection. Episode Timeline 00:00 — Introduction to Ryan Polselli and MammoLinkRyan introduces his background as a board-certified radiologist and breast-imaging specialist and describes his focus on improving access to breast cancer screening. 01:02 — The breast cancer screening paradoxDespite widespread awareness and strong evidence supporting screening, many women still do not receive regular mammograms. Ryan explains why awareness alone has not produced sufficient action. 03:35 — Where the screening process breaks downThe discussion examines the balance between personal responsibility and system responsibility, including the burdens created by work, family obligations, and limited appointment availability. 04:56 — Designing preventive care around human behaviorRyan contrasts urgent medical care with preventive screening. When patients feel healthy, completing screening requires a proactive decision without the emotional urgency that drives emergency care. 06:06 — Making screening compatible with everyday lifeRyan argues that screening must be redesigned around how women actually live rather than requiring patients to navigate numerous scheduling and logistical barriers. 07:12 — Financial barriers and uncertaintyInsurance may cover a routine mammogram, but patients can still face uncertainty involving supplemental imaging, dense breast tissue, diagnostic follow-up, and unexpected bills. 09:23 — Delayed results and lost momentumLong waits for results can increase anxiety and weaken engagement. Ryan explains why faster feedback can restore patient control and encourage better screening habits. 10:39 — From patient experience to systems changeMammoLink began as an effort to improve the individual screening experience but evolved into a broader model connecting patient behavior, economics, employer interests, and payer incentives. 13:04 — How the mobile imaging model worksRyan describes mobile units containing mammography, ultrasound, changing areas, procedure rooms, and other features typically found in an outpatient imaging center. 13:55 — Bringing screening into workplaces and communitiesRecurring visits to schools, employers, municipalities, and government sites allow patients to receive screening where they already spend their time. 14:20 — Social reinforcement and screening adherenceCoworkers can encourage one another to participate, while returning to the same location each year can make regular screening easier to remember and complete. 16:09 — The economics of mobile mammographyMobile screening carries higher capital and operating costs than traditional outpatient imaging, but Ryan describes it as a high-cost, high-yield model capable of reaching populations that might otherwise remain unscreened. 17:00 — Legislative and payer tailwindsCoverage changes involving supplemental breast imaging, along with growing payer interest, may improve the economic viability of comprehensive mobile screening. 18:27 — Access is also about timeRyan emphasizes that patients can be disadvantaged by limited time and flexibility even when they are not financially disadvantaged. 19:54 — Incentives within traditional imaging pathwaysThe conversation considers how fee-for-service payment can encourage separate visits, while a mobile model has stronger operational reasons to complete as much of the episode as possible in one encounter. 21:02 — HEDIS measures and payer motivationRyan explains how quality measures and Medicare Advantage star ratings can create significant incentives for health plans to improve breast cancer screening rates. 22:27 — MammoLink's no-surprise-billing approachRyan describes the company's decision not to send patients an unexpected bill after the visit, even when that means accepting some lost revenue. 25:05 — Technology supporting payment verificationMammoLink is using automated insurance-verification technology to improve up-front accuracy while preserving its principle of no back-end patient billing. 25:30 — Can transparency increase competition?The discussion turns to whether better consumer awareness of price differences between hospitals, outpatient centers, and alternative providers can eventually place downward pressure on costs. 26:46 — Direct pay, privacy, and convenienceRyan discusses the growing number of patients who choose cash payment because they value privacy, simplicity, or freedom from insurance-related friction. 27:51 — Supporting patients after an abnormal findingMammoLink manages diagnostic evaluation up to the point of biopsy and is developing stronger relationships with breast surgeons and health systems to improve downstream handoffs. 29:55 — The rural breast-imaging access gapRyan describes rural communities where mammography may not be available locally and where patients can postpone evaluating a concerning symptom for long periods. 30:40 — Public-sector and community partnershipsMammoLink works with the Florida Department of Health, migrant health organizations, and other partners to bring screening into underserved areas. 31:52 — Rural transformation funding as infrastructure capitalRyan and James discuss whether public funding could cover the initial cost of mobile units while allowing the operating model to become sustainable without permanent subsidy. 33:13 — Expanding beyond FloridaRyan outlines a potential national growth strategy involving grants, outside investment, and targeted entry into cities or states with favorable conditions. 33:55 — Bootstrapping five mobile unitsRyan discusses building the company without outside venture funding and reflects on the effort required to create its existing mobile fleet. 34:22 — The future of patient-centered mobile screeningRyan distinguishes genuinely patient-centered mobile care from simply relocating a traditional service and argues that future expansion will depend on proving outcomes and financial value. 35:30 — Demonstrating employer return on investmentThe conversation explores using clinical, operational, employee, and geospatial data to help employers measure cancers detected, time saved, employee satisfaction, and potential avoided costs. 37:05 — Employers as a preventive-care access channelRyan predicts that employers could play a larger role in providing screening as they seek to strengthen benefits, workforce health, retention, and trust. 37:38 — AI and emerging breast-cancer detection toolsRyan discusses research involving AI, biological markers, RNA-based technologies, and other emerging tools that may complement mammography and genetic screening. 38:39 — No mission without marginThe episode closes with a reflection on why healthcare innovation must be economically sustainable to achieve lasting scale and impact. Godspeed.. James Note: Some statistics and estimates discussed in this episode were provided conversationally by the host or guest and may be approximate. They have not all been independently verified by Healthcare Beans. Listeners should consult current primary sources before relying on specific figures for medical, policy, or business decisions.
Ep 158- Rethinking Medicare Advantage: One Health System's Decision Medicare Advantage enrollment continues to grow, but for many health systems, the administrative burden, prior authorization requirements, delayed care, and financial pressures are prompting leaders to reassess whether these plans continue to support their mission and patients. On this episode Dan sits down with Ivan Mitchell, CEO of Great Plains Health, to discuss why his organization made the difficult decision to terminate its Medicare Advantage contracts. Ivan shares the real-world experiences that shaped this decision, including prolonged prior authorization delays, denied rehabilitation services, increased administrative complexity, and the operational and financial challenges that ultimately affected both patients and providers. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen
Most adults who smoke want to quit, and about half try to do so in any given year, yet fewer than one in ten succeed. That persistent gap between intention and outcome is one of the central challenges in public health, and it's exactly the kind of problem that calls for new thinking about how to communicate with people to support behavior change. Dr. Amanda Graham has been a leading force in doing just that in her role as chief health officer at Truth Initiative, the nation's largest non-profit public health organization dedicated to preventing addiction among young people and helping people of all ages to quit tobacco. On this episode of Raise the Line from Elsevier, Dr. Graham, who holds a PhD in clinical health psychology and has done 25 years of NIH-funded research focused on technology-based cessation interventions, helps us understand the interplay between behavioral science and digital communications in the field. "A well-timed message can really be powerful in interrupting what for many people is kind of an automatic behavior, especially via text, which data tell us is an extraordinarily powerful modality,” she explains to host Lindsey Smith. Tune-in to understand where the field is heading, and to learn about: Why "push" technology may work better than apps and websites when it comes to breaking automatic behaviors; How the rise of e-cigarettes, nicotine pouches, and heated tobacco has scrambled decades of public health messaging; How highschool smoking rates plunged from over 30% to less than 2%. Mentioned in this episode: Truth Initiative Program with Mayo Clinic If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
In this episode, host Ross Frey, Senior Product Manager and resident MTM/CMR strategist, sits down with Cindy Henry, Director of Payer Products at Outcomes, to unpack one of the biggest changes hitting Medicare Advantage plans: CMS's intent to return the CMR completion rate to the Star Ratings program beginning in measure year 2027. Ross and Cindy explore how the industry reacted to the latest CMS Advance Notice, why the CMR measure's return matters, and how MTM strategy has quietly shifted during its two‑year placement on the display page. Together, they outline the pressures plans are feeling—from shrinking margins to rising expectations around clinical quality—and the renewed focus on the value of medication therapy management, total cost of care, and local pharmacy engagement. A key topic throughout the episode is the impact of CMS's expanded MTM eligibility criteria, which significantly increases denominators for 2025 and beyond. Cindy explains how this shift forces payers to rethink scale, budget, ROI, and operational models, while Ross shares Outcomes' cut‑point predictions and how performance is likely to redistribute once the measure becomes active again. The conversation also highlights Outcomes' strategy to support both health plans and community pharmacies as they prepare for 2027. Ross describes work underway to reduce documentation burden, streamline workflows, leverage new technology, and allow pharmacists to practice at the top of their license—ultimately helping MTM delivery scale without sacrificing quality. By the end of the episode, the message is clear: Plans that begin modeling, staffing, vendor alignment, and workflow modernization now will be best positioned when Star Ratings recalibrate in 2029. Listeners are encouraged to explore Outcomes' latest prediction models and analysis at outcomes.com
A 2024 federal watchdog report found that when Medicare Advantage enrollees appealed prior authorization denials for Skilled Nursing Facility (SNF) admission, they won 95% of the time.When an independent reviewer looks at the same cases a plan rejected and reverses the decision nearly every single time, that is not a system working correctly. It is a system producing denials that consistently fail review.
Turning 65 opens the door to Medicare—but it also introduces a maze of choices that can have lasting financial and healthcare consequences. In this episode of Finishing Well, certified financial planner Hans Scheil and co-host Robbie Dilmore break down the critical decisions you'll face when enrolling in Medicare. Should you delay enrollment? What's the difference between Original Medicare with a supplement and a Medicare Advantage plan? How do provider networks, prior authorizations, premiums, and out-of-pocket costs affect your future care? Hans shares decades of experience helping retirees make informed Medicare decisions, explaining why the lowest upfront cost isn't always the best long-term value. Through real-life examples and practical guidance, you'll learn how to avoid common pitfalls and choose a path that fits your healthcare needs, financial goals, and peace of mind. Rooted in biblical wisdom and practical financial planning, this episode will help you approach one of retirement's biggest decisions with confidence instead of confusion. "Visit cardinalguide.com to access free retirement resources, browse our complete library of episodes, and connect with the Finishing Well ministry. Together, we're helping people honor God by finishing well."
America's Work Force Union Podcast brings together two conversations spanning American history, retirement security and a fight over who controls your Medicare coverage. American Legion Media and Communications Director Henry Howard opens with a recap of how the Legion marked America's 250th anniversary, including a reenactment of the first public reading of the Declaration of Independence in Lansing, Michigan on July 8, the date Colonel Nixon first read the document publicly in 1776. Howard also covers the conclusion of the USA 250 Challenge, which engaged more than 3,100 American Legion family members over the past year in fitness, wellness and community service, and a historic flag escort by American Legion riders from Pittsburgh to Arlington on July 4. He then previews the August edition of the American Legion magazine, which highlights ten notable American inventions that shaped the world and honors the late Diane Carlson Evans, the Vietnam combat nurse who led the decades-long fight to establish the Vietnam Women's Memorial on the National Mall. Then, Ohio Alliance for Retired Americans State Director Norm Wernet discusses two developments directly affecting retirees and disabled workers. The first is bipartisan momentum to scrap the Social Security earnings cap following a joint op-ed from Sen. Bernie Moreno and Sen. Elizabeth Warren, and what that step would do to address the 2032 Social Security funding cliff. The second is the WISeR program, a pilot AI prior authorization program now running in Ohio and six other states that is delaying and denying Medicare Advantage coverage with a financial incentive built into the algorithm to keep saying no. Visit legion.org for American Legion updates and retiredamericans.org for the full congressional voting record on retiree issues.
Major developments continue in the Nolan Wells case. As pressure mounts for answers, the governor is finally speaking out about the investigation and the growing public outcry. Tonight, Don breaks down the latest updates, what the governor had to say, and what it could mean for the search for accountability in one of the country's most closely watched cases. We are joined by Ashley Etienne and Monique Pressley to break it all down. This episode is brought to you by Shopify. Stop waiting for permission to build something. Your next revenue stream starts free at shopify.com/lemon This episode is brought to you by Upwork. Visit Upwork.com right now and post your job for free This episode is sponsored by FFRF. Visit https://ffrf.us/don or text DON 511511 to join or learn more. Because freedom belongs to all of us. Text Fees May Apply For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit podcastchoices.com/adchoices
"I always remember feeling like I was part of the clean plate club," says Dr. Christle Guevarra, recalling a childhood spent quietly convinced that her weight was a matter of willpower. That belief followed her through a competitive powerlifting career and medical practice until she finally tried a GLP-1 medication herself and, as she describes it, the constant mental noise around food quieted down. Now a board-certified family and sports medicine physician, traveling team doctor for U.S. Figure Skating, and author of The Beginner's Guide to GLP-1s, Dr. Guevarra brings a rare combination of clinical authority and lived experience to the conversation around obesity medicine. In this episode of Raise the Line from Elsevier, host Lindsey Smith talks with her about what's actually changed in how physicians understand the issue and what it means for patients. "The biggest thing is reframing how we approach weight loss. It's not just a willpower problem, it is a neurobiological problem." Tune in to learn about: Why she said no to a GLP-1 prescription for two years and what finally changed her mind; The real story behind concerns about muscle loss on these medications; What happens when the “food noise" goes silent and a new set of challenges takes its place. Mentioned in this episode: Dr. Christle's website If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
Fraud risks in Medicare Advantage, which now covers more than half of all Medicare beneficiaries, have been flagged as a top priority for government agencies. With that in mind, Rachel Rose, JD, MBA, joins the 1st Talk Compliance podcast to bring her expertise in False Claims Act litigation to the discussion on how best to avoid these risks, or run afoul of the DOJ or CMS. Listen now for firsthand insight into how these cases actually unfold and what providers can do to protect themselves and their practices.
Healthcare is one of the biggest expenses retirees face, yet few people understand how the system behind their care actually works. Jeremy Keil welcomes physician, hospice doctor, and author Dr. Jordan Grumet to discuss the ideas behind his new book, The Healthcare Heist. Discover how financial incentives have reshaped modern healthcare, the growing influence of private equity, and why patients and providers often feel caught in a system that prioritizes business interests over care. Dr. Grumet explains the differences between physician-owned practices and corporate healthcare systems, discusses direct primary care and concierge medicine, shares his perspective on Medicare Advantage versus traditional Medicare with supplemental coverage, and offers guidance for becoming a more informed healthcare consumer. Healthcare aside, hear why Dr. Grumet rejects the traditional definition of retirement and what he's learned since beginning the decumulation phase of his own financial life. For disclosures and conflicts visit keilfp.com/disclosures.
Got questions? Send Ericka a Text!Less than 1% of denied dental claims ever get appealed and insurance companies are counting on you to be in the other 99%. I walk you through the denial management mindset shift that changes everything: stop treating the third appeal like the edge of the map and start using the tools that actually hold payers accountable, including your state insurance commissioner for fully insured plans. We get practical and specific about what makes a denial “unreasonable” or “bad faith” and how to spot the pattern: benefits are active, eligibility is confirmed, documentation supports dental necessity, and the claim still comes back denied. I also explain why we start with state and federal laws before we obsess over codes, because language like prompt pay, network leasing, and silent PPO issues gives your conversations more weight. Then we clean up common risk areas by separating an honest mistake, a contract violation, and fraud, because mixing those up can put a practice in real trouble. From there, we talk tactics: why copy-and-paste appeal templates can work against you in a world where insurers use AI to review claims, and what to use instead. Think ICD-10 diagnosis codes, strong narratives, and patient-specific clinical details that make your claim defensible. Finally, I share documented enforcement examples, including a major fine tied to undisclosed “phantom” frequency limits, and why complaints to regulators compound over time. If you want a denial process that protects patients and stops leaving money on the table, listen all the way through, then subscribe, share this with your office team, and leave a review so more billers learn how to escalate the right way.Sources referenced in this episode:Appeal rate / upheld rate: KFF analysis of CMS data — fewer than 1% of denied ACA marketplace claims are appealed; insurers uphold ~56% of appeals (2023 data), 66% (2024 data). Medicare Advantage: ~57% of appealed denials overturned. (On air we used these instead of the "59% upheld because nobody appealed" framing, which conflated the appeal rate with the uphold-on-appeal rate.)Delta Dental of Washington: Washington State Office of the Insurance Commissioner fined Delta Dental + its health care benefits manager (Wyssta) $130,000 (Oct/Nov 2024) for, among other things, denying claims based on time/frequency limits not filed with or approved by the state; 7 service types and 50 billing codes had undisclosed limits. Triggered by consumer complaints. This is an actual regulatory fine.Self-funded vs. fully insured (the "federal path" mention): The commissioner regulates fully insured plans. Self-funded employer plans fall under federal ERISA law and route to the U.S. Department of Labor (EBSA) instead, not the state commissioner. This is covered in depth in the full denial management talk, not this episode. (Government and church plans are a further exception.)Cigna PxDx: 2023 class action (E.D. Cal.), citing ProPublica reporting — ~300,000 denials in two months, avg. 1.2 seconds per claim, "we literally click and submit." Court allowed the case to proceed March 2025 (abuse of discretion). This is litigation, not a fine — described on air as a lawsuit/court ruling.UnitedHealth nH Predict: Class action (D. Minn.) alleging a 90% error rate on the AI tool and that ~0.2% of policyholders appeal. Court ordered algorithm disclosure in 2026. Allegations in active litigation — stated as such on air.The "0.2% will appeal" motive appears in both the Cigna and UnitedHealth complaints as an allegation of intent. Interested in a Demo of Dentiq - The Billing Command Center? Get on the interest list here:https://4063-dentiq.systeme.io/waitlistGet your Dental Billing Toolkit Here:https://www.dentalbillingdoneright.com/the-dental-billing-toolkitDownload "The Most Underused Codes in Dentistry - And How to Get Them Paid" checklist here:https://docs.google.com/forms/d/e/1FAIpQLSfxnnfSlNd0NPhMoBWq-1D_xU5R8LS4xPhHNKIjfLQwStOUag/viewform?usp=headerSchedule a billing chat with Ericka:https://calendly.com/ericka-dentalbillingdoneright/30minEmail Ericka:ericka@dentalbillingdoneright.comEmail Jen:jen@dentalbillingdoneright.com
Learn the Top 10 Virtual Assistant roles that can help grow your agency—and claim 20 FREE hours with Hire Heroes for a limited time. https://hireheroes.com/ In this episode of the Seven Figures Or Bust Podcast, Christian Brindle and Glen Shelton break down why one of the nation's largest Medicare Advantage carriers is suing CMS over its star ratings—and why every Medicare agent should pay attention. They also discuss the real reason carriers push Home Risk Assessments (HRAs), how Medicare Advantage star ratings impact billions of dollars in funding, and what these behind-the-scenes battles mean for agents, carriers, and beneficiaries. Plus, they explain how carrier decisions, CMS regulations, and legal challenges continue to shape the future of the Medicare industry.
Send us Fan MailWhy does the United States spend more on healthcare than any other nation—yet often achieve worse outcomes? In Part Two of this thought-provoking conversation, Dr. Don Berwick—former Administrator of the Centers for Medicare & Medicaid Services (CMS), internationally recognized healthcare quality expert, and founder of the Institute for Healthcare Improvement (IHI)—joins Chris Comeaux to explore the systemic challenges facing American healthcare and the leadership required to create meaningful reform. From the evolution of Medicare Advantage to the financial incentives shaping healthcare delivery, Dr. Berwick explains why administrative complexity, payment models, and profit-driven incentives continue to drive costs higher while often failing to improve patient outcomes. Together, they examine the future of healthcare policy, value-based care, healthcare leadership, healthcare reform, Medicare, health insurance, and the role employers may play in demanding a more sustainable healthcare system. The conversation also turns to one of healthcare's greatest success stories—hospice and palliative care. Dr. Berwick argues that compassionate, person-centered care isn't simply a better way to care for people nearing the end of life; it provides a blueprint for improving healthcare across every stage of life. The episode concludes with an inspiring challenge to healthcare leaders: speak up for what is right, lead with courage, and never lose sight of healthcare's true mission—to heal, serve, and care for people. Whether you're a healthcare executive, hospice leader, physician, nonprofit executive, health system administrator, board member, or business leader, this conversation offers strategic insights into the future of healthcare—and practical leadership lessons that extend far beyond medicine.⸻Episode Highlights✔ Why Medicare Advantage has drifted from its original mission✔ The hidden cost of healthcare bureaucracy and administrative waste✔ The $80 billion debate surrounding Medicare Advantage payments✔ Why employer-sponsored healthcare may be approaching a breaking point✔ Lessons the U.S. can learn from healthcare systems around the world✔ Why hospice and palliative care represent a model for all of healthcare✔ The moral responsibility of healthcare leaders to speak with courage⸻If you enjoyed this conversation, please Like, Subscribe, and Share this episode with your leadership team, colleagues, board members, and friends. Every conversation helps us build stronger leaders and healthier organizations.
The Friday Five for July 10, 2026: Halfway Through 2026 Ritter Insurance Marketing Summits Musings on Artificial Intelligence CDC High Heat & Medication Guidance Scam Targeting Insurance Agents
Why does the United States spend more on healthcare than any other nation—yet often achieve worse outcomes? In Part Two of this thought-provoking conversation, Dr. Don Berwick—former Administrator of the Centers for Medicare & Medicaid Services (CMS), internationally recognized healthcare quality expert, and founder of the Institute for Healthcare Improvement (IHI)—joins Chris Comeaux to explore the systemic challenges facing American healthcare and the leadership required to create meaningful reform. From the evolution of Medicare Advantage to the financial incentives shaping healthcare delivery, Dr. Berwick explains why administrative complexity, payment models, and profit-driven incentives continue to drive costs higher while often failing to improve patient outcomes. Together, they examine the future of healthcare policy, value-based care, healthcare leadership, healthcare reform, Medicare, health insurance, and the role employers may play in demanding a more sustainable healthcare system. The conversation also turns to one of healthcare's greatest success stories—hospice and palliative care. Dr. Berwick argues that compassionate, person-centered care isn't simply a better way to care for people nearing the end of life; it provides a blueprint for improving healthcare across every stage of life. The episode concludes with an inspiring challenge to healthcare leaders: speak up for what is right, lead with courage, and never lose sight of healthcare's true mission—to heal, serve, and care for people. Whether you're a healthcare executive, hospice leader, physician, nonprofit executive, health system administrator, board member, or business leader, this conversation offers strategic insights into the future of healthcare—and practical leadership lessons that extend far beyond medicine.⸻Episode Highlights✔ Why Medicare Advantage has drifted from its original mission✔ The hidden cost of healthcare bureaucracy and administrative waste✔ The $80 billion debate surrounding Medicare Advantage payments✔ Why employer-sponsored healthcare may be approaching a breaking point✔ Lessons the U.S. can learn from healthcare systems around the world✔ Why hospice and palliative care represent a model for all of healthcare✔ The moral responsibility of healthcare leaders to speak with courage⸻If you enjoyed this conversation, please Like, Subscribe, and Share this episode with your leadership team, colleagues, board members, and friends. Every conversation helps us build stronger leaders and healthier organizations.
About halfway through 2026 — and just a few months before the critical midterm elections — Democrats appear to be doubling down on healthcare as a campaign issue as costs rise and insurance coverage declines.Meanwhile, Congress is taking aim at nonprofit hospitals. Shefali Luthra of The 19th, Rachel Roubein of The Washington Post, and Victoria Knight of Bloomberg Government join KFF Health News' Julie Rovner to discuss these stories and more.Also this week, Rovner interviews KFF Health News' Samantha Liss, who wrote the latest “Bill of the Month” story, about a woman who changed Medicare Advantage plans and found herself at a disadvantage.Visit our website to read a transcript of this episode.Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: Julie Rovner: Axios' “Chinese Fentanyl Makers Find New U.S. Market in Peptides,” by Tina Reed. Shefali Luthra: Stat's “Online GLP-1 Prescriptions Are Often Fast, Easy — And Low on Clinical Oversight,” by Katie Palmer. Rachel Roubein: The New York Times' “Efforts To Help Smokers Quit Stall Under Trump,” by Chistina Jewett. Victoria Knight: Stat's “Booze Schmooze: The Alcohol Industry, Frazzled by Headwinds, Wields Its Power Behind the Scenes,” by Isabella Cueto and Lev Facher.
Corrie ten Boom once said, “If you look at the world, you'll be distressed. If you look within, you'll be depressed. But if you look at Christ, you'll be at rest.” That truth speaks directly to the way many people feel about money. When money becomes the place we look for peace, security, or identity, financial unrest is never far behind. And while it may seem like more money would solve that unrest, Scripture points us to something deeper. Elizabeth Brickman, a Certified Kingdom Advisor® (CKA®), longtime financial advisor, and author of Wealth Blessed and Wealth Confident, has spent more than 25 years helping people think biblically about money. Through her own financial challenges and her work with clients, she has seen that true peace does not begin with a larger bank account. It begins when we stop asking money to carry what only God can. Why Financial Life Feels So Restless Many people feel financially restless because life itself rarely slows down. News, markets, social media, and cultural pressure are constantly telling us that more is better, faster is necessary, and comparison is unavoidable. That message is very different from the wisdom of Scripture. The world encourages us to chase more. God calls us to trust Him. The world tells us to measure our worth by what we own. God reminds us that our identity is found in Christ. The world keeps us anxious about what might happen next. God invites us to seek first His Kingdom. That doesn't mean financial concerns are imaginary. Bills, debt, rising costs, and future needs are real. But unrest grows when those concerns become bigger in our hearts than the Lord's faithfulness. Elizabeth notes that this struggle is not limited to one income level. Financial unrest can affect both believers and unbelievers, the poor and the rich. That is because unrest is not ultimately about how much money we have. It is about the mindset and heart posture we bring to money. When You Feel Overwhelmed One common source of financial unrest is feeling overwhelmed. When bills pile up, debt grows, or expenses feel unclear, it can be tempting to avoid the numbers altogether. Some people stop opening the mail. Others avoid checking their accounts. But avoidance usually increases anxiety rather than relieving it. Proverbs 27:23 says, “Know well the condition of your flocks, and give attention to your herds.” In an ancient agricultural context, that meant understanding the condition of one's livelihood. Today, the principle still applies. Wise stewardship requires clarity. That first step can be uncomfortable. Looking honestly at income, expenses, debt, savings, and giving may feel painful at first. But clarity allows us to move from vague fear to faithful action. Once the numbers are known, a plan can begin. We can ask questions like: What do we owe? What do we need to prioritize? Where can we reduce spending? What habits need to change? How can we continue honoring the Lord with what He has entrusted to us? God is not a God of disorder, but of peace. Facing financial reality is not an act of fear. It can be an act of faith, trusting that the Lord meets us in the truth and gives wisdom for the next step. Building Restful Financial Rhythms Financial peace is often strengthened through simple, faithful rhythms. Elizabeth emphasizes the value of habits because habits reduce the weight of constant decision-making. When giving, saving, spending, and debt repayment are built into regular patterns, we do not have to start from scratch every time money comes in. A budget is not merely a restriction. It is a tool for aligning financial decisions with God-given priorities. When we establish rhythms around generosity, saving, and wise spending, we are better prepared to resist impulse, fear, and comparison. These habits do not replace trust in God. They help us practice it. When You Feel Overlooked by God Another source of financial unrest is feeling overlooked by God. This can happen when others seem to be getting ahead while we feel stuck. It can happen when our hard work does not produce the results we hoped for. It can happen when prayers seem unanswered or when financial progress feels painfully slow. In those moments, we need to remember what Scripture teaches about growth, provision, and timing. God's wisdom often works “little by little.” Proverbs 13:11 says, “Wealth gained hastily will dwindle, but whoever gathers little by little will increase it.” That principle stands against get-rich-quick thinking, gambling, and reckless financial shortcuts. The Lord's way is often patient, steady, and formative. He teaches us to work, give, save, wait, and trust. Financial delay may feel frustrating, but it can also become a place of discipleship. Sometimes the Lord uses seasons of limitation to prepare us for greater faithfulness later. Being overlooked by the world is not the same as being forgotten by God. He sees His children. He knows their needs. And His timing is never careless. When You Feel Overextended A third source of financial unrest is feeling overextended, especially through debt. Debt can weigh heavily on the heart. It limits flexibility, creates pressure, and can make people feel trapped. Elizabeth speaks with compassion here because she has experienced that burden herself. After being caught in a devastating financial situation involving a trusted person who disappeared with borrowed money, she became morally obligated to repay a debt equal to about $200,000 in today's dollars. That season required daily trust, humility, and perseverance. But by God's grace, she paid the debt in full. For those who feel buried by debt, the way forward usually begins with humility and a plan. That may mean living more simply for a season, seeking wise counsel, cutting expenses, increasing income, or pursuing a structured debt-repayment strategy. Debt may be painful, but it does not have to define the rest of your story. God gives wisdom. He gives endurance. And He often uses the process of getting out of debt to reshape our desires, priorities, and dependence on Him. True Peace Begins With Christ Financial unrest often grows when we look to money for what only Christ can give. Money can pay bills, reduce certain pressures, and provide practical options. But it cannot give lasting peace. It cannot secure our identity. It cannot satisfy the soul. It cannot carry the weight of our ultimate hope. That is why biblical financial wisdom begins with worship. Before we ask, “How much do I have?” we need to ask, “Who am I trusting?” When we look at the world, there will always be reasons for distress. When we look only within, we may find fear, worry, or discouragement. But when we look to Christ, we are reminded that our lives are held by the One who is faithful. Financial peace is not found in pretending problems do not exist. It is found in bringing those problems honestly before the Lord and taking the next wise step with Him. So if you feel overwhelmed, seek clarity. If you feel overlooked, remember God's timing. If you feel overextended, humble yourself and begin taking faithful steps toward freedom. More money alone will not solve financial unrest. But Christ can reorder our hearts, renew our minds, and teach us to handle money with wisdom, contentment, and trust. On Today's Program, Rob Answers Listener Questions: I bought a home computer from a rent-to-own company right before COVID, but when work slowed down, I couldn't keep up with the payments. I tried to return it, but they said it would still count as a repossession and told me to keep it. Now the company has gone bankrupt, and a collection agency is offering a discounted payoff I can't afford yet. What legal action could they take if I miss the deadline, and could I go to jail over this? I'm 64 and turning 65 in November. I'm a retired educator with a strong pension and widow's benefit, and I may eventually switch to my own Social Security. I'm receiving lots of Medicare mail and dinner invitations from insurance companies. Where can I get reliable guidance, and how should I decide between Medicare Advantage and a Medigap plan? Resources Mentioned: Faithful Steward: FaithFi's Quarterly Magazine (Become a FaithFi Partner) Our Ultimate Treasure: A 21-Day Journey to Faithful Stewardship by Rob West Wisdom Over Wealth: 12 Lessons from Ecclesiastes on Money Look At The Sparrows: A 21-Day Devotional on Financial Fear and Anxiety Rich Toward God: A Study on the Parable of the Rich Fool Find a Certified Kingdom Advisor® (CKA) FaithFi App Remember, you can call in to ask your questions every weekday at (800) 525-7000. Faith & Finance is also available on Moody Radio Network and American Family Radio. You can also visit FaithFi.com to connect with our online community and partner with us as we help more people live as faithful stewards of God's resources. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.
In this episode, Dr. Ken Cohen, Chief Medical Officer at Optum Health, discusses new research on Medicare Advantage, social vulnerability, and how full-risk care models can improve quality, efficiency, and patient outcomes. He also shares insights on the infrastructure, technology, and strategies needed to advance value-based care.
Millions of Americans were saddened and outraged by the Sandy Hook Elementary shooting in 2012 that took the lives of twenty children and six adults, and were left feeling helpless about the epidemic of gun violence in the U.S. that, sadly, continues to this day. But for our guest today, Shannon Watts, her feelings of devastation about the shooting turned to rage and fueled her unlikely rise to leading Moms Demand Action, which she grew into one of the largest grassroots organizations in the country, mobilizing millions of volunteers to push for stronger gun safety laws. “I wanted to stand shoulder to shoulder with a badass army of women because that's who gets things done in this country,” she says. In this inspiring conversation with Raise the Line host Michael Carrese, Watts pulls back the curtain on how the group achieved its successes and the philosophy of "losing forward" that kept volunteers showing up year after year. In her recent book Fired Up, Watts describes how she is bringing insights from that experience to a new mission: helping women identify their values, abilities, and desires and acting on them without waiting until everything is perfect. Tune-in to learn about: The "false fires" women mistake for passion; Why losing estrogen and testosterone in midlife might actually make women braver, not less so; The one exercise she does with every woman she coaches. Mentioned in this episode: Fired Up book Moms Demand Action If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
This is the WFHB Local News for Thursday, July 9th, 2026. In today's newscast, Gloria Bent joins us on Prescription for Healthcare to discuss denial from United Healthcare's Medicare Advantage coverage while trying to save her husband's life. That's coming up in today's feature report. Also coming up in the next half hour, Correspondent Elena …
In this episode,Jakob Emerson, Associate News Director, Becker's Healthcare, examines the growing litigation over Medicare Advantage star ratings and the billions of dollars tied to quality bonuses. He also explores how AI is intensifying the coding and claims battle between health systems and insurers, creating new operational and financial challenges across the industry.
In this episode, Dr. Ken Cohen, Chief Medical Officer at Optum Health, discusses new research on Medicare Advantage, social vulnerability, and how full-risk care models can improve quality, efficiency, and patient outcomes. He also shares insights on the infrastructure, technology, and strategies needed to advance value-based care.
Michael Chernew, PhD, professor of healthcare policy at Harvard Medical School, joins Josh Israel, MD, and Sean Cavanaugh to discuss the Medicare Payment Advisory Commission (MedPAC) and its role in the Medicare program, including Medicare Advantage (MA) and the Medicare Shared Savings Program (MSSP). Dr. Chernew, who served as MedPAC chair from 2020-2026, shares how MedPAC provides evidence-based recommendations to Congress on payment policies, access and quality of care in Medicare. They examine Medicare solvency, cost-effectiveness concerns in both MA and MSSP, as well as larger challenges to improving the healthcare system for patients and physicians.
We're delighted today to sit down with MDVIP Chief Medical Officer, Dr. Jeffrey Lin to talk about so building a sustainable practice, finding joy in the practice of medicine, and what's happening what the next chapter of Primary Care looks like. Dr. Jeffrey Lin is a board-certified cardiologist, internist, and the newly appointed Chief Medical Officer of MDVIP, the nation's leading network supporting physicians in personalized, preventive, and relationship-driven primary care. A Harvard Medical School graduate and Yale summa cum laude, Dr. Lin completed advanced fellowship training at Massachusetts General Hospital and Columbia University before building a distinguished career that spans academic medicine, elite sports cardiology as a consultant to the NFL Players Association, and executive leadership at Devoted Health, where he was the company's first physician hire and helped build a patient-centered care model serving over 400,000 members across 29 states. He joins MDVIP at a pivotal moment in the organization's growth, bringing with him a career-long conviction that prevention is a long game, that physician joy is inseparable from patient outcomes, and that the future of primary care depends on giving doctors the time and the tools to actually know their patients. --- MDVIP Appoints Jeffrey Lin, MD, FACC, as Chief Medical Officer BOCA RATON, Fla. – April 22, 2026 – MDVIP, the national leader in supporting physicians to provide personalized, preventive, and primary care, today announced the appointment of Dr. Jeffrey Lin as Chief Medical Officer. A board-certified cardiologist and accomplished healthcare executive, Dr. Lin will lead MDVIP's clinical strategy and delivery as the company continues to expand its preventive and relationship-driven primary care model nationwide. Dr. Lin will also collaborate with the network's Medical Advisory Board on MDVIP's current and future offerings. The appointment reflects MDVIP's investment in physician leadership that deeply understands both the patient and provider experience, reinforcing the company's commitment to long-term health outcomes, proactive prevention, and a care model that gives doctors the time and tools to deliver truly personalized care. A cardiologist and internist by training, Dr. Lin has a longstanding commitment to prevention and optimizing health through data-driven, lifestyle-oriented approaches. He joins MDVIP from Devoted Health, where he served as National Medical Director and was the company's first physician hire, responsible for building its clinical care platform from the ground up. Since 2019, he helped lead the development and scaling of a comprehensive, patient-centered care model integrating preventive care, chronic disease management, and longitudinal wellness for primary care patients across the country, growing the clinical team to serve over 400,000 members across 29 states. As Chief Medical Officer, Dr. Lin will work closely with affiliated physicians and the MDVIP team to enhance the MDVIP experience for patients and providers alike. His priorities include strengthening MDVIP's preventive and wellness programs, supporting physicians transitioning into more manageable practice sizes, and expanding the MDVIP model to new physician segments and patient populations across different life stages. "MDVIP was built on the belief that primary care should be proactive, personal and sustainable for physicians," said Larry Kutscher, CEO and Board Chairman of MDVIP. "Dr. Lin has devoted his career to those same principles, designing care models that prioritize prevention, meaningful time with patients and better long-term health. He will be a powerful advocate for our physician community and a key partner in shaping the future of MDVIP." Dr. Lin's passion for MDVIP's mission is rooted in his early years in practice, when he saw firsthand how fragmented, specialist-heavy care consumed patients' lives and made it difficult to focus on prevention and long-term health. "As a cardiologist, I've always viewed health as a long game," said Dr. Jeffrey Lin, Chief Medical Officer of MDVIP. "The choices we make in our 40s and 60s shape the next 30 years of our lives. MDVIP has spent more than 25 years building a model that gives physicians the time and tools to focus on prevention and real relationships with patients. I'm excited to help bring that kind of care to more doctors and patients across the country." Dr. Lin also emphasized the importance of elevating the physician experience. "You can't deliver great long-term outcomes if the people providing care are burnt out," he added. "I'm looking forward to partnering with our affiliated clinicians to bring more joy back into their practice and help patients live longer, healthier lives." With the appointment of Dr. Lin, MDVIP is beginning a new chapter in its growth story, doubling down on personalized, relationship-centered care and expanding its influence among patients and physicians nationwide. About Dr. Jeffrey Lin Dr. Jeffrey Lin is a board-certified cardiologist, internist, and an accomplished physician executive dedicated to advancing personalized, preventive, and relationship-driven care. He previously served as National Medical Director at Devoted Health, a tech-enabled Medicare Advantage organization, where he's helped lead the development and scaling of a comprehensive, patient-centered care model nationwide since 2019. A cardiologist by training, Dr. Lin has a longstanding commitment to prevention and optimizing cardiovascular health through data-driven, lifestyle-oriented approaches. Earlier in his career, he served as Assistant Professor of Medicine at Mount Sinai Medical Center in Miami Beach and Co-Director of Cardiac Rehabilitation, where he built a thriving ambulatory cardiology practice and developed programs that enabled patients to achieve meaningful, sustained improvements in heart health. Dr. Lin's experience also includes caring for elite and professional athletes as a cardiology consultant to the National Football League Players Association, as well as leading clinical research on cardiovascular performance and endurance. His work has been published in leading medical journals, including the Journal of the American College of Cardiology and Circulation. He is also a Fellow of the American College of Cardiology. Dr. Lin earned his medical degree from Harvard Medical School and graduated summa cum laude from Yale University. He completed his residency in internal medicine at Columbia University Medical Center, followed by advanced fellowship training in cardiovascular medicine, sports cardiology, and cardiac imaging at Massachusetts General Hospital and Columbia University.
Don and D.L. Hughley are back together, and absolutely nothing is off limits. From Clarence Thomas and the birthright citizenship ruling to Megyn Kelly's latest racist rant, Trump's failing "Great American State Fair," and the future of MAGA, the laughs come fast and the takes hit even harder. Plus, Don and D.L. announce their brand-new DL + DL: Anything Goes Tour, and trust us, if this conversation is any indication, you won't want to miss what's coming. This episode is sponsored by FFRF. Visit https://ffrf.us/don or text DON 511511 to join or learn more. Because freedom belongs to all of us. Text Fees May Apply This episode is brought to you by Lean. Visit https://TAKELEAN.com and enter LEMON for your 20% discount and free rush shipping For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit podcastchoices.com/adchoices
In the United States, nearly 70% of people say they want to die at home, yet the majority still die in medical settings, often after receiving care that may not match their goals and values. Closing that gap between preference and reality is at the heart of the work being done by End Well, a nonprofit dedicated to transforming how we think about, plan for, and experience the end of life. "The gap isn't about people wanting the wrong things. It's that our culture and our incentives aren't aligned with helping those wishes actually happen at the end of life,” says Dr. Shoshana Ungerleider, End Well's founder and president. As Dr. Ungerleider explains to Raise the Line host Michael Carrese, End Well sponsors an annual symposium and year-round activities to bring together clinicians, patients, caregivers, and innovators to improve that alignment. Key steps include earlier integration of palliative care, allowing providers time for listening and goal setting with patients, and normalizing conversations about what matters most to people. This compelling conversation on reframing end of life care also covers how to bring wonder, joy, and hope into end-of-life conversations, and End Well's work to change how death is portrayed in the media. Mentioned in this episode:End Well If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
What's next, Dow 60K or 40K? Irrational Exuberance is now 30 (Happy Anniversary!), new methods for pricing college tuition, new car purchases slow and Medicare Advantage denials. Plus Trump accounts set to launch and Rule of 55.
SUMMARY Arundhati Parmar speaks with Jill Schwartz-Chevlin, Chief Medical Officer at Vinca, about the evolution of palliative care from a hospital-based, end-of-life service to a community and home-based model for patients living with serious illness. Jill explains how Vinca grew from an advanced care planning platform into a value-based palliative care company serving patients across five states, primarily through Medicaid and Medicare Advantage plans. The conversation covers the critical distinction between palliative care and hospice, the cost savings data that health plans are paying attention to, and what it will take for Medicare to finally build a sustainable reimbursement model for the specialty. KEY TAKEAWAYS Palliative care is not hospice. It is symptom management and whole-person support for patients still pursuing active treatment for serious illness, including cancer, COPD, and advanced heart failure. More than 75% of hospitals now have palliative care teams, but their positioning around end-of-life discussions has created a widespread misconception that palliative care equals dying. Home-based palliative care through Vinca produces a 42% reduction in ER admissions and a 53% reduction in hospitalizations. Only three states (California, Hawaii, and New Jersey) have established a Medicaid benefit specifically for palliative care. Traditional Medicare offers no such benefit. The current fee-for-service model for palliative care is not sustainable. Most palliative care programs linked to hospices survive only because the hospice subsidizes them. KEYWORDS palliative care at home, home-based palliative care, serious illness management, palliative care vs hospice, Vinca health, value-based palliative care, Medicaid palliative care benefit, Medicare Advantage palliative care, community palliative care, advanced care planning, hospice length of stay, ER reduction palliative care, whole-person care, serious illness, home health palliative care, CMO interview healthcare, palliative care reimbursement, MedCity Pivot podcast Links and resources Connect with Arundhati Parmar aparmar@medcitynews.com Arundhati Parmar (@aparmarbb) on X MedCity News EPISODE HIGHLIGHTS [00:02:04 – 00:02:36] Jill defines palliative care: symptom relief, patient wishes, team-based approach [00:03:11 – 00:03:46] Why hospital palliative care teams created the end-of-life association [00:06:13 – 00:07:06] Vinca's 15-year journey from advanced care planning to full palliative care services [00:11:43 – 00:12:07] The data: 42% ER reduction, 53% hospitalization reduction [00:12:52 – 00:13:31] Patient story: metastatic pancreatic cancer, golf one month ago, ER the next [00:18:47 – 00:19:29] Jill clarifies the hospice misconception: 90% of hospice care happens at home [00:22:50 – 00:24:10] Why Medicare's fee-for-service model for palliative care is failing and what should replace it
MEDICARE ADVANTAGE MINUTE: ARE THE TRADEOFFS FROM PRIOR AUTHORIZATIONS WORTH IT? THIS IS THE SINGLE BIGGEST BURDEN FOR PATIENTS WITH CHRONIC CONDITIONS ONE COMPANY'S MEDICARE SUPPLEMENT RATE INCREASE IN THE STATE OF UTAH IS A WHOPPER A PROSPECTIVE CLIENT CHECKS IN WITH SEVERAL PITHY QUESTIONS Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE ENROLLMENT GUIDE" - DOWNLOAD FREE "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" ....AND A PODCAST! @ DBJ@M4TLM.com W medicareforthelazyman.com T (630) 878-5055 Review Us On Google For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
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While Elsevier's most recent Clinician of the Future Report shows increasing adoption of artificial intelligence tools among physicians and nurses, and optimism that they will improve quality of care in the future, a majority raised concerns about trust and reliability. To increase the level of trust, 60% said transparent citations of evidence-based and peer-reviewed research will be key. How to provide that transparency is our focus today as Raise the Line host Lindsey Smith welcomes Elsevier colleagues Rhett Alden and Raman Kaur to guide us through the complexities involved, including the concept of traceability and what role it plays in how AI tools such as Elsevier's ClinicalKey AI are built and deployed. “Traceability changes the confidence that a clinician has in an AI tool so that they aren't trusting the AI, they're trusting the underlying evidence they're consuming from the AI-assisted platform,” says Raman, who brings years of experience as a primary care practitioner to her work. It's also important, Rhett adds, to provide additional information, pulled from both the clinician's query and the patient's medical record, to inform clinical thinking. “ClinicalKey AI can be more than a response engine by establishing a larger context to provide a more precise answer for that individual patient.” In this thought-provoking discussion, these experts also provide insights on: Mitigating bias in AI results; Using AI responsibly with sustainability in mind; What type of clinician will benefit most from AI Mentioned in this episode: ClinicalKey AI Clinician of the Future Report If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast
What happens when two of the Republican Party's top former strategists start spilling the tea? Rick Wilson and Stuart Stevens pull back the curtain on the GOP like never before, exposing decades of hypocrisy, the party's obsession with LGBTQ+ issues, and the shocking stories they witnessed from the inside. From the so-called "Pink Mafia" to MAGA's culture wars, nothing is off limits. It's funny, jaw-dropping, and guaranteed to have Republicans clutching their pearls. And after years of hearing Donald Trump gush about men's physiques, Arnold Palmer's anatomy, and a seemingly endless parade of very gay-adjacent comments, one question inevitably comes up: Could Trump be gay? (We're kidding... mostly.) This episode is sponsored by Incogni. Go to https://incogni.com/donlemon and use code donlemon for 60% off. Incogni HELPS wipe yourself from the Internet — they can't harm you if they can't find you. Click the link below to claim your 60% off and get your personal data off the market! Erase yourself from the internet This episode is brought to you by Shopify. See less carts go abandoned and more sales go with Shopify and their Shop Pay button.Sign up for your one-dollar-per-month trial today at https://SHOPIFY.COM/lemon This episode is sponsored by FFRF. Visit https://ffrf.us/don or text DON 511511 to join or learn more. Because freedom belongs to all of us. Text Fees May Apply This episode is brought to you by Helix. Go to https://helixsleep.com/don for 20% off Sitewide and 25% off Luxe Mattresses and 30% off Elite Mattresses For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode of Sg2 Perspectives, host Trevor DaRin is joined by Sg2 experts Brian Esser and Jayme Zage, PhD, for a discussion of recent health care headlines and what they may signal for health systems. The conversation explores affordability and AI, hospital rankings, Medicare Advantage tensions, workforce pressures, and GoodRx's subscription strategy. Together, they separate signal from noise and highlight how leaders can think about technology, payer dynamics, labor supply and consumer engagement in the years ahead. We are always excited to get ideas and feedback from our listeners. You can reach us at sg2perspectives@sg2.com, or visit the Sg2 company page on LinkedIn.
In this episode, Scott Becker reviews 8 key healthcare developments, including telehealth expansion, Medicare Advantage challenges, CEO turnover, AI governance, and more.
Revenue cycle metrics can reveal far more than days in A/R, cash collections, or cost to collect. In this episode, Jon Vitiello, SVP & CFO at St. Luke's Health, joins Stuart Newsome to discuss how CFOs interpret RCM signals, separate operational noise from financial risk, and use revenue cycle insight to guide strategy, investment, Medicare Advantage response, and patient access performance.Brought to you by www.infinx.com
The Knicks are NBA champions, but should they head to the White House? After James Dolan announced the team plans to visit, questions are already swirling: Is the entire team on board, and what does that visit mean in today's political climate? Tonight, Don breaks it all down, along with the powerful message of hope, democracy, and unity from today's opening ceremony at the new Obama Presidential Center. Michelle Obama had some words for Donald Trump! This episode is brought to you by BetterHelp. BetterHelp makes it easy to get matched online with a qualified therapist. Sign up and get 10% off at https://BetterHelp.com/donlemon This episode is sponsored by Byron Publishing. Get your copy of “Bullies, Parasites and Slaves” at https://www.BPS.online or text the word, “BULLY” to 511511 and receive an immediate link to get the book – paperback, E-book or audio. Text Fees may apply. This episode is sponsored by Lean. Visit https://TAKELEAN.com and enter LEMON for your discount. For free and unbiased Medicare help, dial 212-931-0855 to speak with my trusted partner, Chapter, or go to https://askchapter.org/don DISCLAIMER: Chapter and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Chapter Advisory, LLC represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 18,160 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Chapter agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options. Average potential savings are based on realized premium, co-pay, and out of pocket savings estimates self-reported by consumers that worked with Chapter Advisory LLC to enroll in a Medicare Supplement, Medicare Advantage, and/or Part D Prescription Drug Plan. The average is limited to consumers that chose to self-report. Savings information is subject to periodic updates and corrections. There is no guarantee of savings and any savings may vary by policy type, state, or other factors. Learn more about your ad choices. Visit megaphone.fm/adchoices
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