Podcasts about Optum

The land of Big Tech Therapy has been making headlines. I cover some of them in this episode.*The links shared below are a reference only and do not necessarily reflect the opinions of Marie Fang, Private Practice Skills, or its sponsors.If you'd like a great summary of all that I covered, check out ZynnyMe's article:https://www.zynnyme.com/blog/alma-headway-and-the-big-questionIf you feel compelled to do something, this r/therapists post links to several options at the systemic level:https://www.reddit.com/r/therapists/comments/1tvzpov/support_and_advocacy_for_therapists/Build Better Health's Mental Health Insurance Reform Task Force's Petition (if you'd like to sign):https://actionnetwork.org/petitions/we-demand-a-system-that-reflects-the-true-value-of-mental-health-careThank you to Paubox for sponsoring this episode. Paubox makes HIPAA-secure email and forms easy and streamlined. Check them out here:⁠https://hubs.la/Q04k58tL0⁠*Get $250 off your first year with Paubox with coupon code "SKILLS"*Bonus Deal:* If you add the Paubox badge to your website you get an extra $100 off your first year - that means you can get your whole first year free if you apply both deals!Citations:Alma has investments from Cigna and Optum:https://cignaventures.com/alma-raises-130m-in-series-d-funding-led-by-thoma-bravo-to-advance-its-mission-to-simplify-access-to-high-quality-affordable-mental-health-care/Health Care Service Corporation (HCSC), the parent company of several Blue Cross Blue Shield programs, invests in Headway:https://www.hcsc.com/newsroom/news-releases/2023/strategic-investment-headway-behavioral-healthReference: HCSC is parent company of Blue Cross Blue Shield:https://www.hcsc.com/who-we-areRula backed by Blue Venture Fund:https://bhbusiness.com/2024/09/17/digital-mental-health-platform-rula-health-expands-to-50-states/Reference: Blue Venture Fund invests on behalf of Blue Cross Blue Shield:https://blueventurefund.com/Headway and Alma announce 30 percent cut in Optum Rates, January 2025:https://clearhealthcosts.com/blog/2024/11/2-digital-mental-health-platforms-cut-pay-rates-for-therapists-with-unitedhealths-optum-stirring-anger/Aetna cuts rates with Alma-contracted therapists:https://bhbusiness.com/2026/05/21/aetna-cuts-rates-with-alma-contracted-therapists/r/therapists megathread on Aetna's rate cuts through Alma:https://www.reddit.com/r/therapists/comments/1tj1bl1/megathread_aetna_alma_reimbursement_changes_90837/APA urges Aetna to halt rate cuts:https://updates.apaservices.org/apa--american-psychiatric-association-urge-aetna-to-pause-reimbursement-rate-cuts-for-behavioral-health-cliniciansAetna Launches Aetna Mental Health on Demand:https://www.aetna.com/insights/news/aetna-launches-mental-health-on-demand.htmlCVS Announces Aetna Mental Health on Demand:https://www.cvshealth.com/news/condition-management/aetna-launches-aetna-mental-health-on-demand-to-provide-real-time-access-to-care-and-ongoing-support.htmlProof News Article: "Woman's Talkspace Therapy App Sessions Exposed in Court"https://www.proofnews.org/womans-talkspace-therapy-app-sessions-exposed-in-court/FTC Sues Amazon for Monopoly Power:https://www.ftc.gov/news-events/news/press-releases/2023/09/ftc-sues-amazon-illegally-maintaining-monopoly-powerClass Action Lawsuit Against Headway:https://www.classaction.org/news/headway-hit-with-class-action-over-alleged-disclosure-of-patient-info-to-googleClear Health Costs Article: "Therapists have misgivings on the platforms: Alma, Headway etc. and the business of therapy”https://clearhealthcosts.com/blog/2025/11/therapists-have-misgivings-on-the-platforms-alma-headway-etc-and-the-business-of-therapy/Website: www.privatepracticeskills.comThis podcast is not intended as professional or legal advice. Be sure to seek the services of a professional if you are in need of them.

CMS continues to pull on the levers it has at its disposal to rein in national healthcare spend, including rulemaking around Medicare Advantage. In April, CMS announced the final rate for MA plans for CY2027, after a controversial proposed rule generated animated pushback — and a fair bit of panic — among payers. In this episode, host Abby Burns speaks with Alex Balmes, Vice President of Actuarial Services at Optum, to unpack what did — and didn't — end up in the final rate announcement, and what that signals for the future of the Medicare Advantage program. Together, they explore the components of the final rate that are most important for payers and providers to pay attention to, respectively, and why. Also in the 2027 final announcement, but not discussed in this episode: four measures are being added or updated in Star ratings calculations (Colorectal Cancer Screening; Care for Older Adults – Functional Status Assessment; Concurrent Use of Opioids and Benzodiazepines (COB); Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)) and three are being removed (Care for Older Adults – Pain Assessment, Medication Reconciliation Post-Discharge, Medication Therapy Management (MTM) Program Completion Rate for Comprehensive Medication Review (CMR)) We're here to help: Read the 2027 CMS Announcement | 2027 | CMS Episode | 286: A Medicare Advantage reset — and what comes next Ready-to-Use Slides | Medicare Advantage market outlook Stay informed | Healthcare policy updates Tool | Policy Scenario Impact Calculator Connect with an Optum Advisory expert | Optum Learn more about Advisory Board's 2026 summit series. A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

After a decidedly difficult few years in the world of nursing, things have seemingly gotten better — at least, on paper. And that's reflective of a lot of hard work on the part of nursing leaders. But when we look at how long nurses plan to stay in the profession, we see a different story taking shape. In this episode of Radio Advisory, host Abby Burns is joined by Advisory Board nursing expert Ali Knight and Optum expert Sherilynn Quist. Together, they unpack what today's workforce data is really telling us and what it misses, the root causes driving nurses' discontent, and why strengthening the nursing workforce can't be left to nurse leaders alone. We're here to help: Episode | 274: The nurse engagement tactic leaders may be missing Expert Insight | Labor costs continue to go up. What does it mean for health systems? Expert Insight | Engage frontline staff to increase margin Webinar | 5 key trends shaping the nursing workforce today Webinar | Inform your workforce decisions with Advisory Board's benchmarks Learn more | Optum Advisory: Sustainable Growth and Margin Consulting 5 strategies to close gaps in bladder cancer care A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Across the industry, leaders are talking about a “battle of the bots”—with payers and providers racing to deploy AI across the revenue cycle. But that narrative may be more hype than reality. In this episode, Rae Woods is joined by Advisory Board experts Isis Monteiro and Elysia Culver to separate fact from fiction. They break down where AI is actually delivering value today—and why it's showing up as efficiency gains and cost avoidance, not revenue growth. And they make the case for a different approach: stop chasing AI for its own sake, and start focusing on margin protection, operational discipline, and the problems that actually need solving. We're here to help: Report | Revenue cycle claims denial benchmarks Report | Addressing plan-provider friction: 3 insights from Optum's Payer-Provider Abrasion survey Case Study | 3 steps to prevent prior authorization denials Learn | AI in healthcare: Evaluating promising use cases Playlist | Radio Advisory Provider Strategy and Financial Outlook playlist Playlist | Radio Advisory Tech and AI playlist Learn about Advisory Board's 2026 summits A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Crystal Run Healthcare or Optum has announced by email to certain patients they would be permanently closing the OB/GYN practice in Rock Hill.More ICE agents may be headed to NY. Spectrum news reports the border czar says more agents could be sent if legislation passes that limits how law enforcement can work with the agency, it's called the "Local Cops, Local Crimes Act". NYSEG along with Rochester Gas and Electric are working to relocate natural gas meters inside homes and businesses to outdoor locations that are safer and more accessible.A second-year SUNY Sullivan Liberal Arts & Sciences student from Monticello has received the Chancellor's Award for Student Excellence.        

There is recent evidence that OWCP (under the U.S. Department of Labor) has increasingly began to outsource significant portions of claims-related services for FECA (federal workers' compensation) to third-party vendors, including private companies traditionally known for state workers' compensation claims management. This is a change in the entire structure of the FECA and OWCP government division's responsibilities. OWCP has been slowly outsourcing divisions of OWCP to outside contracts in the form of third party vendors. This began with  medical bill processing (e.g., past transitions to vendors like CNSI now called ACCENTRA) and  medical authorizations.  This began when OWCP decided to outsource the pharmacy benefits to an outside corporate vendor called OPTUM, a pharmacy benefit manger to manage all of OWCP's pharmacy benefits. We can expect to see an increasing amount of companies continue to be added for specifically handling broad OWCP claims adjudication, the overall trend of outsourcing to experienced private-sector TPAs vendors from the state workers' comp ecosystem is now the wave of the future. For more information read the show transcript. The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  Dr. Taylor's contact email information is:https://fedcompconsultants@protonmail.com If you need a medical provider or assistance with an OWCP /  DOL claim in  Pensacola Florida you can make an appointment to see Dr. Taylor  at the clinic at  FWC Medical Centers . To make a consultation with Dr. Taylor  call the clinic at 813-215-4356  in Florida. For responses email Dr. Taylor at fedcompconsultants@protonmail.comSupport the showFEEDSPOT TOP #1 Federal Workers Compensation Podcast & #6 National Workers Compensation Podcast:For responses email Dr. Taylor at fedcompconsultants@protonmail.comSupport the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

The U.S. healthcare system is approaching a major inflection point. Nearly $1 trillion in Medicaid cuts are set to take effect in January 2027, driven by new work requirements, more frequent eligibility checks, and tighter limits on state financing. While the policy changes are months away, their consequences are already clear: millions of Americans are at risk of losing coverage, and provider organizations — many operating on margins near zero — will absorb the downstream impact through rising uncompensated care. In this episode, hosts Rae Woods and Abby Burns are joined by former Optum Executive Director of Product and Strategy Sunay Shah to help healthcare leaders move from “scramble” to strategy. Drawing on lessons from past Medicaid shifts, including redeterminations and state level work requirement experiments, they explain why administrative disenrollment —not ineligibility — is the biggest threat facing patients and providers alike. Together, they break down what health systems can do now to keep eligible patients covered: redesigning workflows earlier in the patient journey, using technology more thoughtfully, partnering with community organizations, state agencies, and operational support partners, and rebuilding trust with patients during moments of vulnerability. We're here to help: Episode | 288: Health policy update: VBC, site-neutral payments, and 340B Playlist | Radio Advisory health policy playlist Ready-to-Use Resource | Your guide to CMMI's 25+ innovation models Expert Insight | How policy changes will impact your bottom line White Paper | Navigating the next era of Medicaid On-Demand Webinar | Adapting to the changes in Medicaid policies Want to learn more about how Optum can help? Connect with our team today Register today for the 2026 Advisory Board Summit in Washington, D.C. 2026 State of Healthcare Procurement: Cost, Quality, Resilience A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Send us Fan Mail(Part 2 of 2) Grab a seat and pour yourself a cold one! In this episode, Mike and Dan are cracking open the white paper from Optum, titled "Low Hours, High Impact".For years, the "more is better" 40-hour-a-week model has been the industry standard, but the data is starting to tell a different story. We're diving deep into the science and the shift toward Value-Based Care, exploring how focused, high-quality interventions can sometimes move the needle further than pure volume.In this "pour," we're serving up:The 40-Hour Hangover: Why the "intensive" model might not always be the most effective for every learner, especially the little ones.Efficiency on Tap: Breaking down Optum's findings on how lower-intensity, high-precision services can drive meaningful clinical outcomes.The Payer's Perspective: A look at how major payers like Optum are redefining "Medical Necessity" and what that means for your clinic's billing and documentation in 2026.Quality over Quantity: How to advocate for the right amount of hours without sacrificing progress or burning out your RBTs.Whether you're a BCBA navigating authorization battles or a business owner looking at the future of ABA funding, this episode delivers the straight talk you need—minus the boring jargon.Tune in, drink up, and always analyze responsibly. Support the show

In this episode, Steve Yurjevich, Chief Executive Officer of Optum Insight's Payer Market and a member of the American Heart Association Executive Leadership Team, joins the podcast to discuss rising healthcare costs and the growing adoption of AI across the payer landscape. He shares how the industry is shifting from pre-pay models to true avoidance strategies, focusing on preventing unnecessary care and improving overall system efficiency.

In this episode, Steve Yurjevich, Chief Executive Officer of Optum Insight's Payer Market and a member of the American Heart Association Executive Leadership Team, joins the podcast to discuss rising healthcare costs and the growing adoption of AI across the payer landscape. He shares how the industry is shifting from pre-pay models to true avoidance strategies, focusing on preventing unnecessary care and improving overall system efficiency.

Neste episódio, conversamos com as Drs. Marcia Keiko Tabuse e Raíra Moraes sobre suas experiências no atendimento oftalmológico de pacientes com TEA. Elas compartilham estratégias práticas para consultas, dicas para exames (como preparação, esquiascopia pré-dilatação e uso de Lea Symbols), protocolos personalizados, questões sensoriais (ex.: intolerância a óculos e oclusão) e lições aplicadas à oftalmologia.Materiais de Apoio:Chang MY, Doppee D, Yu F, Perez C, Coleman AL, Pineles SL. Prevalence of ophthalmologic diagnoses in children with autism spectrum disorder using the Optum dataset: a population-based study. Am J Ophthalmol. 2021;221:147–53. doi:10.1016/j.ajo.2020.08.048. Hoover K, Di Guglielmo MD, Perry B. Disparities in vision screening in primary care for young children with autism spectrum disorder. Pediatrics. 2023;151(4):e2022059998. doi:10.1542/peds.2022-059998 Iman Yahya, M Ashwin Reddy. Barriers to ophthalmic care for children with autism spectrum disorder. Paediatrics and Child Health. doi: 10.1016/j.paed.2025.09.005. SBOPCast 30. O que o oftalmopediatra precisa saber sobre autismo.

Send us Fan Mail(Part 1 of 2) Grab a seat and pour yourself a cold one! In this episode, Mike and Dan are cracking open the white paper from Optum, titled "Low Hours, High Impact".For years, the "more is better" 40-hour-a-week model has been the industry standard, but the data is starting to tell a different story. We're diving deep into the science and the shift toward Value-Based Care, exploring how focused, high-quality interventions can sometimes move the needle further than pure volume.In this "pour," we're serving up:The 40-Hour Hangover: Why the "intensive" model might not always be the most effective for every learner, especially the little ones.Efficiency on Tap: Breaking down Optum's findings on how lower-intensity, high-precision services can drive meaningful clinical outcomes.The Payer's Perspective: A look at how major payers like Optum are redefining "Medical Necessity" and what that means for your clinic's billing and documentation in 2026.Quality over Quantity: How to advocate for the right amount of hours without sacrificing progress or burning out your RBTs.Whether you're a BCBA navigating authorization battles or a business owner looking at the future of ABA funding, this episode delivers the straight talk you need—minus the boring jargon.Tune in, drink up, and always analyze responsibly. Support the show

SummaryIn this episode, Sean and Terry Fletcher discuss the latest issues in healthcare compliance, focusing on problematic billing practices, the risks of retrospective diagnosis coding, and the influence of third-party payers like Optum. They explore how these practices threaten provider integrity and patient care, offering insights and advice for healthcare professionals navigating these challenges.Key TopicsHealthcare billing and coding practicesRisks of retrospective diagnosis coding and claims manipulationImpact of third-party payers on provider integrityUncovering the Truth Behind Healthcare Billing FraudHow Payers Like Optum Are Influencing Medical Coding

Send us Fan MailWhat if food worked better than medication for managing diabetes?In this clip from our episode “Food As Medicine: From Trend to Treatment”, CareTalk host John Driscoll and guest Spencer Pratt, Chief Growth Officer at NourishedRx, share the clinical data behind their food as medicine approach to diabetes care.

This week, the Glaucomfleckens are feeling a bit "spicy" as they navigate the grogginess of daylight savings and the fallout of their recent trip to New Orleans. Will shares a harrowing story from a recent live show where an ad-libbed joke about sperm banking and "the sisters" nearly cost him the audience, only to be saved by the laughing nuns in the front row. Between beignets and redfish, the conversation turns to the high-stakes world of healthcare policy. The gloves come off as Will discusses his recent viral collaboration with Senator Elizabeth Warren regarding the "Breakup Big Medicine Act". He addresses the social media backlash from universal healthcare advocates, offering a "realist" perspective on why incremental progress and bipartisan bills are necessary in a capitalist-minded country. It's a candid look at the friction between utopian ideals and the legislative grind. Finally, the discussion hits home with an update on the Eugene Emergency Physicians in Oregon. Will recounts his trip to the state capitol to support local doctors fighting a corporate takeover by an Atlanta-based firm. From the "moral weaponization" used to prevent doctor strikes to the PR nightmares that keep hospital administrators up at night, this episode is a call to action for patients and providers alike to be "loud and obnoxious" in the face of corporate greed. Takeaways: Why a front row of nuns ended up being Will's favorite audience for jokes about testicles. The bipartisan bill in 2026 that aims to stop giant conglomerates like Optum from taking over your local doctor's office. Will's "spicy" take on why demanding "Universal Healthcare or nothing" might actually be hindering medical progress. The "David and Goliath" battle in Eugene, Oregon, where local legislators found their hands tied by a 2,000-mile-away corporation. Why your doctor is likely terrified to tell you what's actually happening behind the scenes at their hospital. — 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. Go to Cozy Earth now for a Buy One Get One Free Pajama Offer from 1/25-2/8! Yes, go to ⁠⁠⁠⁠⁠⁠cozyearth.com⁠⁠⁠⁠⁠⁠ they are doing a BOGO pajama promo. Just use my Code: KNOCKKNOCKBOGO Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us Fan MailFood as medicine is moving from buzzword to real healthcare strategy.In this CareTalk episode, Spencer Pratt, Chief Growth Officer of NourishedRx, explains why nutrition is finally getting the policy, payer, and consumer support needed to impact chronic disease at scale.

This podcast episode recorded at day one of Digital Health Rewired 2026 explores how technology and data can help deliver neighbourhood health. The NHS 10 year health plan includes the creation of a Neighbourhood Health Service, which aims to bring care closer to home and reduce healthcare inequalities. Neighbourhood health teams will bring together multi-disciplinary professionals to focus on patients with multiple long-term conditions and people with complex needs. In this episode of Digital Health Unplugged, host Jordan Sollof discusses the new service with Ben Hampshire, regional director at Optum, and Dr Rowan Sil, chief clinical information officer (CCIO) at Leicester, Leicestershire and Rutland Integrated Care System (ICS). Hampshire highlights the digital capabilities required to make the neighbourhood health model work effectively, including the use of data for population health management, tools to support elective recovery, and technologies that help patients to ‘wait well'. Dr Sil discusses the importance of equipping clinicians with joined-up systems and the role of digital in connecting voluntary and community organisations into neighbourhood care pathways. They also examine the importance of ensuring that underserved populations are not excluded from digitally enabled neighbourhood care and share some real-world examples of where neighbourhood working is already making a difference. Guests: Ben Hampshire, regional director at Optum Dr Rowan Sil, CCIO at Leicester, Leicester and Rutland ICS  

Case IH is expanding its Optum tractor lineup with a new series designed to handle a wide range of field and transport applications, combining higher horsepower with updated ride quality and integrated technology. At Commodity Classic in San Antonio, Texas, RealAgriculture’s Bernard Tobin spoke with J.E. Cadle, medium tractor marketing manager with Case IH, about... Read More

Send us Fan MailEvery year, millions of Americans end up in emergency rooms and hospital beds for conditions that could be treated just as well, and far more safely,in their own homes. So why does care still default to the most expensive, most disruptive setting possible? And who's actually doing something about it?Lon Hecht, CEO, Care2U joins host David Williams, President of Health Business Group to discuss bringing high-acuity care into the home, why hospital at home has struggled to scale, and how payers and providers are finally starting to align around a better model.

Andy and Brendan went LIVE on YouTube following the conclusion of the 2026 Players Championship, recapping an electric Sunday back nine that ended in Cameron Young's second PGA Tour victory. The two initially give some credit to "The Boys" after a week full of adversity in the AirBNB but came with the trade off of a big win for Mr. 1,000. Young defeated Matt Fitzpatrick following a blow up from 54-hole leader Ludvig Åberg. Despite a sleepy Saturday and a slow start to Sunday, the last 90 minutes at TPC Sawgrass delivered for viewers once again. Andy and Brendan discuss Cameron Young's history as a "big game player" and how the setup with long rough helped him as a longer hitter off the tee. They also unpack Åberg's collapse on holes 11 and 12 and his gameplan that ended up getting him in trouble. Grades are given to Cam, Ludvig, Scottie Scheffler, the course setup, NBC, and other contenders as is tradition at a "major" event. The Boys, Joseph LaMagna and PJ, join in for the back half of this episode to celebrate a Victory Monday for the only recurring guest in "Lunch with The Boys" history. PJ shares insight from his weekend on the ground and his time following the NYGC tandem of Young and Fitzpatrick on Sunday, while Joseph shines some light on Sudarshan Yellamaraju, one of the breakout players of this week. We wrap with some small unsubstantiated rumors after a successful week in Jacksonville for the 2026 Players Championship. Thank you to ⁠⁠⁠Optum⁠⁠⁠ for their support of our Players Championship coverage.

We got a live rollicking one! Andy and Brendan went live after leaving the opening round of The Players Championship at TPC Sawgrass. They react to some early mover and shakers, Collin Morikawa's instant WD, and how the course changed, evolved, and punched back at the players early in the championship. They react to Rory McIlroy giving it a run with his injury and Scottie Scheffler's somewhat middling round with some struggles off the tee. They make some predictions for the next three days and also discuss some storylines that no one is talking about here. They spend the last half of the podcast reacting to Brian Rolapp's grand rollout of some major plans to change and tweak the PGA Tour as announced on Wednesday in a theatrical setting at the Global Home. Can he actually get this proposal across the line facing increased pushback from players and other stakeholders in the game? Thank you to ⁠⁠Optum⁠⁠ for their support of our Players Championship coverage.

On a very special episode of The Fried Egg Golf Podcast, five-time major champion and career grand slam winner Rory McIlroy sits down with Kevin Van Valkenburg to talk legacy, career goals, life after golf, and his bucket list courses. Thank you to ⁠⁠Optum⁠⁠ for their support of our Players Championship coverage.

Minnesota District 58A Representative Kristi Pursell recaps the week in the Minnesota Legislature, including keeping up with the Senate, a press conference in regards to a pair of bills proposed in both chambers to ban the herbicide paraquat and to fund Parkinson's research in Minnesota, another bill proposed to ban neonicotinoid seeds, a bill proposed to release the Optum report, and more. 

In this episode, Krista Nelson, CEO of Optum Health, shares her vision for strengthening value based care through a more focused care delivery model, stronger clinician support, and expanded technology capabilities. She also discusses Medicare Advantage policy stability, the role of AI in reducing administrative burden, and how partnerships across the healthcare ecosystem can improve outcomes and patient experience.

In this episode, Krista Nelson, CEO of Optum Health, shares her vision for strengthening value based care through a more focused care delivery model, stronger clinician support, and expanded technology capabilities. She also discusses Medicare Advantage policy stability, the role of AI in reducing administrative burden, and how partnerships across the healthcare ecosystem can improve outcomes and patient experience.

How did health systems perform in 2025, and which strategic growth priorities are top-of-mind for 2026? Health systems have entered the year with both momentum from buoyed volumes, and mounting pressure as those volumes don't necessarily translate to healthy margin. This week, host Abby Burns sits down with Advisory Board expert Marisa Nives and Optum consulting expert Alex Kist to unpack results from Advisory Board's annual Strategic Planner Survey. They explore how health systems are—and aren't—running at growth, and what separates the systems that are able to turn volumes and revenue into margin, from those that aren't. Be sure to catch next week's episode, when Advisory Board experts discuss the data that planners need (and often lack) to make these strategic decisions with confidence in 2026. We're here to help: Webinar | The 5 growth levers to help make your health system stronger (not just bigger) ICYMI: Webinar | The top 10 trends impacting health systems in 2026 Report | 6 ways to reduce referral leakage from primary to specialty care Report | 3 ways to pursue differentiated growth for your service lines Episode | Ep. 225: Patients are back – so why aren't hospital margins? Playlist | Radio Advisory Provider Strategy and Financial Outlook playlist Expert Insight | 3 trends shaping healthcare in 2026 (and how to respond) Connect with an Optum expert | https://optum.co/3vrzyw Real-time transparency infographic A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Andy and Brendan are just about ready to head down to Ponte Vedra for a "major" March event, but we've already missed out on one Players tradition! Andy can't believe that the yearly TPC Sawgrass arrival videos did not make it into Sunday's Arnold Palmer Invitational broadcast. NBC couldn't cut away from a duel between Daniel Berger and Akshay Bhatia on the back nine that ended with Akshay's third playoff win on the PGA Tour. The two break down Bhatia's comeback win and standing in the game as one of the premier players under the age of 25. The constant comparisons between Rickie Fowler and Arnold Palmer and some complaints from Justin Thomas regarding the setup at Bay Hill also feature prominently in this Arnold Palmer Invitational recap. The Players DID release their featured groups on Sunday afternoon, leaving a spot for an injured(?) Rory McIlroy and a struggling Justin Thomas to be on non-stop coverage for the first two rounds. Andy's "Event of the Week," the Puerto Rico Open, was "must see TV" with a leaderboard full of young talent including John Daly II, Blades Brown, and winner Ricky Castillo. Patrick Reed notched another DP World Tour top 10, but could not stop the blaze of Dan Bradbury at the Joburg Open. Brendan then shifts the conversation to Jon Rahm's win at LIV Hong Kong, his first individual win since 2024. Neither Brendan nor Andy are moved much by this win for Rahm and point out that maybe playing a LIV schedule is not the best preparation for a major championship, unlike the test presented by Bay Hill this week. Lastly on results, Zach Johnson is one-for-one in his Champs Tour career, taking down the James Hardie Pro Football Hall of Fame Invitational! Sorry to all Ben Crane bettors, as he finished outside of the top 30 in his Senior Tour debut. This Gambling Podcast regrets the error. Check back on Tuesday as Andy and Brendan go live(?) to preview the 2026 Players Championship! Thank you to Optum for their support of our Players Championship coverage.

Andy Johnson is joined by Sean Martin of the PGA Tour to preview the upcoming 2026 Players Championship. Andy and Sean discuss the quest for a third win at TPC Sawgrass for both Rory McIlroy and Scottie Scheffler, breakout players to watch like Jacob Bridgeman and Chris Gotterup, and make their picks for who wins the PGA Tour's premier event. They also preview PGA Tour CEO Brian Rolapp's Wednesday press conference as rumors swirl regarding the 2027 "Scarcity Schedule." The second half of this episode is a re-airing of Garrett Morrison's "Fried Egg Stories" episode on the making of TPC Sawgrass. Originally airing on March 13, 2020, Garrett tells the story of how commissioner Deane Beman and architect Pete Dye turned that land into a new kind of golf venue—and how the pros reacted when they competed on it for the first time. This episode features interviews with Beman, U.S. Open and Players champion Jerry Pate, architect Tom Doak, TPC Sawgrass project manager Vernon Kelly, and journalists Adam Schupak and Sean Martin. It includes music from Assaf Ayalon, Avi Goldfinger, Maya Johanna, Ian Post, and Swirling Ship, and Kevin McLeod. Thank you to Optum for their support of our Players Championship coverage. Visit ⁠Cobalt⁠ and use code "FRIEDEGGPOD15" for 15% off: https://cobalt-golf.com/discount/FRIEDEGGPOD?redirect=%2Fcollections%2Fdiscountable-products

Health Affairs' Rob Lott interviews Derek T. Lake on his recent paper exploring new research on Optum's acquisitions, finding the company tended to buy physician practices already using ambulatory surgery centers and that its ASC acquisitions were followed by higher prices for competing insurers.Order the February 2026 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: T1D in the Olympics & Superbowl, Trump RX goes live, Ozempic pill available soon, tech updates from Medtronic, Beta Bionics, Eversense 365 and more! Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  T1D Screening info All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Episode transcription with links: Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bringing you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. Quick reminder: We are just over one week from our first Moms' Night Out event of the year. While the plans are all set – the speakers, the vendors, the raffles and the fun is ready to go, it's always amazing how many people hear of these event last minute. That's fine, they're welcome! But if you're thinking of attending a future event – registration is open for We're going to Nashville next March 6-7 and Detroit in September – no need to wait. And we've got Club 1921 events for health care professionals and patient leaders in 6 cities this year! All the info is over at diabetes-connetionss.com events/   Okay.. our top story this week: XX Gotta be a quick shout out to some incredible T1D athletes – we had TWO in the super bowl this past weekend – Chad Muma of the New England Patriots and Logan Brown of the Seattle Seahawks AND there are at least two athletes with type 1 competing at the Winter Olympics. Hannah Schmidt competes in ski cross for Canada – she was diagnosed with Type 1 diabetes at age 12 years old.  Anna FarnSchadt Fernstäd a Czech skeleton racer diagnosed in 2022 after she'd already been to several Olympics. We wish them all the best!   https://english.radio.cz/skeleton-racer-anna-fernstadtova-overcoming-adversity-headfirst-down-ice-8876699 XX The government website TrumpRx.gov is live..  the website does not sell prescription drugs. Instead, it allows people to look up their drugs and then navigate to buy them elsewhere, either from a major drug company or a pharmacy. The 43 drugs listed on the site have prices ranging from $3 to over $5,500. TrumpRx does include warnings that the site may not be the best option to save money on prescriptions. Each product page advises: "If you have insurance, check your co-pay first — it may be even lower." For now, the website says its prices are for people paying with their own money, rather than going through insurance. The only insulin listed right now is Lilly's insulin lispro – and it's the same price as you'd find through Illy's insulin value program. I looked up diabetes meds.. For example, if you have an insurance co-pay of $25 a month for Farxiga, a drug often used for diabetes, you would be paying $182 on TrumpRx. As you can imagine, though ,this is complicated and as with most of our healthcare system, it may be good in some cases and not much help in other.  I'd suggest calling your local pharmacist or checking with your human resource dept. https://www.nytimes.com/2026/02/06/health/trumprx-prescription-drug-prices-consumers.html XX Novo Nordisk will launch some doses of its oral semaglutide for diabetes under the brand name Ozempic pill in the second quarter of this year. The company said the U.S. Food and Drug Administration has approved Ozempic tablets in three different doses. Novo says The new Ozempic name is intended to help patients and health care professionals more easily recognize the available treatment options for type 2 diabetes Semaglutide tablets have been available under the brand name Rybelsus Ruh BELL sis for diabetes since 2019 but with different dosing. The pill is also approved to reduce the risk of certain cardiovascular conditions in adults with type 2 diabetes who are at high risk for these events. The FDA had approved the new doses based on a bioequivalence study and the clinical trial data for Rybelsus, Novo said. https://www.reuters.com/business/healthcare-pharmaceuticals/novo-launch-ozempic-pill-diabetes-second-quarter-this-year-2026-02-04/ XX https://www.contemporarypediatrics.com/view/early-screening-for-type-1-diabetes-found-effective-in-children XX Possible new way to identify and track the progress of type 1 diabetes before clinical onset. A recent study published in Science Advances described the application of subcutaneous microporous scaffolds. These are inserted and have been shown to  identify changes in cancer, multiple sclerosis, and T1D by capturing changes of immune cells over the course of a disease. This is a proof of concept study in mice.. so very early days. https://www.news-medical.net/news/20260204/Implantable-immune-scaffold-predicts-type-1-diabetes-weeks-before-symptoms.aspx XX A large global genetics study shows that many key drivers of Type 2 diabetes operate outside the bloodstream. In a major international project led in part by the University of Massachusetts Amherst and Helmholtz Munich in Germany, researchers linked hundreds of genes and proteins to the disease. The work, published in Nature Metabolism, points to a key challenge in diabetes research: the biology behind rising blood sugar does not play out the same way in every part of the body. It also shows why including people from many backgrounds matters, since genetic clues that stand out in one population may be faint or invisible in another. Huge study, 2.5 million people worldwide comparing patterns across seven tissues tied to diabetes and four global ancestry groups, then asked a simple question: what do you miss if you only measure blood? Across the seven tissues, the researchers found causal evidence pointing to 676 genes. Yet overlap with blood was limited: only 18% of genes with a causal effect in a primary diabetes tissue, such as the pancreas, showed a matching signal in blood. At the same time, 85% of genetic effects observed in diabetes-relevant tissues were completely absent from blood-based analyses. The findings lay out a roadmap for future research aimed at understanding the biological pathways underlying Type 2 diabetes and developing more effective treatments. https://scitechdaily.com/massive-global-study-rewrites-the-biology-of-type-2-diabetes/ XX Express Scripts settled the U.S. Federal Trade Commission's claims its insulin pricing practices violated antitrust and consumer protection laws, and agreed to changes aimed at lowering costs for patients, insurers and small pharmacies The settlement, first reported by Reuters, fits with that goal, and allows the FTC to pare down a case brought by the former Biden administration against Cigna's Express Scripts, UnitedHealth Group Inc's (UNH.N), Optum unit and CVS Health Corp's (CVS.N), CVS Caremark. The case against Optum and Caremark is ongoing. Pharmacy benefit managers, which set how drugs are covered by health insurance, have faced a decade of scrutiny from regulators and lawmakers over pricing practices. While the industry has already made reforms, the settlement gives the FTC power to enforce broader changes at Express Scripts. The 10-year agreement restricts Express Scripts' ability to engage in practices critics say contribute to high costs, like pocketing rebate payments from drugmakers based on the list price of drugs. The FTC estimates the agreement could save patients as much as $7 billion over a decade. https://www.reuters.com/world/cigna-settles-ftc-insulin-case-commits-overhauling-drug-pricing-2026-02-04/ XX Audio? Congress has passed bipartisan legislation to extend and strengthen the Special Diabetes Program (SDP), a cornerstone of Federal investment in type 1 diabetes (T1D) research. The President signed the legislation and it is now law. Extends the SDP through December 31, 2026, and increases funding from $160 million to $200 million annually. Strengthens overall funding for the National Institutes of Health (NIH) by $415 million. Increases diabetes research funding at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) by $10 million. Created by Congress and administered by the NIH, the SDP has contributed nearly $3.6 billion to T1D research and has played a role in nearly every major breakthrough in the field. A recent study conducted by Avalere Health shows that of the nearly 3.6 billion invested into the SDP by Congress since the establishment of the program, the Federal Government has realized $50 billion in healthcare savings through improved health outcomes from the use of SDP driven therapies and devices https://www.breakthrought1d.org/news-and-updates/congress-passes-bipartisan-extension-of-the-special-diabetes-program-securing-critical-t1d-research-funding/ XX Dexcom is rolling out what they're calling AI-enabled enhancements to Stelo, further transforming how users track and understand their glucose health. Expanded Smart Food Logging including a comprehensive nutrition database of more than 1M meals that provides a breakdown of calories, carbohydrates, protein, fat, dietary fibers, and more. More ways to meal track including text search, barcode scanning or taking a photo of the meal, creating a seamless and intuitive meal tracking solution. A redesigned Daily Insights feature which will introduce a new interface with more personalized recommendations. The newest features will launch nationwide in the coming weeks.  XX Beta Bionics has received a warning letter from the Food and Drug Administration following an inspection last year, the company disclosed on Friday. The diabetes technology company said in a securities filing that the warning letter concerns non-conformities with the company's quality management system, medical device reporting, and correction and removals. The warning letter has not yet been posted by the FDA.   The company said in the filing that it has already taken actions to improve the processes described in the warning letter, and it is working on a written response to the FDA.   The firm does not expect the warning letter to affect the planned launch of a new insulin patch pump by the end of 2027. Beta Bionics unveiled a prototype of the device, called Mint, last year at the American Diabetes Association's Scientific Sessions. The company also does not expect the warning letter to affect its financial results. https://www.medtechdive.com/news/beta-bionics-receives-fda-warning-letter/811140/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue%3A+2026-02-04+MedTech+Dive+%5Bissue%3A81423%5D&utm_term=MedTech+Dive&fbclid=IwY2xjawPwhDZleHRuA2FlbQIxMABicmlkETFaUUcyYmNQWldjZ2xudElic3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHouF8M3IstTyslPRgeHWUWVVdOAGOtzPWt_yNFcj9eYruqSPz3e86Iwcbpt8_aem_7q4D97vJVjHKfEwvoyUpgw XX Sequel Med Tech is reviewing co-founder Dean Kamen's ties to Jeffrey Epstein after recently released documents revealed new details about the longstanding relationship between the two men. The documents show that Kamen visited Epstein's island, and remained in contact with him for years after Epstein was convicted of sex crimes involving minors. Kamen has not been accused of any wrongdoing. In a statement, Sequel Med Tech said the Manchester-based company is aware of the documents pertaining to Kamen and – quote - "Sequel's Board of Directors has unanimously decided to engage an external law firm to review these disclosures and provide recommendations aligned with our mission to serve people living with diabetes," Kamen has not issued a statement regarding his reported connection to Epstein.   https://www.bostonglobe.com/2026/02/04/metro/nh-dean-kamen-jeffrey-epstein-review/ https://www.bostonglobe.com/2026/02/04/metro/nh-dean-kamen-jeffrey-epstein-review/ https://www.nbcboston.com/news/local/nh-inventor-placed-on-leave-after-epstein-messages-surface-report-says/3888569/ XX Abbot reports 860 serious injuries linked to the recall of some of its glucose monitoring sensors. We told you about this recall late last year, these numbers are an FDA update.     Abbott said the sensors can provide incorrect glucose readings over extended periods, which could lead to users making dangerous treatment decisions, including eating excessive carbohydrates along with skipping or delaying insulin doses, potentially leading to serious health risks. The company said it has identified and resolved the cause of the issue, which relates to one production line among several that make Libre 3 and Libre 3 Plus sensors.   https://www.reuters.com/business/healthcare-pharmaceuticals/abbott-recalls-glucose-sensors-after-seven-deaths-linked-faulty-readings-2026-02-04/ XX Updates from Medtronic & Senseonics – and a first from Nick Jonas.. right after this..   I'm excited to share that the FDA has cleared the MiniMed 780G system with the Instinct sensor, made by Abbott, for people with type 2 diabetes.  Medicare has also now approved coverage for the Instinct sensor for use with the MiniMed 780G system. This clearance and expanded coverage mean more people will have access to pairing our most advanced automated insulin delivery technology with the Instinct sensor, that offers a smaller, 15-day sensor experience.  They're also launching the MiniMed 780G system Pump Evaluation Program.  This program gives individuals living with diabetes the ability to try the full MiniMed 780G system at no cost for 30 days.† This includes the pump, the sensor of their choice, one month of infusion sets and reservoirs, everything but the insulin. They'll contact your doctor for you to get a prescription and get the process rolling. https://www.medtronicdiabetes.com/pump-evaluation-program XX Senseonics announced today that its Eversense 365 continuous glucose monitor (CGM) system received CE mark approval – that's European clearance.  This comes on the heels of the launch of Eversense 365 with Sequel Med Tech's twiist pump, marking the first pump integration for the CGM. Senseonics plans to launch Eversense 365 in Germany, Italy, Spain and Sweden in the coming months. Meanwhile, Senseonics continues to work toward an FDA investigational device exemption (IDE) submission for its next-generation Gemini transmitter-less CGM by the end of this year. https://www.drugdeliverybusiness.com/senseonics-ce-mark-eversense-365-cgm/ XX A huge shout out to Dr. Emily Blum, who just accomplished riding 100 miles in Antarctica for Breakthrough T1D! Despite having no direct connection to Type 1 Diabetes, Emily has been riding and fundraising for BreakthroughT1D for 10 years now. She is an integral part of the Georgia Ride team, training and riding many miles, and most importantly has raised tens of thousands of dollars to support the cause of ridding the world of T1D. She is surgeon and deeply involved with medical innovation, with an incredibly busy schedule, but jumped at the chance to take on the challenge of riding a century on every continent. Having already completed North America, Europe, Australia, Asia, and now Antarctica, only Africa and South America remain. Emily rides on and continues to be an inspiration to everyone who meets her. XX   https://diabetes-connections.com/t1d-connection-and-people-magazine-elise-zach-share-their-story/ XX Nick Jonas's becomes the first artist ever to wear a CGM on an album cover - new upcoming solo album Sunday Best, releasing Feb. 6.  The release says: This marks a powerful step forward in normalizing diabetes and raising awareness for the condition on a global scale. This moment adds to the growing visibility of diabetes in pop culture, alongside milestones like a Type 1 diabetes Barbie and Pixar characters wearing diabetes technology.

Welcome to RIMScast. Your host is Justin Smulison, Business Content Manager at RIMS, the Risk and Insurance Management Society.   In this episode, Justin interviews Megan Miller, the CEO of the Spencer Educational Foundation, and John Button, ERM strategist and RIMS-CRMP Workshop instructor. The episode is divided into two interviews. Justin and Megan review the Spencer activities coming up around RISKWORLD 2026 and later, with a focus on driving students into insurance and risk careers and on providing risk scholarships to build the industry. Justin and John focus on John's ERM and risk philosophies and the key skills and knowledge the next wave of risk practitioners will need as risk management moves into strategic risk modes. They discuss the RIMS-CRMP virtual workshops that John teaches, and James Lam's RIMS-CRO Certificate Program in Advanced Enterprise Risk Management, which John endorses. They talk about RISKWORLD 2026, which is coming up.   Listen for tips on inviting the next wave of students into the risk profession and preparing for upcoming trends in risk.   Key Takeaways: [:01] About RIMS and RIMScast. [:17] About this episode of RIMScast. We will be joined by Spencer Educational Foundation CEO, Megan Miller, and ERM strategist and RIMS-CRMP Workshop instructor, John Button. But first… [:47] RIMS Risk Foundations Certificate Program. This beginner program will guide you through the risk landscape and help evaluate the purpose, function, and process of risk management. On completion, you will receive a Digital Risk Foundation certificate and 24 RIMS CE credits. [1:07] Cohort Number One starts on February 10th and 11th, with "Fundamentals of Risk Management," and then, on February 25th, "Risk Taxonomy," followed by two on-demand courses. Register now because the next cohort will be held in August. A link is in the notes. [1:28] RIMS members always enjoy deep discounts on the virtual workshops. [1:32] Webinars The next RIMS webinar will celebrate Women's History Month by exploring the success of women in construction risk on March 6th. We'll be joined by a Chief Risk Officer, an underwriter, and a broker. [1:45] They will explore their career paths, risk and safety philosophies, and lend some insight as to why this is the time for the next generation of leaders to rise. Visit RIMS.org/webinars and check out the link in this episode's show notes. [2:00] RISKWORLD General registration is open for RISKWORLD 2026, which will be held from May 3rd through the 6th in Philadelphia, Pennsylvania. Visit RIMS.org/RISKWORLD or RIMS.org. Register today to take advantage of those sweet advance rates through the end of this month! [2:24] On with the Show! Returning to RIMScast is one of my favorite people, the CEO of the Spencer Educational Foundation, Megan Miller! Spencer Day is coming up on February 23rd. We want to hear all about what she has in store for us this month, and at RISKWORLD 2026. [2:50] Megan Miller will also present a special introduction for the "Hard Hats and High Stakes" Webinar on March 6th. Let's get to it! [3:08] Interview! Spencer Educational Foundation CEO Megan Miller, welcome back to RIMScast! [3:30] Megan says the Spencer Educational Foundation had a great year in 2025. They surpassed their goals. They're riding into 2026 on top of the wave. They are also starting Year 1 of implementing their next Five-Year Strategic Plan through 2030. [3:55] Megan says they have some big growth goals; they're hoping to raise $10 million a year by 2030. They ended last year at just over $4 million. [5:13] Spencer Day on February 23rd is held in conjunction with Insurance Careers Month. The Insurance Careers movement is to get students thinking about careers in insurance. [5:29] Holding Spencer Day during Insurance Careers Month raises awareness about what the Spencer Educational Foundation is doing to help drive more students into insurance careers. [5:36] The Spencer Educational Foundation tries to raise at least $7,500 from individual contributors that day to fund an additional scholarship. If they can raise $7,500, they can give out one more scholarship in 2026 and set one more person on the path to a career in risk. [6:18] At RISKWORLD, the Spencer Educational Foundation holds three events: Pickleball Social on Saturday, May 2nd, with sponsor Optum, the Gallagher Topgolf Golf Tournament on Sunday, May 3rd, and the 5K Fun Run on Tuesday, May 5th, with new sponsor Bold Penguin. [7:59] The 5K Fun Run will take place at Boathouse Row at 6:30 a.m. [8:57] The Spencer Soirée will be held on Monday, May 4th, at 5:30 p.m. It's Spencer's big donor appreciation event. At the Spencer Soirée, Spencer announces the winners of the International Student Risk Management Challenge that takes place all day on Sunday, behind closed doors. [9:16] On Monday morning, you'll have the opportunity to see the top three student teams present. Over 50 teams are competing. They submit their papers online, and the judges select the top eight teams to be flown to RISKWORLD. In 2025, half of the teams were international. [10:01] For some students, it was the first time they had ever been to the U.S. It's an incredible opportunity. In 2024, the team from Hyderabad, India, won. Justin had them as RIMScast guests. [10:20] The 2025 winning team was from the University of Wisconsin-Madison. [10:32] At the RISKWORLD conference, the top eight teams present behind closed doors on Sunday, and the judges select the top three. On Monday, those presentations are open to the public. It's impressive to hear the students talking through their cases. Come and watch! [10:53] On Monday, at the Spencer Soirée donor appreciation event, the first, second, and third place winners are announced, with cash prizes. It's a big audience, and the students answer the judges' questions. Megan says that the students are poised and super bright. [12:08] The 2026 Spencer Funding Their Future Gala will be held on Thursday, September 17th, back at the Waldorf Astoria, which was recently reopened after extensive renovations. Megan says it's stunning. [13:30] There are two honorees for the gala, Sierra Signorelli from Zurich, and Marya Propis from RT Specialty. Marya was one of the earliest RIMScast guests. She has been heavily involved in Spencer. [13:51] Megan says Zurich has been a strong partner of the Spencer Educational Foundation for a very long time. Sierra has taken on an expanded role at Zurich. [14:09] Marya is the former board chair who hired Megan within the Spencer organization. [14:35] For more information about the Funding Their Future Gala, listeners can reach out to Megan Miller or Brianne Kelly-Prensa at the Spencer Educational Foundation. [15:00] Megan mentions some of the new names at the Spencer Educational Foundation. Brianne Kelly-Prensa is the new Development Manager, helping Megan with fundraising and finding new partnerships. Amisha Kitani is the new Program Administrator. [15:31] Amisha was an intern at LVMH through Spencer's internship grant program. [16:10] Megan was a Spencer scholarship recipient. While she was at Swiss Re, she received a Spencer scholarship for the part-time Master's program. Spencer was very instrumental in helping Megan complete her MBA. [16:37] Spencer also has two board members who are Spencer scholarshop recipients: Robin Roeder and Cristina Vigilante. As Spencer grows and impacts more students, he loves to see them come back into the fold. [17:13] Justin shares details about the presenters of the RIMS webinar on March 6th, "Hard Hats and High Stakes: Women Leaders Shaping Construction Risk Management," including a special introduction by Megan Miller. Megan is excited about it. [19:01] The webinar is not only in honor of Women's History Month but also in advance of Construction Safety Awareness Week in May. Justin says this important sector deserves the spotlight. [19:39] If you have any questions for Megan, find her at SpencerEd.org. Justin tells Megan, it is such a pleasure to see you again. [19:56] Our next interview features John Button, CRMP, an Enterprise Strategic and Technology Risk Strategist for American Systems and an Instructor for the UCLA Extension Business School, specifically for implementing their Enterprise Risk Management course. [20:24] John Button is one of the instructors for the RIMS-CRMP Virtual Workshop Series. John will be leading the March 10th and 11th Workshop, and the June 9th and 10th Workshop. [20:39] We are going to get a glimpse into his risk perspective and philosophy. We're going to talk about strategic risk management and where he believes ERM is headed in the short and long term. Let's get to it! [20:52] Interview! RIMS-CRMP Commissioner John Button, welcome to RIMScast! [21:10] John heard about the RIMS-CRMP from other practitioners who were getting certified. John worked with Joseph Mayo on a couple of his books, the latest being Cultural Calamity. Joseph suggested the RIMS-CRMP to John. John looked into it. [21:41] John fell in love with the RIMS-CRMP, as it is a foundational risk management certification. [21:52] Justin adds that John Mayo was the first RIMS-CRMP Story. John says the RIMS-CRMP has been a pretty exclusive club, but it's spreading quickly around the globe, and once you've gotten it, you start to see who else has it. [23:16] Justin asks about strategic risk management. John says when he was studying for the RIMS-CRMP, he was well aware of strategic risk management, and he had been an enterprise risk management advisor at Gartner, but it wasn't practiced as much then as we see it today. [23:45] While studying for the RIMS-CRMP, John learned of the RIMS Strategic Risk Management Framework. He thinks it is one of the clearest ways of thinking about strategic risk management. It started connecting the dots for him about the value chain and benchmarking. [24:21] John says there's been an evolution in business from hazard risk to operational risk to strategic risk, and the real value is within strategic risk management. With strategic risk, what we focus on is largely the business model or foundational assumptions of the organization. [25:22] It will involve your customers, your financial model, your capabilities, and your value proposition. Strategic management deals with deciding the direction of a company, where you are trying to go, and the business model for how you are going to achieve success. [25:48] John says strategic is fundamentally different from operational, which may involve the execution of parts of the strategy, keeping the lights on, and running the business. [26:21] John says the most important skills for future risk leaders are to understand the decision science and analysis component of measuring uncertainty. That involves a basic understanding of statistics, probability theory, and the psychology of biases. That's critical. [27:23] John tells of helping develop risk quantification courses for RIMS for risk managers to learn how to measure and communicate risk in economic terms, for leaders in an organization. That skill set will differentiate risk practitioners in companies in achieving goals and objectives. [28:18] The people in an organization doing the work of mitigating the risk are often labeled as owning the risk. John says a risk is an uncertainty that will negatively impact an objective. Whose objective is threatened by the risk? Knowing that, you can build the accountability bridge. [29:58] John says when the ownership of risk is not known, most executive decision-makers use System One, instinctive thinking. System Two thinking requires deliberation and problem-solving. When a risk owner is identified, executives switch to System Two thinking. [31:37] Accountability is a by-product of risk owner identification. [32:09] Quantitative risk analysis allows you to accurately and mathematically measure risk. You can't count risk with ordinal scales that only tell you the order of things. When you measure risk quantitatively or statistically, you can accurately forecast the financial impact of an event. [33:51] That forecast enables executives to make more informed decisions. You can add risks in a mathematically coherent way. You can see how risks hang together for the organization. [35:12] John says a good risk culture is an organization that practices what it preaches. John would expect to see incentives built into measuring performance. It's not just whether you met your goals and objectives, but also whether you followed good risk management practices. [36:38] John says a lot of organizations speak to it, but what they say and what they do are often two separate things. [37:13] There's a big push right now for using more quantitative tools and skills for doing risk management. Risk management is more than quantitative measurement or decision analysis. John sees mistakes from companies looking only at the short term. [37:57] If you do risk management well, with a solid risk culture, there is always the possibility or probability of failure. Any company, even with great risk management, can be susceptible to systemic risk and big surprises. Having a good risk culture lowers the probability of failure. [38:47] John says they touch on risk culture during the RIMS-CRMP Workshops. It's about trying to develop a programmatic and systematic approach to risk that is consistent, coherent, and serves as the foundation for further growth. It's the beginning of the journey, not the end of it. [39:30] John discusses flipping the script from uncertainty to opportunity. He notes that risk managers often focus on compliance, which was great in the past. The future, with its move toward strategic risk management, will need far more than risk event forecasts. [41:03] John believes the next phase will come from using your imagination, in collaboration with AI, to see beyond the five-year strategy timeframe, to develop hypotheses and a different kind of forecast about where trends, drivers, and conditions will show up in the risk landscape. [41:56] John thinks risk management will move outside of the organization. The next wave of practitioners will be equipped quantitatively, helped by AI, and will help to steer strategy and the strategic direction of business models to find the opportunities for innovation. [42:27] Justin says this has been such an enlightening conversation and mentions that John will be leading the virtual workshops for RIMS-CRMP on March 10th and 11th and June 9th and 10th. What is John Button's instruction style? [42:53] John enjoys teaching. He's currently teaching Implementing Enterprise Risk Management at UCLA. What's important to him is making sure people are crystal-clear, understand the foundation, and can analyze the concept. [43:19] John reduces most challenges in risk management to communication. What one person means by cyberrisk may not be what somebody else means. He makes sure those he is teaching feel confident when they walk away, ready to go. His teaching style is thorough. [43:59] John always stays back after the webinar to answer questions. Some people contact him later with questions, and he's more than happy to help them. [44:18] Justin mentions the RIMS-CRO Certificate Program in Advanced Enterprise Risk Management, hosted by James Lam. John introduced himself to James Lam at the FAIR Conference 2022, after reading his book. John took the RIMS-CRO Certificate Program. [45:07] John says they worked live for about four hours every other week for six sessions, with each module building on the previous one. The next cohort will begin in April. Registration closes on April 6th. That course will run biweekly from April 14th to June 23rd, 2026. [45:55] Check out RIMS's social channels to see a testimonial from John talking about the course. It was extremely beneficial for him and for the others who shared their perspectives on it. [46:40] John will be at RISKWORLD 2026. Last year was his first RISKWORLD, and having attended a lot of business conferences, he shares that he was blown away by how awesome RISKWORLD is. John invites you to reach out to him if you go, and he'll be happy to talk to you. [47:15] Special thanks to both of our guests, Megan Miller, the CEO of the Spencer Educational Foundation, and John Button, one of our valued RIMS-CRMP Commissioners and virtual workshop instructors. [47:29] Links to SpencerEd.org and to John's upcoming virtual workshops for the RIMS-CRMP Exam Prep are in this episode's show notes. Register now, and let them know how great they sounded on RIMScast in February 2026! [47:46] Plug Time! You can sponsor a RIMScast episode for this, our weekly show, or a dedicated episode. Links to sponsored episodes are in the show notes. [48:15] RIMScast has a global audience of risk and insurance professionals, legal professionals, students, business leaders, C-Suite executives, and more. Let's collaborate and help you reach them! Contact pd@rims.org for more information. [48:33] Become a RIMS member and get access to the tools, thought leadership, and network you need to succeed. Visit RIMS.org/membership or email membershipdept@RIMS.org for more information. [48:50] Risk Knowledge is the RIMS searchable content library that provides relevant information for today's risk professionals. Materials include RIMS executive reports, survey findings, contributed articles, industry research, benchmarking data, and more. [49:07] For the best reporting on the profession of risk management, read Risk Management Magazine at RMMagazine.com. It is written and published by the best minds in risk management. [49:21] Justin Smulison is the Business Content Manager at RIMS. Please remember to subscribe to RIMScast on your favorite podcasting app. You can email us at Content@RIMS.org. [49:33] Practice good risk management, stay safe, and thank you again for your continuous support!   Links: RISKWORLD 2026 Registration — Open for exhibitors, members, and non-members! Reserve your booth at RISKWORLD 2026! Spencer Educational Foundation | Spencer Day — Feb. 23, 2026 RIMS Legislative Summit — March 18‒19, 2026 on Capitol Hill, Washington, D.C. | Register now! RIMS-CRO Certificate Program In Advanced Enterprise Risk Management | April‒June 2026 Cohort | Led by James Lam RIMS Risk Management magazine | Contribute RIMS Now RISK PAC | RIMS Advocacy RIMS-Certified Risk Management Professional (RIMS-CRMP) | Insights Video Series Featuring Joe Milan! The Strategic and Enterprise Risk Center RIMS Diversity Equity Inclusion Council RIMS-CRMP Story, featuring John Button Upcoming RIMS-CRMP Prep Virtual Workshops: RIMS-CRMP Exam PrepMarch 10‒11 | April 21‒22, 2026 | June 9‒10, Virtual Full RIMS-CRMP Prep Course Schedule See the full calendar of RIMS Virtual Workshops "Applying and Integrating ERM" | Feb 4. Risk Foundations Certificate Program | Feb. 10 "Facilitating Risk-Based Decision Making" | March 4‒5 Upcoming RIMS Webinars: "Hard Hats & High Stakes: Women Leaders Shaping Construction Risk Management" | March 6 | Presented by RIMS RIMS.org/Webinars   Related RIMScast Episodes: "Risk Decision-making in 2026 with Joseph A. Milan, Ph.D." "The Evolving Role of the Risk Analyst" "Risk Rotation with Lori Flaherty and Bill Coller of Paychex" "Energizing ERM with Kellee Ann Richards-St. Clair"   Sponsored RIMScast Episodes: "Secondary Perils, Major Risks: The New Face of Weather-Related Challenges" | Sponsored by AXA XL (New!) "The ART of Risk: Rethinking Risk Through Insight, Design, and Innovation" | Sponsored by Alliant "Mastering ERM: Leveraging Internal and External Risk Factors" | Sponsored by Diligent "Cyberrisk: Preparing Beyond 2025" | Sponsored by Alliant "The New Reality of Risk Engineering: From Code Compliance to Resilience" | Sponsored by AXA XL "Change Management: AI's Role in Loss Control and Property Insurance" | Sponsored by Global Risk Consultants, a TÜV SÜD Company "Demystifying Multinational Fronting Insurance Programs" | Sponsored by Zurich "Understanding Third-Party Litigation Funding" | Sponsored by Zurich "What Risk Managers Can Learn From School Shootings" | Sponsored by Merrill Herzog "Simplifying the Challenges of OSHA Recordkeeping" | Sponsored by Medcor "How Insurance Builds Resilience Against An Active Assailant Attack" | Sponsored by Merrill Herzog "Third-Party and Cyber Risk Management Tips" | Sponsored by Alliant   RIMS Publications, Content, and Links: RIMS Membership — Whether you are a new member or need to transition, be a part of the global risk management community! RIMS Virtual Workshops On-Demand Webinars RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Strategic & Enterprise Risk Center RIMS-CRMP Stories — Featuring RIMS President Manny Padilla!   RIMS Events, Education, and Services: RIMS Risk Maturity Model®   Sponsor RIMScast: Contact sales@rims.org or pd@rims.org for more information.   Want to Learn More? Keep up with the podcast on RIMS.org, and listen on Spotify and Apple Podcasts.   Have a question or suggestion? Email: Content@rims.org.   Join the Conversation! Follow @RIMSorg on Facebook, Twitter, and LinkedIn.   About our guests: Megan Miller, CEO, Spencer Educational Foundation John Button, RIMS-CRMP, Enterprise, Strategic & Technology Risk Strategist, American Systems   Production and engineering provided by Podfly.  

In this eye-opening interview, Clay sits down with Michael Jones, owner of Helping Hand Family Pharmacy in Vicksburg, to expose the pharmacy benefit manager (PBM) "racket" that's devastating independent pharmacies across Mississippi. Michael breaks down how PBMs—middlemen like Express Scripts (Cigna), CVS Caremark, and Optum (UnitedHealth)—started as claim consolidators but evolved into profit machines through spread pricing, manufacturer rebates, and vertical integration, forcing locals to sell meds below cost and leading to widespread closures.   He shares his fight's origin: Post-COVID reimbursement drops hit hard, shuttering stores like People's Drugstore, creating "drug deserts." Michael dug into campaign finances, uncovering PBM-linked donors influencing lawmakers, and went public—posting at his store and on social media—to rally customers. A Mississippi audit revealed Optum paying affiliates 20x more than independents, while PBM profits soar into billions.   Urgent action: Support House Bill 1672 (State Affairs Committee) and Senate Bill 2575 (Public Health and Welfare)—bills must exit committee by February 3. Michael urges calls to the Capitol switchboard at (601) 359-3770 to demand fair reforms. Last year's near-win died at the eleventh hour; don't let it happen again. This is a battle for community businesses—stand up before independents vanish!

In this episode, we're joined by Karthik Viswanathan. Formerly a product leader at AT&T, Macy's, and Optum, he's now the founder of TalAiro, an HR tech startup that is rethinking the operating system for recruiting. Karthik argues that the hidden failure of the modern tech stack is forcing the user to serve as a “manual integration layer. He explains how the push to "unbundle" features results in a “Chaos Tax”— consuming 40-60% of the workday with fighting disconnected tools rather than doing their jobs. Beyond that, Karthik also discusses: How AI can make work more human: Why the true value isn't in replacing jobs, but automating the "devil's cut" of administrative work. The journey from enterprise leader to founder: What building TalAiro from scratch taught Karthik about prioritization after years of leading enterprise product orgs, such as focusing on the 20% of workflows that drive 80% of the value Links LinkedIn: https://www.linkedin.com/in/karthikvish/ TalAiro: https://www.talairo.ai/ Chapters 00:00: Introduction 00:54: Karthik's product background 02:58: The "chaos tax" and how tool sprawl negatively impacts product efficiency 04:25: Challenges in HR tech 09:26: Working backwards from customer problems to build your digital solution 11:53: How TalAiro differentiates itself as an HR tool 15:03: The role of AI in enhancing human potential 20:59: Karthik's transition from enterprise to startup leader 27:14: Conclusion Follow LaunchPod on YouTube We have a new YouTube page (https://www.youtube.com/@LaunchPodPodcast)! Watch full episodes of our interviews with PM leaders and subscribe! What does LogRocket do? LogRocket's Galileo AI watches user sessions for you and surfaces the technical and usability issues holding back your web and mobile apps. Understand where your users are struggling by trying it for free at LogRocket.com (https://logrocket.com/signup/?pdr). Special Guest: Karthik Viswanathan.

Mark Fithian is the cofounder of WideOpen, a consultancy that helps organizations achieve sustainable growth through strategic customer experience. Mark's expertise in CX is informed by more than thirty years of work across industries, partnering with leading brands such as Providence, SAP, PayPal, Optum, IBM, BMW, the American Cancer Society, and Microsoft. Before founding WideOpen, he held leadership roles on both the client and agency sides, as well as in strategic consultancies.Mentioned on the ShowRead Mark's profile on the WideOpen website: https://www.thisiswideopen.com/our-teamConnect with Mark on LinkedIn: https://www.linkedin.com/in/markfithian/Get Mark's book, The CX Imperative: https://a.co/d/316xGzXO'Brien and Mark discussed the book Good Strategy, Bad Strategy by Richard Rumelt: https://a.co/d/9GSTIfN Timestamps(00:00:00) Welcome to People Business with O'Brien McMahon(00:01:45) What is the difference between customer experience and user experience?(00:02:22) And how did you get into this work in the first place? (00:07:24) What is the purpose of business? (00:08:35) Why do businesses struggle with customer experience? (00:11:24) "The Great Distancing": what it is and why it hurts customer experience(00:13:44) What makes good incentives in customer experience? (00:15:15) How does a business know when they are doing CX well?(00:20:08) How does executive leadership get involved in good CX?(00:32:49) Who should be responsible for customer experience?(00:40:41) Mark's 5 Pillars of Customer Experience(00:44:19) What does strategy mean to you? (00:55:21) How to get started with customer experience and how to contact Mark Fithian.

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to⁠ outcomesrocket.com Real-time transparency between payers and providers is becoming one of the most transformative levers in the healthcare industry. In this episode, Madhu Pawar, Chief Product Officer at Optum, discusses how her team is tackling the long-standing inefficiencies buried in today's claims processes. She explains how Optum Real connects payers and providers through a real-time multi-party hub, uses AI to interpret contracts and encounter data, and equips providers with AI-first workflows that dramatically reduce denials, rework, and confusion for patients. Madhu also highlights early pilot results with Allina Health, demonstrating improvements in both patient experience and operational accuracy. She shares why 84% of first-time denied claims are avoidable, why eliminating that friction is at the core of Optum's mission, and why value-based care will benefit enormously from real-time intelligence. Looking ahead, Madhu outlines a bold vision in which real-time payment flows, AI-enabled clinical insights, and improved data exchange reshape the entire system's operations. Tune in and learn how real-time transformation could redefine healthcare's future! Resources Connect with and follow Madhu Pawar on LinkedIn. Follow Optum on LinkedIn and visit their website!

Kristi Henderson invented telehealth at the University of Mississippi Medical Center decades before anyone thought healthcare needed it. While her colleagues were optimizing traditional clinic workflows, Kristi was asking a different question: What if geography didn't dictate healthcare access? By the time the pandemic forced everyone else to figure out virtual care overnight, she'd already spent two decades perfecting it. What makes her approach distinctive isn't just her track record at Amazon, Ascension, and Optum. It's that she worked every level of the healthcare system for 24 years before reaching the C-suite. She understands frontline friction because she lived it. At Amazon, Kristi discovered a framework that changed everything: one-way doors versus two-way doors. Some decisions are irreversible and demand precision. Others are experiments where failure means pivoting fast. That distinction became her playbook for tackling problems most leaders won't touch. But her most counterintuitive move? When she became CEO of Confluent Health, her first hire wasn't a CFO or COO. It was a leader for internal communications. Because brilliant transformation plans fail without deliberate stakeholder engagement. Change happens at the speed of trust. Now Kristi is betting on something that sounds almost naively optimistic: that AI will finally give clinicians their time back by eliminating friction, not replacing human connection. She uses AI daily as her "sidekick" and is building an organization where technology supercharges what only humans can do. Key Takeaways: Why Kristi kept raising her hand for jobs no one else wanted and how taking the hardest assignments became her competitive advantage The Amazon framework that changed everything: one-way doors versus two-way doors, and how to know which type of decision you're making What "change happens at the speed of trust" actually means in practice when you're transforming organizations Kristi's "reverse innovation" approach: why bottoms-up transformation consistently outperforms top-down mandates The counterintuitive first hire Kristi made as CEO, and why communication infrastructure matters more than most leaders realize How to handle naysayers strategically instead of avoiding them or trying to convince them Why Kristi believes the workforce crisis isn't permanent if leaders focus on the right problem The specific ways Kristi uses AI daily as a CEO, and why she sees it as the key to bringing joy back to clinical practice About the Guest Kristi Henderson, DNP, is CEO of Confluent Health, a family of physical therapy and occupational therapy companies. She spent the first 24 years of her career as a practicing nurse practitioner before pioneering telehealth at the University of Mississippi Medical Center, long before the pandemic made it mainstream. Kristi has since led digital transformation at Ascension Health, built clinical operations for Amazon Care, and served as CEO of Optum Everycare. She's Board Chair of the American Telemedicine Association and affiliate faculty at Dell Medical School and the University of Washington School of Nursing. Her career has been defined by raising her hand for challenges others declined and building tech-enabled care models that improve outcomes while reducing clinician burden. Chapters 00:00 - Introduction at Confluent Health 01:57 - From Bedside to Boardroom: The Leadership Journey 06:10 - Amazon Care Lessons: One-Way vs Two-Way Doors 11:07 - Change Happens at the Speed of Trust 14:11 - Overcoming Naysayers: The Early Days of Telehealth 19:11 - Bringing Joy Back to Medicine 22:56 - AI Hacks and Daily Innovation Guest & Host Links Connect with Laurie McGraw on LinkedIn Connect with Kristi Henderson on LinkedIn Connect with Inspiring Women Browse Episodes | LinkedIn | Instagram | Apple | Spotify

Happy New Year from WEDI! Michael offers some quick bites from our top 3 most downloaded episodes of 2025: #3: Rethinking Value-Based Care: Why Children Can't Be Left Behind (Taylor Beery, Imagine Pediatrics, Ep 219) #2: Electronic Health Records- An Integral Partner in Health Care Accessibility (Prerana Laddha, Epic, Ep 189) #1: Bridging the Data Gap- The Role of Standards & Technology in Genomic Data Exchange (Dr Sandy Rolfe, Optum, Ep 188). Be sure to listen to these episodes in their entirety by visiting our podcast page, www.wedi.org/category/podcasts

About Madhu Pawar:Madhu Pawar is a board director and cross-disciplinary technology leader operating at the intersection of healthcare, data, and product innovation. She serves on the Board of Directors at Talkspace (NASDAQ: TALK) and is the Chief Product Officer for Optum Insight, where she drives product strategy and platform innovation across UnitedHealth Group's most critical assets. Prior to Optum, she spent over six years at Google leading the global SMB Ads product ecosystem—overseeing AI-driven insights platforms, multi-billion-dollar revenue lines, and large-scale engineering, product, and operations teams across multiple continents. Madhu also teaches consumer analytics in healthcare as an adjunct professor at Carnegie Mellon University. Earlier in her career, she was a partner in McKinsey's Global Healthcare Practice, where she built and scaled technology and services businesses for payers, providers, and fast-growth health companies. She began her career in software engineering at Hewlett-Packard Labs, earning patents in authentication and location-aware computing, followed by roles at PwC in security and technology. Madhu holds graduate degrees from Stanford School of Medicine and Carnegie Mellon University and a bachelor's in computer engineering from Nanyang Technological University.Things You'll Learn:Real-time data exchange between payers and providers can significantly reduce the confusion, delays, and costs associated with today's claims processes. AI-enabled reasoning over contracts and encounters improves accuracy from the start.Optum Real aims to bridge the transparency gap by connecting stakeholders through a multi-party hub, enabling real-time understanding of coverage and reimbursement. Early pilots show tangible reductions in denials and improved patient clarity.The majority of first-time denied claims are avoidable, signaling an industry-wide opportunity to remove unnecessary rework. Solving this problem increases efficiency for providers, payers, and patients.Real-time intelligence opens the door for more effective value-based care arrangements. When providers can see financial implications instantly, incentives align more naturally.The long-term vision includes real-time payment flows, AI-driven clinical decision support, and improved patient engagement. Breaking down paper-based silos will unlock entirely new use cases at scale.Resources:Connect with and follow Madhu Pawar on LinkedIn.Follow Optum on LinkedIn and visit their website.

In this episode (from our National Conference), moderated by WEDI Chair Merri-Lee Stine (Aetna) and featuring Steve Berkow (InterSystems), Anna Taylor (MultiCare), and Stephan Rubin (Optum), we dive into the real-world state of CMS 0057 implementation, bringing together perspectives from payers, vendors, providers, and the HL7 Da Vinci implementer community. Our guests unpack where progress is being made, where complexity has crept in, and why testing, trust, and simplicity are critical to success. From navigating multiple players and messy real-world data to lessons learned from incremental implementation, the conversation highlights practical solutions that can move the industry forward. We close with a look ahead to 2026 and what the 0057 landscape—and broader interoperability environment—may look like as policy, technology, and collaboration continue to evolve.

What happens when a class clown from Monaghan builds one of the most quietly impactful healthtech companies in Europe - and then takes on the U.S. healthcare system? In this year-end episode of The Shot of Digital Health Therapy, we sat down with Neill Dunwoody

This episode, from our November National Conference, explores one of healthcare's most persistent challenges: how hospitals and health plans can move from operating at cross-purposes to truly rowing in the same direction. Our guests are Danielle Lloyd, SVP of Private Market Innovations and Quality Initiatives, AHIP and Molly Smith, Group VP for Public Policy, American Hospital Association. Led by moderator Stephan Rubin from Optum, Danielle and Molly dig into the misconceptions that providers and payers often hold about each other and discuss how better data transparency, shared incentives, and policy alignment — including recent CMS rules such as 0057F — can help bridge long-standing divides. The 3 examine the future of prior authorization, the promise and limits of interoperability initiatives like TEFCA and the CMS Aligned Network, and why value-based care still struggles to scale despite years of policy focus. Finally, they look ahead to the role of AI, automation, and emerging data standards in reshaping care delivery and payment, and ask what real payer-provider collaboration must look like to deliver a more seamless, efficient, and patient-centered healthcare system.

Subscribe to UnitedHealthcare's Community & State newsletter.Health Affairs' Rob Lott interviews Dan Arnold of Brown University to discuss his recent paper exploring higher payments within UnitedHealth's Optum network, which found UHC Paid Optum providers more than non-Optum Providers using price transparency data. Order the November 2025 issue of Health Affairs.Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcast Subscribe to UnitedHealthcare's Community & State newsletter.

About Harpaul Sambhi:Harpaul Sambhi is a serial entrepreneur and the founder of Magical, where he's building Agentic AI for healthcare to transform how people and systems interact in one of the world's most vital industries. Based in the San Francisco Bay Area, Harpaul combines a deep technical background with a passion for human-centered innovation. Before founding Magical in 2020, he built and sold Careerify to LinkedIn, where he later led product initiatives within LinkedIn Talent Solutions and Microsoft, helping shape the future of talent acquisition and HR technology.Alongside building companies, Harpaul has served as Entrepreneur in Residence at Bain Capital Ventures, Advisor at On Deck, and a Limited Partner in leading VC funds, including Bain Capital Ventures, iNovia Capital, and OnDeck. Earlier in his career, he authored Social HR (published by Thomson-Reuters) and lectured at the Schulich Executive Education Centre on innovation, technology, and the evolving workplace.At his core, Harpaul is guided by simple principles—striving to be a good human and a dedicated father, husband, son, brother, and friend—while working with great people to build great products that make a difference. A graduate of the University of Waterloo with a degree in electrical engineering, he continues to live by curiosity, humility, and the drive to create technology that serves people, not the other way around.About Doug Hires:Douglas Hires is a seasoned healthcare executive, consultant, and entrepreneur with over 35 years of leadership experience across the healthcare and information technology sectors. Based in Dallas, Texas, Douglas has built a distinguished career driving operational excellence, business transformation, and financial performance for some of the nation's leading healthcare organizations. His expertise spans providers, payers, government, and life sciences, and his track record includes accelerating growth, restructuring operations, and guiding organizations through strategic reinvention.Currently, Douglas serves as Executive Advisor at Magical, Managing Partner at JD Hires Advisory Group, and Founder & President of New World Wine Designs, where he combines his business acumen with his passion for fine wine and craftsmanship through bespoke wine cellar design and building. He also advises healthcare and sales organizations through roles with Healthcare IT Leaders and SalesSparx LLC, lending his strategic insight to help teams scale with precision and purpose.Previously, Douglas held multiple senior leadership roles at Optum, including Chief Operating Officer for OptumInsight Provider and COO of the Hospital Services Division, overseeing end-to-end revenue cycle operations for Dignity Health's 36 hospitals. His earlier career includes executive roles at Santa Rosa Consulting, 3M Health Information Systems, SoftMed Systems, and First Consulting Group, where he earned recognition as a respected thought leader and sought-after industry speaker.Things You'll Learn:Agentic AI surpasses automation by reasoning, adapting, and executing end-to-end workflows, thereby freeing healthcare workers from repetitive tasks.Healthcare organizations are already seeing results, such as doubling prior authorization volume while cutting staff needs and decision times in half.The shift from RPA to agentic AI mirrors the evolution from MapQuest to autonomous vehicles, smarter, smoother, and self-correcting.Successful AI adoption requires attention to change management and staff reallocation, not just technology deployment.Evaluating AI vendors using six key pillars (reasoning, adaptability, interoperability, agility, scalability, and fault tolerance) helps cut through the hype and identify real solutions.Resources:Connect with and follow Harpaul Sambhi on LinkedIn.Connect with and follow Doug Hires on LinkedIn.Follow Magical on LinkedIn.Visit Magical's website.

Join us for a deeply human and candid conversation with someone who has mental health experiences from every angle. Melissa Fors Shackelford is a healthcare executive and the author of the Amazon #1 Best Seller, Harnessing Purpose.While Melissa is known for building compelling brands and advising Fortune 100 leaders, her path to purpose was forged through personal adversity. In this episode, we normalize the conversation on family mental health and substance abuse as Melissa shares:The Impact of Family Adversity: How growing up with family members affected by substance abuse profoundly shaped her life choices, empathy, and career path.The Power of Experience: Her invaluable perspective gained from working at institutions like Hazelden Betty Ford and how it taught her about the complexity of mental health and recovery.The Vital Tool: The role of journaling as a non-negotiable practice for processing difficult emotions and finding clarity in the face of chaos.Making the Leap: What inspired her to leave behind a high-level corporate career (at Optum, Cigna, etc.) to bet on herself and build her own purpose-driven consulting practice, Shackelford Strategies.Breaking the Barrier: Why making yourself available to ask for help is the most crucial step in activating your support circle and fostering true mental resilience.Melissa brings a rare blend of corporate expertise and personal vulnerability, proving that leading with integrity requires you to first understand and embrace your own story. This episode offers essential encouragement for anyone seeking to blend their personal challenges into a foundation for meaningful impact.Support the showHave a question for the host or guest? Want their freebee? Are you looking to become a guest or show partner? Email Danica at PodcastsByLanci@gmail.com.This show is brought to you by Coming Alive Podcast Production.CRISIS LINE: DIAL 988

This week on That Entrepreneur Show, host Vincent A. Lanci sits down with Melissa Fors Shackleford, award-winning marketer, bestselling author of Harnessing Purpose, and founder of Shackleford Strategies. With over 20 years of experience leading marketing for powerhouse organizations like Optum, Cigna, and Hazelden Betty Ford, Melissa brings unmatched insight into what it means to build a brand with soul — one grounded in authenticity, purpose, and impact.In this inspiring episode, Melissa reveals how to: ✨ Build a mission-driven brand that goes beyond logos and taglines.

The Trump Administration reaches a deal to lower prices on weight loss drugs, the FDA fast-tracks biosimilars, and a new report shows UnitedHealthcare pays its Optum physicians more than others. Hear the latest on The Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.

The state of Minnesota is hiring a third-party auditor to look for fraud in 14 Medicaid programs. These programs are intended to provide housing and care for people with disabilities and severe mental illnesses. Gov. Tim Walz announced Wednesday the state will temporarily stop paying providers of these services while the auditor, Optum, analyzes billing. A statement from the governor's office said this pause will last 90 days, but's not clear when it will begin. Josh Berg is director of Minnesota services and strategic growth for nonprofit Accessible Space, Inc. He's also on the board of directors of Association of Residential Resources in Minnesota, which lobbies on behalf of disability service providers. He spoke to MPR News host Nina Moini about how this pause could impact how providers can care for people with disabilities and severe mental health illnesses.

Approximately one in four people will face a cancer diagnosis. For most, the hardest part won't be the treatment itself but the waiting, the 3 AM questions, the logistical maze of care coordination that can mean the difference between hope and despair. Ann Stadjuhar knows this truth from both sides of the stethoscope. When Ann navigated her own cancer diagnosis, she had every advantage: 20 years of healthcare expertise, knowledge of case volumes, connections to top surgeons at Optum. Yet even she found the system overwhelming. Her uncle in rural New Mexico wasn't as fortunate; by the time he reached MD Anderson, inadequate local care had sealed his fate. These parallel experiences crystallized Ann's mission at Reimagine Care: ensuring no one faces cancer alone, regardless of their zip code or insider knowledge. This conversation comes at a critical moment. As cancer increasingly strikes younger populations, with many cancers now appearing in people's 20s and 30s rather than their 50s, we need innovators who understand that technology without empathy is just expensive machinery. Ann represents a new breed of healthcare leaders who see AI not as a replacement for human connection, but as a way to multiply it. "The worst part of cancer is the wait," Ann explains. "We can be there 24/7 to understand whether there may be social determinants of health needs. I need a ride to treatment. I need someone to watch my dog. I have issues paying my electric bill. Sometimes people are honestly more comfortable telling the bot they're having these challenges." After two decades revolutionizing digital health from women's health to pandemic response centers, Ann calls cancer care her "capstone." She's witnessed how the 18-month health system adoption cycle literally costs lives. Now, armed with Meta glasses and AI tools that multiply her capabilities "times four," she's racing against a broken system where your uncle's zip code shouldn't determine whether his cancer stays operable. In this episode of Inspiring Women with Laurie McGraw, discover how one woman's journey through cancer transformed into a mission to democratize access to the kind of insider knowledge that can save lives. From the Cancer X Accelerator to Reimagine Care's AI companion REMI, Ann reveals why the future of cancer care isn't about choosing between humans and machines. It's about creating technology sophisticated enough to know that sometimes, the most advanced intervention is simply helping someone find a dog sitter so they don't miss chemotherapy. For Ann Stadjuhar, reimagining cancer care isn't about replacing human connection. It's about multiplying it. In a healthcare system where staying curious might be the difference between innovation and stagnation, between treatment and tragedy, she's proof that the most powerful technology is the kind that remembers to be human. Key Insights: Why patients confess more to AI than to their doctors, and what that means for care How social determinants of health become matters of life and death in cancer treatment The hidden complexities even healthcare insiders struggle to navigate Why the next generation needs emotional intelligence more than technical skills How one woman's cancer diagnosis became a blueprint for system-wide change About the Guest:  Ann Stadjuhar brings 20+ years of digital health innovation to her role as Chief Growth Officer at Reimagine Care. From launching pharmaceuticals to scaling population health tools, she's run what she calls "the gauntlet" of healthcare transformation. Her personal cancer journey while at Optum revealed the gaps even insiders face, inspiring her mission to ensure 24/7 companionship for every cancer patient through AI-powered human care. Guest & Host Links Connect with Laurie McGraw on LinkedIn Connect with Ann Stadjuhar on LinkedIn Connect with Inspiring Women Browse Episodes | LinkedIn | Instagram | Apple | Spotify

On episode 244, we welcome Troyen Brennan to discuss the pitfalls of the US healthcare system, the fee-for-service model's implications for patient outcomes, primary care as a more viable alternative, Walmart's failed attempt to establish primary care clinics, Optum's contrasting success, how to incentivize primary care, AI streamlining prior authorizations, increasing government funding and venture capital for primary care, how preventative care keeps patients from falling through the cracks, and why medical professionals tend to dislike the business side of medicine. Troyen A. Brennan is an adjunct professor of health policy and management at the Harvard T. H. Chan School of Public Health. A former professor of medicine at Harvard Medical School and the former chief medical officer at CVS Health, he is the author of The Transformation of American Health Insurance: On the Path to Medicare for All and Just Doctoring: Medical Ethics in the Liberal State. His new book, available October 7, 2025, is called Wonderful and Broken: The Complex Reality of Primary Care in the United States. | Troyen A. Brennan | ► Website | https://www.researchgate.net/scientific-contributions/Troyen-A-Brennan-38805570 ► Linkedin | https://www.linkedin.com/in/troyen-brennan-494bb533 ► Wonderful and Broken Book | https://amzn.to/3KBnjQD Where you can find us: | Seize The Moment Podcast | ► Facebook | https://www.facebook.com/SeizeTheMoment ► Twitter | https://twitter.com/seize_podcast ► Instagram | https://www.instagram.com/seizethemoment ► TikTok | https://www.tiktok.com/@seizethemomentpodcast ► Patreon | https://bit.ly/3xLHTIa  

Nick is a rider who proves that passion, persistence, and maybe a touch of stubbornness can take you pretty far—whether that's up a Wasatch climb at sunrise or across the finish line at Leadville. He grew up in Salt Lake City as the oldest of three kids. He earned his Eagle Scout, served an LDS mission in Milan, Italy, earned his Economics degree from the U and MBA from Westminster. He even found time to volunteer at the 2006 Turin Winter Olympics, supporting the U.S. Olympic Team with athlete services and translation. He's been with Optum for 23 years, working his way up from sales to Director of Business Operations, and I think he'd tell you the reason he's stayed so long is because of the people and relationships. He's been married to his wife, Jennilynn, for 17 years - and she keeps him fueled with plenty of baked goods. He is a proud dad of two (one through fertility treatments and one through adoption), and shares his home with Bella, a 5-year-old St. Bernard who probably weighs more than all of his bikes combined. He's been passionate about sports since he was young. He ran track and cross country, once ran a marathon, finishing in 4hrs and 4 min, and swore ‘never again,' and eventually found his true love in cycling. Since then, he's tackled countless endurance events—multiple century rides, six LOTOJAs, Steamboat Springs Gravel, and most recently, the Leadville 100 MTB. Nick is so grateful for the Mi Duole team. Riding with them has pushed him to grow as a cyclist while also creating meaningful friendships that extend beyond the bike.  Around the house, he's known as the guy who fills the garage with bikes, never stops talking about cycling, and occasionally finishes a project or two in between rides. Passionate, disciplined, and just stubborn enough to keep pushing through the hard stuff is what makes him such a strong rider and a great husband and father.