Podcasts about payers

Jacob and Nikhil sit down with Frank Wu, the Co-Founder and CEO of Taro Health. Taro Health is a health insurance plan currently live in Maine and Oklahoma that offers unlimited primary care and mental health visits. The company has raised over $18m from investors like Hummingbird Ventures, Quiet Capital, and FPV Ventures. They discuss creating value in InsurTech, building a health plan for Direct Primary Care providers, what's next for health insurance, and more. [0:00] Intro[0:18] Frank's Background and Journey[1:17] Introduction to Taro Health[2:50] Challenges and Strategies in Health Insurance[7:24] Direct Primary Care Model[13:01] Patient and Doctor Archetypes in DPC[17:01] Enrollment and Market Strategies[28:56] Generative AI in Health Insurance[35:31] Quickfire Out-Of-Pocket: https://www.outofpocket.health/

Tyler Oldenburg, Tournament Chairman, joins JMN to discuss the importance of volunteers in making the Payers a success. Some 1500-2000 volunteers service the event annually, and most of them are returning volunteers -- Tyler volunteered for 12 years himself! Visit ThePlayers.com for more information on how you can volunteer for next year's event.

Highmark Health, Mass General Brigham Health Plan, SCAN, and TytoCare leaders discuss strategies for creating innovative, high-impact healthcare products.    Tune in to learn:   How traditional health plans are rethinking product design in the face of growing competition from direct-to-consumer models Strategies for creating more personalized, flexible, and transparent offerings that resonate with today's healthcare consumers The role of data, technology, and innovation in modernizing health insurance products Real-world success stories from leading organizations who are successfully navigating this evolving market Panelists:  Maria Baker, VP, Health Strategy & Delivery, Highmark Health Lena Perelman, VP, Medicare Product Operations, SCAN Health Plan Roni Mansur, Vice President of Product Management, Mass General Brigham Health Plan Suzi Pigg, Vice President, Payers, TytoCare https://www.brightspotsinhealthcare.com/events/innovating-product-design-for-growth-and-member-engagement/   This episode is sponsored by TytoCare: TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are six times higher than traditional telehealth services; reduces the total cost of care by an average of five percent; diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for the successful deployment and adoption of the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 250 major health systems and health plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.   Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

Health plan leaders from Cambia Health Solutions, Highmark Health and League share strategies for driving consumer engagement, improving health outcomes, and optimizing payer-provider relationships. Learn how health plans can shift from broad segmentation strategies to truly personalized, member-centric healthcare by harnessing data, AI, and digital transformation.     Learn how health plans are using AI-driven insights to deliver tailored interventions.

  The Friday Five for February 14, 2024: Apple iOS 18.3.1 Updates Trend Alert: Smart Ankle Watch? Egg Substitutions for Baking & Protein Healthcare Regulatory Update (of sorts) The Postseason Game Plan   Download Your FREE Copy of The Postseason Game Plan Now!   Apple iOS 18.3.1 Updates: Adorno, José. “IOS 18.3.1 Now Available Ahead of Big Ios 18.4 Upgrade.” Bgr.Com, BGR, 10 Feb. 2025, bgr.com/tech/ios-18-3-1-now-available-ahead-of-big-ios-18-4-upgrade/. Disotto, John-Anthony. “iOS 18.4 Could Be the Biggest iPhone Upgrade Ever – Here's Why.” TechRadar.Com, TechRadar, 11 Feb. 2025, www.techradar.com/phones/iphone/ios-18-4-could-be-the-biggest-iphone-upgrade-ever-heres-why. Phelan, David. “Apple iOS 18.4 Release Date: The Major iPhone Update Is On Its Way.” Forbes.Com, Forbes Magazine, 8 Feb. 2025, www.forbes.com/sites/davidphelan/2025/02/08/apple-ios-184-release-date-the-major-free-iphone-update-is-on-its-way/. Rossignol, Joe. “iOS 18.4 Will Include These New Features for Your iPhone.” MacRumors.Com, MacRumors, 5 Feb. 2025, www.macrumors.com/2025/02/05/ios-18-4-expected-features/.   Trend Alert: Smart Ankle Watch? Lovejoy, Ben. “The Five Reasons Some People Wear Their Apple Watch on Their Ankle.” 9to5Mac.Com, 9to5Mac, 10 Feb. 2025, 9to5mac.com/2025/02/10/the-five-reasons-some-people-wear-their-apple-watch-on-their-ankle/. Skwarecki, Beth. “Why (and How) to Wear Your Apple Watch on Your Ankle.” Lifehacker.Com, Lifehacker, 11 Feb. 2025, lifehacker.com/health/why-and-how-to-wear-an-apple-watch-on-your-ankle. Heater, Brian. “Tiktok Influencers Are Wearing Apple Watches on Their Ankles.” Techcrunch.Com, TechCrunch, 10 Feb. 2025, techcrunch.com/2025/02/10/tiktok-influencers-are-wearing-apple-watches-on-their-ankles/.   Egg Substitutes for Baking & Protein: David, Lauren. “8 Egg Substitutes for Cooking and Baking.” Aarp.Org, AARP, 10 Feb. 2025, www.aarp.org/home-family/your-home/info-2025/egg-substitutes-cooking-baking.html. Valente, Lisa. “10 Foods with More Protein Than an Egg.” Eatingwell.Com, EatingWell, 18 Nov. 2024, www.eatingwell.com/article/291485/10-foods-with-more-protein-than-an-egg/. McDonell, Kayla. “13 Effective Substitutes for Eggs.” Healthline.Com, Healthline Media, 7 Feb. 2024, www.healthline.com/nutrition/egg-substitutes. Phaneuf, Taryn. “Egg Prices Are Rising Again. Here's Why They're So High.” Edited by Laura McMullen, Nerdwallet.Com, NerdWallet, 11 Feb. 2025, www.nerdwallet.com/article/finance/why-are-eggs-so-expensive. Lannon, KJ. “Egg Prices Got You Scrambling? Here's 3 Substitutes to Use in Your Cake Mix.” Tastingtable.Com, Tasting Table, 10 Feb. 2025, www.tastingtable.com/1780478/egg-substitutes-boxed-cake-mix/.   Healthcare Regulatory Update (of sorts) Bell, Allison. “10 House GOP Health Program and Tax Change Ideas.” Thinkadvisor.Com, ThinkAdvisor, 24 Jan. 2025, www.thinkadvisor.com/2025/01/24/10-house-gop-health-program-and-tax-change-ideas/. Muoio, Dave. “Consumer Financial Protection Bureau Shake-up Leaves Medical Debt Reform in Limbo.” Fiercehealthcare.Com, Fierce Healthcare, 6 Feb. 2025, www.fiercehealthcare.com/regulatory/consumer-financial-protection-bureau-shakeup-leaves-medical-debt-reform-limbo. Muoio, Dave, et al. “Healthcare Lobbying 2025: Here Are the Top Policy Issues for Hospitals, Payers, Docs and Tech.” Fiercehealthcare.Com, Fierce Healthcare, 12 Feb. 2025, www.fiercehealthcare.com/regulatory/healthcare-lobbying-2025-here-are-top-policy-issues-hospitals-payers-docs-and-tech.   The Postseason Game Plan: https://postseasongameplan.com/   Resources: 5 Types of Content to Share on Social Media: https://lnk.to/asgf20250131 Best Apps for Sports Fans: https://lnk.to/asga78 Guidelines for Sharing Personal Beneficiary Data with Other TPMOs: https://lnk.to/asg647 MedicareCENTER FAQs: https://lnk.to/asg645 PlanEnroll FAQs: https://lnk.to/asg646   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance     Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Not affiliated with or endorsed by Medicare or any government agency.

 In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down key developments in the payer world. They discuss CVS Health's stock surge, the impact of Medicaid policy changes, and UnitedHealth's aggressive reputation management.

Ohio-based Avation Medical has developed a bioelectric wearable device for at-home treatment of overactive bladder, promising improved quality of life for patients suffering from the most common cause of incontinence and urinary urgency.In Episode #38 of the MedTech Speed to Data Podcast, Andy Rogers discusses the Vivally System, entrepreneurship, and more with Avation Medical co-founder Jill Schiaparelli.Need to KnowBioelectric medicine is an alternative to pharmaceuticals and surgery — Selectively stimulating the nervous system can enhance, control, or fix a function without the tradeoffs of other treatments. Overactive bladder is a prime candidate for bioelectric solutions — Forty-five million Americans have overactive bladder, with nine million preferring adult diapers to traditional treatments.Nitty GrittyAlthough not fully understood, overstimulation of nerves in the bladder wall produces spasms, creating an urge to urinate as often as thirty times a day in extreme cases.Few sufferers choose sacral nerve stimulation, the gold standard treatment, which requires a device implanted near the spine to stimulate nerves regulating bladder behavior.“The moment you say surgery, it complicates things.” Schiaparelli explains. “You need a physician who knows how to do it, you need a patient who's willing to have what could be a very extensive surgery, and you need a payer who's willing to pay for the surgery.”Drugs for overactive bladder have unwelcome side effects that cause most patients to drop out of the care pathway. “When you look at those dynamics,” Schiaparelli says, “it screams a need. Patients want something that takes surgery out of the equation, doesn't have the side effects of drugs, and is convenient.”Avation Medical's Vivally System is an ankle-worn device that indirectly stimulates the sacral nerve through the tibial nerve without surgery. The device measures responses to adjust its stimulation automatically in real-time.“This physiologic closed loop allows the patient to have personalized, effective therapy in just thirty minutes once a week,” Schiaparelli says.Data that made a differenceAs a serial entrepreneur, Schiaparelli has learned that success requires understanding and meeting the needs of three key stakeholders: the patient, the physician, and the payer:Overactive bladder patients dissatisfied with traditional treatments are an enormous market. Most physicians can only offer prescriptions for imperfect drug therapies that do not generate revenue for their practices. Payers don't like either option since surgery costs reach $40,000 while drugs require lifetime prescriptions.“Every area we checked into, it made sense. This technology in this market checked all those boxes to say there's a need. We thought this was a real opportunity to disrupt the market.”But success requires addressing the needs of other stakeholders, including regulators and investors.Regulators' expectations, for example, drove Avation Medical's decision to implement quality control processes while starting its first clinical trial. “We knew that was going to be very important because we planned to use the clinical trial with our FDA submission.”Aligning Avation Medical's investors' expectations was just as important, with each investment round supporting the next stage in development and commercialization.Schiaparelli takes a holistic perspective on a Med Tech startup's data strategy.“It's speed, absolutely,” Schiaparelli says, “but it's also intelligent data that speaks to the needs of all the people that you'll need to demonstrate to down the line.”

In what can seem like a polarizing pharma-PBM dynamic, MM+M 40 Under 40 honoree Mnwabisi Mbangata, associate director, market access strategy at Vertex, explains how he looks to build bonds with payers, in a conversation with MM+M's Heerea Rikhraj.And for our Trends segment, we'll break down all the analysis of ads from healthcare brands that aired during Super Bowl LIX, including our opinion on who won the pharma ad extravaganza. Check us out at: mmm-online.com Follow us: YouTube: @MMM-onlineTikTok: @MMMnewsInstagram: @MMMnewsonlineTwitter/X: @MMMnewsLinkedIn: MM+M To read more of the most timely, balanced and original reporting in medical marketing, subscribe here.

Mike and Beau discuss why they believe Mike Florio should not be allowed to interview Falcons players and personnel after a line of questioning to Michael Penix Jr. they believe to be questionable.

Michael Serbinis, CEO and Founder of League, sits down with Eric to for a compelling discussion on how digital innovation is reshaping healthcare. Discover how League's platform empowers health plans like Highmark to deliver personalized, data-driven experiences that simplify navigation, improve engagement, and enhance member satisfaction. Mike shares fascinating insights on: The power of a unified digital front door for healthcare consumers  Real-world examples of how League amplifies care access and reduces costs  The role of personalization in creating Amazon-like experiences for healthcare  Mike also reflects on lessons from his entrepreneurial journey, including his time working with Elon Musk and how it inspired his vision to transform healthcare. Listen in for actionable strategies on leveraging technology to meet evolving consumer expectations and drive better outcomes. About Mike Michael Serbinis founded League in 2014. League accelerates the digital transformation of the healthcare consumer experience (CX). Serbinis has led the company since its inception, raising over $235 million in funding and driving exponential growth as League powers healthcare's biggest brands.    Mike has had a long and distinguished career as a serial entrepreneur, rocket scientist, engineer and investor. Most recently, Serbinis was the founder and CEO of Kobo, a digital reading company that rivals Amazon's Kindle worldwide. Before that, he founded cloud storage pioneer DocSpace and then built Critical Path, a messaging service that handled one-third of the world's email. Serbinis is also Chair of the Board of Directors for the Perimeter Institute, the world's leading center for scientific research in theoretical physics.    Now, as the CEO of League, Serbinis is focused on healthcare transformation. Payers, providers and pharmacy retailers build on the League platform to accelerate digital transformation and deliver high-engagement, personalized digital experiences. Millions worldwide use and love solutions powered by League to access, navigate and pay for care.   About League  Founded in 2014, League is the leading healthcare consumer experience platform, reaching more than 20 million people around the world and delivering the highest level of personalization in the industry. Payers, providers, and consumer health partners build on League's platform to deliver high-engagement healthcare solutions that improve health outcomes. To date, League has raised $235 million in venture capital funding, powering the digital experiences for some of healthcare's most trusted brands, including Highmark Health, Manulife, Medibank, and Shoppers Drug Mart.   Bright Spots in Healthcare is produced by Bright Spots Ventures Bright Spots Ventures brings healthcare leaders together to share working solution or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime. Visit our website at www.brightspotsinhealthcare.com

In this episode, MAI team members share thought-provoking quotes and insights gathered from conversations this year with key decision makers involved with IDNs, Community Oncology Practices, Payers & Pathways.

Coming out of the pandemic we learned some important lessons.  One of the important ones is that effective RCM (Revenue Cycle Management) is essential to running a successful medical practice.  The challenges and importance of RCM have never been greater.  Payers are continuing to take advantage of healthcare organizations with poor RCM.  Healthcare organizations that don't have high quality RCM will always struggle with cash flow problems.  This leaves them struggling to provide services to patients let alone continuing to innovate.  Of course, the opposite is also true.  Medical practices with great RCM are thriving. At the eClinicalWorks National Conference, I sat down with Sandy Washburn, VP of Operations at Compass Health Systems, to learn about their efforts to do effective RCM at their organization.  Washburn leads off our interview by describing how important RCM is to the success of their organization.  Plus, she talks about how RCM including things like claims and denials have become more and more challenging over time. Learn more about Compass Health Systems: https://www.compasshealthsystems.com/ Learn more about eClinicalWorks: https://www.eclinicalworks.com/

Send us a textWelcome to this week's Safe Dividend Investing's podcast. You may want to go to the printed transcript, provided with this podcast, to review the 5 outstanding US stocks and 5 outstanding Canadian stocks identified this week. It is interesting to see these 10 stocks strengths and weaknesses revealed by 9 data elements.The first 190 Safe Dividend Investing podcasts answered hundreds of  questions from my podcast listeners and readers of my publications. Not wanting to repeat  material that has already been covered, the weekly podcasts now deal with identifying each week 10 dividend stocks whose recent exceptional share price growth may make them worth considering as possible portfolio acquisitions.Visit www.informus.ca for information on my six investment guide books and stock scoring software.IANimacd@informus.caIan Duncan MacDonaldAuthor, Artist, Commercial Risk Consultant,President of Informus Inc 2 Vista Humber Drive Toronto, Ontario Canada, M9P 3R7 Toronto Telephone - 416-245-4994 New York Telephone - 929-800-2397 imacd@informus.ca

In this replay/compilation episode, we explore the drastic changes in healthcare costs since the government's increased involvement, particularly focusing on the shift from individual out-of-pocket expenses to public health insurance covering a significant portion of costs. We discuss the economic impacts of these changes, such as rising premiums, claim denials, and the restrictions placed on insurance companies by laws like the Affordable Care Act. The episode emphasizes the need for a free market system to make healthcare more affordable and critiques how government policies have led to inefficiencies and higher costs. (00:00) The Impact of Government on Healthcare Costs (00:35) Historical Healthcare Expenditures: A Closer Look (02:17) Out-of-Pocket Costs and Public Health Insurance (03:21) The Role of Private Health Insurance (04:58) The Free Market Solution to Healthcare (05:19) Affordable Care Act: Challenges and Consequences (06:17) Insurance Mandates and Market Dynamics (07:48) The Economics of Health Insurance (13:25) Conclusion: Addressing the Real Problems in Healthcare

The Genomic Answers for Kids program at Children's Mercy Kansas City has increased access to cutting-edge genomic sequencing for children suspected of having rare genetic diseases and improved the diagnostic yield of these tests. The program has collected samples from 8,000 rare disease patients and their family members and diagnosed about 2,000 people to date. Nevertheless, payers have been reluctant to increase reimbursement rates for more comprehensive genomic testing, posing a challenge to its sustained and expanded use for children who can benefit from it. We spoke to Tomi Pastinen, director of the Center for Pediatric Genomic Medicine at Children's Mercy Kansas City, about the success of the program to date, the reimbursement challenges, and the future of the technology.

Part 2 of a 2 part episode looking at how payers and providers are transforming healthcare through value-based care partnerships.  The moderator is Denny Brennan, WEDI Board Member, Co-Chair of its Education Committee, and Executive Director of the Massachusetts Health Data Consortium.  The panel: Anna Taylor, AVP, Population Health & Valiue Based Care, Multi Care Connected Care Ben Pollock, PhD, Senior Associate Consultant II, Division of Health Care Delivery Research, Mayo Clinic Semira Singh, Director Population Health, Providence Brian Wallace, Vice President, Data Analytics and Reporting, Centene Corporation

From WEDI's Value-Based Care Spotlight in November, Part 1 of a 2 part episode looking at how payers and providers are transforming healthcare through value-based care partnerships.  The moderator was Denny Brennan, WEDI Board Member, Co-Chair of its Education Committee, and Executive Director of the Massachusetts Health Data Consortium.  The panel: Anna Taylor, AVP, Population Health & Valiue Based Care, Multi Care Connected Care speaker Ben Pollock, PhD, Senior Associate Consultant II, Division of Health Care Delivery Research, Mayo Clinic Semira Singh, Director Population Health, Providence Brian Wallace, Vice President, Data Analytics and Reporting, Centene Corporation

Have you ever wondered if dropping a vision plan could actually help your practice grow? It's a tough decision, but one that could reshape your patient relationships and increase your practice's revenue. In this week's Power Hour episode, Eugene Shatsman speaks with Steve Alexander, a consultant with over 20 years of experience in eye care, to tackle the question so many optometrists wrestle with. 

This episode explores how payers can navigate the challenges and opportunities of alternative payment models in healthcare. Jakob Emerson speaks with Angie Adams, VP of Product Management at i3 Healthcare Solutions, about agility and technology for contract management, as well as key objectives for payers and the future of healthcare payer operations.This episode is sponsored by i3Healthcare Solutions.

In this episode, hosts Payal Nanavati and Savanna Williams talk to Aaron Cummings and Stephen Holland about the Trump and Harris campaigns' approaches to issues affecting the health care industry. This podcast episode features the following speakers: Aaron Cummings serves as the co-chair of Crowell's Government Affairs Group and was Chief of Staff to U.S. Senator Chuck Grassley (R-IA) from 2019-2023. Today, Aaron helps clients make sure their views are represented in policy discussions in Capitol Hill, the White House, and throughout the federal government, including advising clients on health care legislative and policy. Stephen Holland is an senior counsel in Crowell's Government Affairs Group, where he leverages his extensive experience advising members of Congress and their staff as a policy advisor and attorney active in health care legislation. In his most recent role prior to joining Crowell, Stephen spent five years on the Energy and Commerce Committee staff under the leadership of Ranking Member and former Chairman Frank Pallone (D-NJ). Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

One year ago, on October 30, 2023, President Joe Biden signed an executive order laying the groundwork both for how federal agencies should responsibly incorporate artificial intelligence (AI) within their workflows and how each agency should regulate the use of AI in the industries it oversees. What has happened in the past year, and how might things change in the next? On this episode, Epstein Becker Green attorneys Lynn Shapiro Snyder, Eleanor Chung, and Rachel Snyder Good reflect on what is new in health care AI as a result of the 2023 executive order and discuss what industry stakeholders should be doing to comply and prepare for future federal regulation of AI in health care. Article – HTI-1 final rule: https://www.healthlawadvisor.com/oncs-information-blocking-enhancements-under-the-hti-1-rule-are-in-effect Article – HTI-2 proposed rule: https://www.healthlawadvisor.com/as-the-window-for-comments-closes-on-onc-astps-hti-2-proposed-rule-whats-in-hti-2-and-what-does-it-mean-for-you Webinar – New Final Regulation Prohibiting Algorithmic Discrimination by Health Care Providers and Payers: https://www.ebglaw.com/insights/events/new-final-regulation-prohibiting-algorithmic-discrimination-by-health-care-providers-and-payers Webinar – Demystifying AI Tools in Health Care, An Introduction for Federal Policymakers: https://www.ebglaw.com/insights/events/alliance-for-health-policy-demystifying-ai-tools-in-health-care-an-introduction-for-federal-policymakers Visit our site for related resources and email contact information: https://www.ebglaw.com/dhc83. Subscribe for email notifications: https://www.ebglaw.com/subscribe. Visit: http://diagnosinghealthcare.com. This podcast is presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

Karen Elmore is living in denial(s).     Her job as Senior Clinical Documentation Quality Coordinator for BJC Healthcare involves a daily battle against a never-ending tide: Payers denying diagnoses on the perceived basis of lack of clinical support. Recently she's had to deal not only with human payers, but artificial intelligence denials as well.    Karen's organization has worked hard to stem this never ending tide, and found some success with uniform organizational clinical guidelines and consistent education and engagement.     We talk denials, appeals, preventing future denials through provider education, and  Kansas City Chiefs football (still undefeated as of publish date), on this episode of Off the Record.    On this show we cover:    Karen's unique role as program manager for CDI at BJC, including responsibilities for physician education, engagement, and denials prevention  Typical denials for sepsis, respiratory failure, and malnutrition: What payers are using for ammunition  What payers are the worst offenders, and particularly creative (and egregious) tactics  AI denials—how do you spot them, and combat a machine?  Provider engagement strategies and relaying denials back to physicians  Legitimate reasons for denial and ongoing documentation shortfalls  Karen's Kansas City Chiefs obsession—inside an average Sunday in the Elmore household (it's crazy) 

Patient rights: do you know about the rights you have in regard to healthcare? There is a lot of information for you that Sara and Thayer serve to you here, in terms you can understand.  They both work for the Partnership to Improve Patient Care, or PIPC (a coalition).Sara Traigle van Geertruyden is the Executive Director at PIPC. Thayer Roberts is the Deputy Director.  Sara, an attorney, joined PIPC in 2011 and serves at the firm, Thom Run Partners.  Sara focuses policies to advance a patient centered health system, from patient engagement in research to driving outcomes that matter to patients in healthcare payment and delivery.  Sara is a healthcare and welfare policy expert with over 25 years of experience, beginning her career on Capitol Hill working for former Senator John Breaux (D-LA) from 1996-2003, and later as an attorney at the law firm Patton Boggs.  Thayer joined PIPC in 2019. Thayer works with PIPC's diverse membership of patients, healthcare providers, researchers, and other groups to ensure that patient centricity is at the core of the nation's health care system.  Thayer has expertise in health care value assessments and their implications on patients and people with disabilities and continues to engage in this topic both at the Federal and State level. Chair of PIPC: (From their website) Tony Coelho is a former United States congressman from California, and primary author and sponsor of the Americans with Disabilities Act. Tony was elected to Congress in 1978 and served for six terms until 1989. He served on the Agriculture, Interior, Veterans Affairs, and Administration Committees during his tenure, specializing in disabled rights. In 1986, Tony was elected House Majority Whip. As the chief vote counter for his party, Tony oversaw a series of Democratic victories in the House on measures ranging from the budget to cutting off funds for the war in Central America. Tony was the original author of the Americans with Disabilities Act, signed into law by President George H.W. Bush. By 1994, the U.S. Census Bureau reported that some 800,000 more people with severe disabilities had found employment than were employed when the bill was first enacted. Tony currently serves as the DNC Disability Council Chair, seeking to ensure that the political process is accessible to people with disabilities. President Bill Clinton appointed Tony to serve as Chairman of the President's Committee on Employment of People with Disabilities, a position he held from 1994 to 2001. He also served as Vice Chair of the National Task Force on Employment of Adults with Disabilities. In 1998, Clinton appointed Tony as the United States Commissioner General at the 1998 World Expo in Portugal. Clinton also appointed Tony as Co-Chair to the U.S. Census Monitoring Board, a position he held until his appointment as general chairman of the Gore presidential campaign.Sara and PIPC work with nonprofit organizations, like The Bonnell Foundation to help us to understand and keep track of all the legislation on the books, and coming down the pipeline. To contact PIPC go to: https://www.pipcpatients.orgTo find PIPC on social media check them out at: @PIPCpatients (on twitter and LinkedIn)Another resource Sara and Thayer suggest: https://www.patientaccessproject.orgAcronym's used during this podcast: Prescription Drug Affordability Board (PDAB)Rare Disease Advisory Council (RDAC)National Association for State Health Policy (NASHP)Institute for Economic and Clinical Review (ICER)Equal Value of Life Year Gained (EVLYG)HR 485 Protecting Healthcare for all Patients Act   Read it here: https://www.congress.gov/bill/118th-congress/house-bill/485 Please like, subscribe, and comment on our podcasts!Please consider making a donation: https://thebonnellfoundation.org/donate/The Bonnell Foundation website:https://thebonnellfoundation.orgEmail us at: thebonnellfoundation@gmail.com Thanks to our sponsors:Vertex: https://www.vrtx.comViatris: https://www.viatris.com/en

In this episode, Scott Becker is joined by Jakob Emerson, Associate News Director at Becker's Healthcare, to discuss the latest developments in the payer and insurance space. They cover leadership changes at CVS, quarterly performance insights from Elevance and UnitedHealthcare, and the evolving landscape of payer-hospital relationships.

This podcast discusses the two models of infusion services to facilitate outpatient and home health care, and the care benefits and challenges associated with therapy. A patient care goal is to enhance the care experience and best streamline infusion therapy through a modality that is most efficient, while equally safe, and less disruptive to day-to-day activities. Health-systems have developed strategies for optimizing a balance between the use of home infusion and hospital outpatient infusion services to ensure optimal patient care and financial performance. Payers implement a variety of tools that enhance care affordability based on formulary status, site of care restrictions, and medication dispensing model (i.e. brown bagging, white bagging, etc.). Proposed legislative policies and regulatory reforms that impact Medicare payments may have a key role towards infusion services through changes in the payment structure.   The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

In this episode, hosts Payal Nanavati and Megan Beaver talk to Alice Hall-Partyka and Spencer Bruck about the recently released Mental Health Parity and Addiction Equity Act (MHPAEA) final rule. Alice and Spencer delve into the key new provisions of the rule, including the requirements for Non-Quantitative Treatment Limitations comparative analyses and the focus on data outcomes. Relevant resources: Tri-Agencies Finalize NQTL Comparative Analysis Standards in Final Rule Final Mental Health Parity Rule Spurs Loper Bright Legal Threat Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

Jacob and Nikhil sit down with Parth Mehrotra, CEO of Privia Health. Privia is a physician enablement platform partnering with 4500+ providers towards practice improvement and value-based care. They discuss the most important ways to manage risk, building effective physician enablement solutions, the future of value-based care programs & contracts, and more. [0:00] Intro[0:55] Privia's Business Model and Footprint[3:26] Physician Choices and Privia's Role[6:06] Evolution of Value-Based Care[8:42] Future Role of Payers in Healthcare[10:48] Choosing Geographic Markets for Expansion[11:53] Physician Enablement Market Dynamics[15:02] Influencing Practice Processes Without Ownership[18:52] Evaluating Value-Based Programs[21:47] Capabilities Needed for Risk-Based Contracts[24:28] Risk Pooling and Healthcare Economics[28:31] Future of Value-Based Care[31:40] Primary Care and Specialist Roles[36:18] Commercial vs. Medicare Value-Based Care[39:30] AI in Healthcare: Current and Future Applications[43:02] Quickfire Out-Of-Pocket: https://www.outofpocket.health/

Payers can use AI as an assistant, not as a replacement, to reviewing claims and prior authorizations.

SPOOKY Season has officially started and goddam are there plenty of things to be scared of! That's why I had to bring back the EPIC Mini-Series "Halloween Havok" for 2024! Part 2: "Ford HATES late payers" ft. (new) bro to the show, Rapper WÜLF!! Ford, as of recently, YES, the same makers of the Taurus/Focus/Contour/Explorer, etc., filed for a patent that is not only (kinda) genius but invasive and BEYOND Finance-shaming!! Miss 3 payments on your future lease and they'll program the vehicle to REPOSSESS ITSELF without you even knowing!! So I had to ask daily driver WÜLF for his input!!! Imagine of all brands, it's FORD that comes up with self-repossessing vehicles? Ford REALLY SAID all you broke ass bitches will get stole on/repossessed on like that AND MORE on "Ford HATES late payers" - EP 123 of "AhhFuGGiT" ft. WÜLF - UP NOW!!! CHECK OUT HIS LATEST SINGLE/VIDEO: "Contra"!! https://www.youtube.com/watch?v=P11HHlWOlV8 CHECK OUT THE WÜLF OF QUEENS!: https://www.instagram.com/lamewulf https://www.youtube.com/ @wulfyseason https://www.wulfyseason.bandcamp.com https://open.spotify.com/artist/5tVl3b6do21583cBodY94N?si=DgfE2w8jRMKLxwRA3XT0kg&utm_medium=share&utm_source=linktree&nd=1&dlsi=0b66d34319794361 LIKE | RATE | COMMENT | FOLLOW | SUBSCRIBE https://www.youtube.com/whodissis1 https://www.twitch.tv/whodissis1 https://www.instagram.com/whodissis1 https://www.instagram.com/whodissbeenwatching https://www.instagram.com/ahhfuggit https://www.tiktok.com/@whodissis1 https://twitter.com/whodissis1 MORE AUDIO VERSIONS OF AhhFuGGiT: https://linktr.ee/whodissis https://soundcloud.com/whodissis1 https://open.spotify.com/show/6hyS2l2KdQDkX5rfNH5AIp https://podcasts.apple.com/ca/podcast/ahhf…it/id1084220877

Jacob and Nikhil sit down with Bryony Winn, President at Carelon. Carelon is the diversified services business within Elevance Health (formerly Anthem), serving 1 in 3 Americans through advanced primary care, behavioral health, specialty enablement, and whole health solutions. They discuss what payers are thinking about, making value-based care work, creating effective provider partnerships, and more.[0:00] Introduction to Vital Signs Podcast[0:41] Understanding Elevance Health and Carelon[1:49] The Future of Healthcare Integration[2:57] Carelon's Strategy and Partnerships[3:47] Navigating Healthcare Transitions[5:22] Lessons from Healthcare Partnerships[8:10] The Role of Value-Based Care[9:55] Innovations and Challenges in Healthcare[21:59] The Commercial Healthcare Landscape[25:00] Cross-Business Initiatives and Medicaid Innovations[28:15] The Impact of Generative AI in Healthcare[32:32] QuickfireOut-Of-Pocket: https://www.outofpocket.health/

The Tararua District mayor has offered a "heart felt personal apology" for a botch up that's left some rate payers owing thousands of dollars that the coouncil must collect. A mistake calculating direct debit payments for rates, that dates back to 2018, means more than 320 households have been under charged and 281 have paid more than they should. To make things worse it's hit the most vulnerable households; those already getting rates rebates, Tararua District Mayor Tracey Collins spoke to Lisa Owen.

In this episode, Scott Becker highlights the year-to-date stock performance of major private equity firms like Blackstone, KKR, and Apollo Global, alongside health insurers UnitedHealth, Cigna, and CVS. Tune in for insights on which companies are thriving and which are facing challenges.

In this episode, Scott Becker highlights the year-to-date stock performance of major private equity firms like Blackstone, KKR, and Apollo Global, alongside health insurers UnitedHealth, Cigna, and CVS. Tune in for insights on which companies are thriving and which are facing challenges.

Meta, Alphabet, and Salesforce were healthy businesses making profits and seen as “the big guys”. Why did they start paying a dividend? What does it change for them... and for you? Should you grab some shares? Download the Dividend Income for Life Guide. Make sure to check out the complete show notes. Twitter: @TheDividendGuy FB: http://bit.ly/2Z7Q5gF YouTube: http://bit.ly/2Zs6r1r DividendStocksRock.com

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma and Biotech world.Target has launched a collection designed by 'fur-fluencers' to attract pet owners, along with reality TV-styled social content and national ads featuring mascot Bullseye. PayPal's new ad campaign stars Will Ferrell and emphasizes the use of PayPal for both in-store and online transactions. Old Navy is celebrating its 30th anniversary with a '90s-inspired collection and campaign. JC Penney's football-themed campaign includes weekly deals promoted by celebrities like Shaquille O'Neal. Walmart is using Fubo's takeover ad format to connect content and commerce in a CTV environment, highlighting the importance of digital accessibility, the impact of generative AI on marketing strategies, and the evolution of in-store retail media.Steward Health Care has been auctioning off assets, with 15 hospitals transitioning to interim managers and the sale of its Arkansas facility. A data breach at a CMS contractor could affect over 946,000 Medicare beneficiaries. PBM executives have declined to revise controversial testimony given to a House committee. The Biden administration has finalized a rule raising mental health coverage standards for private plans. Medicare Advantage bonuses are expected to drop for the first time since 2015. Payers are exploring ways to improve the quality of provider data through technology.J&J led a $50 million financing round for imaging company SpectraWave, which will support commercial expansion and product additions for their system used in treating coronary artery disease. Apple announced a new sleep apnea feature for its smartwatch, while Roche is set to launch a new continuous glucose monitoring system in Europe. The FDA has found that many AI devices lack validation data, with only 28% being tested prospectively. Singapore is seen as an ideal hub for medtech companies looking to expand in Southeast Asia.A new lung cancer drug developed by Summit has shown a "striking" benefit over Keytruda in a detailed study, confirming earlier claims by the company. The positive results led to a significant increase in shares. In other news, three biotechs raised $700 million in IPOs, the House backed a bill restricting China's role in US biotech, and Centessa's sleepiness drug showed promising results.The Senate is expected to hold Steward CEO Ralph de la Torre in contempt for failing to appear before a subcommittee. In other news, Elevance is acquiring Indiana University Health's insurance business, and Steward Health Care has sold some assets and transitioned hospitals to interim managers. Abortion laws are changing in the US, with North Dakota overturning a near-total ban. California's data exchange framework is proving successful in improving health equity and streamlining information.Three biotechs, Bicara Therapeutics, Zenas Biopharma, and MBX Biosciences, raised $700 million in IPOs, marking the busiest week for biotech stock sales since February. Biotech IPOs are considered the industry's lifeblood, providing insight into mature startups waiting to test public markets. Moderna admitted during an investor presentation that they were overly optimistic about their RSV vaccine's market share potential compared to rivals GSK and Pfizer. Roche's subcutaneous Tecentriq received FDA approval, beating competitors Merck and Bristol Myers to market. Additionally, Gilead's shot succeeded in its second HIV trial.Biopharma Dive provides in-depth journalism and insight into trends shaping biotech and pharma, covering topics from clinical readouts to FDA approvals, gene therapy, drug pricing, and research partnerships. Subscribe to Biopharma Dive for daily news and insights in the industry.

It's Brunch-Time - habt Ihr schon genügend Euronen gespart für die Playstation 5 Pro? Mindestens 800 Euro soll das PS5-Upgrade kosten und die gesamte Crew lässt es sich natürlich nicht nehmen diesen waghalsigen Preis von Sony einzuordnen. Außerdem berichtet Micha von seinem Playthrough von Hellblade 2 und Michi erklärt, warum Ihr Test Drive: Solar Crown trotz schlechter Tests eine Chance geben könntet. Manu und Anne haben sich in der Welt von Caravan SandWitch entspannt und ein wundervolles und farbenfrohes Abenteuer in Angriff genommen, während Micha in den Beat'em Ups von Marvel vs Capcom Fighting Collection Kinnhaken gesetzt hat. Außerdem in den News: Yves Guillemot und sein Ubisoft und ein hoffentlich fiktives Szenario im Mailbag. Wir wünschen viel Vergnügen.

So, I had a chance to read Dr. Marty Makary's new book, which is called Blind Spots; and here's why I wanted to get him to come back on Relentless Health Value and talk to you, people of the healthcare industry. It's because of something that he said on page 127 and which I've been mulling over for probably years, actually. To Read The Full Article Including Links Mentioned, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. It's this idea of what is appropriate care and how good are we at ensuring that patients/members get said appropriate care. Lots of people are of the same minds because appropriate care has come up in the show with Ben Schwartz, MD, MBA (EP434); John Lee, MD (EP438); Spencer Dorn, MD, MPH, MHA (EP446); Tom Lee, MD (EP445).  I mean, an estimated 21% of all medical care is potentially unnecessary. And unnecessary is, of course, one category of things that are not appropriate. This is according to a national survey of physicians: 25% of diagnostic tests, 22% of all medications, and 11% of all procedures are unnecessary/inappropriate. This is billions of wasted dollars doing stuff that shouldn't be done, and it's not appropriate care. But think about this: How many visions for how to fix healthcare and how to reduce waste depend upon a broad-stroke assumption that we will materially ensure that patients are getting best-practice (ie, appropriate) care? That we cut down on over-medicalization and surgeries on the back end and add appropriate preventative stuff and optimal medical therapy to the front end? Dr. Makary and I delve into the challenges of ensuring patients receive appropriate care, touching on medical dogma, financial, business, and legal incentives, and the importance of measuring practice patterns. Dr. Makary provides practical advice for clinical leaders, payers, and plan sponsors on promoting transparency, improving health literacy, and steering members towards higher performing providers. To Read The Full Article Including Links Mentioned, click here. 07:32 What is appropriate care? 10:19 Why what we think might be appropriate care might not be appropriate care. 10:34 Why is medical dogma damaging to appropriate care? 12:45 Why we need less absolutism in medical practice. 13:37 How is groupthink prevalent in medicine? 14:02 Why do we resist new ideas? 17:43 How do providers figure out what to believe and what not to believe? 20:59 “If you leave it to the medical profession to fix itself … so far, it's not going well.” 22:33 How does supporting health literacy affect appropriate care? 30:23 “People need to find their care based on quality and price.” 34:28 What proportion of medical care is deemed unnecessary right now?  

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma e Biotech world. This week's commercialization news includes Dupixent's success in a chronic hives study, Lilly's development of a weekly insulin shot, and BioMarin's plans for growth. The House backs a bill restricting China's role in US biotech, while Lykos CEO is set to depart after FDA rejection and layoffs. The newsletter also discusses key developments in cell therapy and offers insights on utilizing a direct-to-patient model in the healthcare industry. Various resources and upcoming events in the biopharma industry are also highlighted. Biopharma Dive provides in-depth journalism and insights into the latest news and trends shaping the biotech and pharma industries.BridgeBio has reduced its gene therapy budget after data from a trial on an adrenal gland medicine did not meet the company's investment threshold. GlaxoSmithKline has discontinued a herpes vaccine after it did not meet efficacy goals in a phase 2 study. Roivant has launched a new 'vant' focused on a hypertension drug. Centessa's sleepiness drug has shown promising results in early studies, leading to a rise in the company's shares. Additionally, Dupixent has succeeded in a chronic hives study, giving Sanofi and Regeneron a chance to resubmit their application for approval. Investors are also paying attention to Centessa's sleepiness drug. This news comes alongside updates on other pharmaceutical developments, such as Saxenda's effectiveness for children as young as 6 and Roche's expansion of R&D labs. Additionally, the newsletter covers upcoming events and resources for biopharma professionals. Biopharma Dive provides in-depth coverage of news and trends in the biotech and pharma industries, including clinical trials, FDA approvals, gene therapy, drug pricing, and research partnerships.Iowa has awarded Centene's subsidiary, Iowa Total Care, a Medicaid managed care contract worth $2.8 billion. Telehealth groups are urging Congress and the White House to extend controlled substance virtual prescribing before pandemic-era flexibilities expire. The Biden administration has finalized a rule raising mental health coverage standards for private plans. Steward Health Care received court approval to sell its three most valuable hospitals to Orlando Health for $439 million. The importance of data quality in realizing value from medical imaging data is emphasized by Enlitic. Payers are encouraged to optimize quality and grow revenue through key strategies in an upcoming webinar. Healthcare Dive provides in-depth journalism and insight into the most impactful news and trends shaping healthcare across various sectors like health IT, policy & regulation, insurance, digital health, payer-provider partnerships, and value-based care.Novo Nordisk showcased its investigational GLP-1 pill that resulted in a remarkable 13% weight loss. This comes after positive Phase I results for the pill, which analysts compared to weight loss pills being developed by Lilly and Pfizer. Expanded coverage for cardiovascular disease under Medicare could have significant implications for Novo's obesity drug, Wegovy. Analysts estimate that the expansion of Wegovy's label beyond obesity could lead to an annual Medicare spending of $145 billion. Meanwhile, GSK has abandoned the development of its herpes vaccine after disappointing Phase I/II results, and Crispr Therapeutics and Vertex Pharmaceuticals are facing challenges in making their sickle cell gene therapy profitable. Novo's other drug, Saxenda, was found to effectively and safely lower BMI in children, according to a study published in NEJM. Additionally, Lilly continues to make progress with its once-weekly insulin, while Bain has raised $3 billion for a fund supporting life sciences companies. The biopharmaceutical industry continues to see changes, with Biomarin facing challenges and Terns moving forward in the obesity spac

Anne Saulnier, the trailblazing CEO of Hex IQ, joins us to reveal how reimbursement data is revolutionizing healthcare sales. With her unique expertise in both marketing and enterprise software, Anne sheds light on the groundbreaking changes brought about by the 2020 law that mandates insurance companies to disclose negotiated rates. This newfound transparency empowers medical sales reps to showcase ROI compellingly, target the right customers, and accelerate their sales cycles. From Hex IQ's innovative solutions to the enthusiastic reception from healthcare professionals, Anne shares the journey of bringing actionable reimbursement data to the forefront of the industry.   Anne's story of founding Hex IQ is a testament to vision and perseverance. We explore her background, the pivotal moment that led to Hex IQ's creation, and the competitive edge the company offers in making healthcare data transparent and actionable. The episode delves into the challenges of market awareness and the positive impact Hex IQ's solutions have had on medical sales reps and physicians alike. Anne takes us through the user-friendly features of their software that streamline access to complex data and optimize sales strategies.   But Anne is more than just a pioneering CEO; she's also a hobby farmer, mother of three, and stand-up comedian. We get an inside look at how she balances these roles and what drives her to excel both professionally and personally. From high-risk hobbies to the future of AI in healthcare, Anne's multifaceted life offers a rich tapestry of insights and inspiration. This episode also tackles the critical issue of data security, emphasizing the measures needed to protect business transactions in the healthcare sector. Join us for an engaging and enlightening conversation that spans the realms of data science, personal passions, and industry innovation.   Meet the guest:   Anne Saulnier is a data nerd, a comedian, a hobby farmer, a former skydiver, and the CEO of a data science company called HexIQ. She and her team are on a mission to disrupt healthcare by revealing how money flows between major payers (such as Blue Cross Blue Shield, United, Cigna, and Aetna) and medical practices, health systems, and private equity firms.   Visit: https://hexiq.com/podcast/   Best Book - Blink by Malcolm Gladwell (https://www.amazon.com/Blink-Power-Thinking-Without/dp/0316010669) Best Food/Restaurant - Halibut Fish at Scales Restaurant in Portland, Maine (https://www.opentable.com/scales?ref=1068) Best TV Show - Old Man (https://www.imdb.com/title/tt5645432/)     Watch Anne's Stand-up comedy snippets on her TikTok Account - https://www.tiktok.com/@annesaulnier

This Unfiltered episode of Fixing Healthcare features Dr. Jonathan Fisher, a respected cardiologist and advocate for physician well-being, and Dr. Robert Pearl, healthcare leader and author of ChatGPT, MD. Jeremy ... The post FHC #147: Game theory and healthcare—the complex relationship between doctors, payers and patients appeared first on Fixing Healthcare.

In this episode, hosts Payal Nanavati and Savanna Williams talk to Roma Sharma and Wietse Vanpoucke about the European Union's Artificial Intelligence Act, which establishes a common regulatory and legal framework for AI within the European Union. This podcast episode features the following speakers:   Roma Sharma is a counsel in Crowell's Health Care Group, where she advises a variety of health care clients on navigating the use of AI in the industry and complying with federal and state laws and regulations. Wietse Vanpoucke is an associate in Crowell's Brussels office, where his practice focuses on the life sciences and digital health sectors, relying on his deep experience with European and Belgian regulatory affairs and legal procedures. Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

Good morning from Pharma and Biotech daily: the podcast that gives you only what's important to hear in Pharma e Biotech world.Biopharma company ArsenalBio recently raised $325 million in funding, marking one of the largest biotech funding rounds of the year. This news comes as Biomarin focuses on growth plans centered around their drug for skeletal disorders. However, the gene and cell therapy investment market is currently experiencing a slowdown, with fewer funding rounds closed compared to previous years. On a positive note, a high-dose study of Biogen's spinal muscular atrophy drug showed promising results, while Denali Therapeutics and Regenxbio are moving forward with drug approval applications. In the oncology research sector, advancements in treatments, particularly in cancer immunotherapy and personalized medicine based on genetics, continue to be made. Despite these successes, there are reports of challenges faced by gene therapy companies, such as the closure of Astellas Gene Therapies' manufacturing facility affecting 100 employees and employers hesitant to cover the costs of rare disease treatments.The EU GMP Annex 1 revision has significant impacts on drug manufacturers, as non-compliance puts their ability to create and sell products in impacted markets at risk. Manufacturers must assess components for readiness to comply with the new regulations to avoid manufacturing non-compliance, potential product recalls, and market exclusions. To maintain compliance, staying informed about key considerations and taking steps to mitigate risks is crucial.Mississippi has awarded medicaid contracts to Centene, Molina, and TrueCare. Steward Health Care faced financial challenges with unprofitable deals in Massachusetts, while CEO Ralph de la Torre snubbed a Senate subpoena. Molina appointed its CFO to oversee its medicaid and ACA marketplace businesses. Healthcare providers are addressing burnout among staff, trends in telehealth and provider-payer relationships are being discussed. In California, the Senate passed a bill to regulate private-equity healthcare deals while a judge blocked Ohio from enforcing laws restricting medication abortions.Edwards recently laid off more than 500 employees after selling its critical care division to BD. The FDA has issued warning letters to four companies regarding ozone cleaners for CPAP machines. Abbott has partnered with Beta Bionics to integrate its glucose sensor with an automated insulin delivery system. The European Heart Group recommends renal denervation for some patients with uncontrolled high blood pressure.Biopharma Dive's newsletter on September 5, 2024, highlighted various key topics in the biopharma industry focusing on industry trends and developments. Additionally, it featured sponsored content on AI's role in life sciences and white papers on process analytical technology in the biopharma industry.The pharmaceutical industry faces challenges in reputation and communication with the media despite recent successes such as the development of COVID-19 vaccines. Merck & Co.'s Chief Communications and Public Affairs Officer is promoting openness and transparency in communication to improve the industry's reputation.Cell and gene therapy research is gaining interest from investors and innovators despite facing challenges in keeping up with industry growth. The latest developments focus on overcoming barriers with outside support and potential advancements in CAR-T cell therapy options.Payers can strategically use technology to build a solid data foundation by improving provider data quality through new technology tools.Researchers need to effectively collect social determinants of health (SDoH) data while ensuring privacy and security. A playbook provides insights on utilizing SDoH data effectively for health economics & outcomes research.Industry professionals are invited to join Snowflake Industry Day, a virtual event focusing on how technology leaders use

If you placed your faith in Jesus, we want to give you a free gift! Click below to fill in your information so we can mail you your gift or you can pick it up at one of our in-person services at 8:30AM, 10:15AM, 12PM, & 1:45PM. https://churchalivenj.churchcenter.com/people/forms/129025 Subscribe to Our Channel: https://www.youtube.com/channel/UCEHNDPb5XMkf1LyqoTU30vg Help Support and Grow our Ministry to reach people around our community and spread the love of Jesus: https://churchalivenj.churchcenter.com/giving Stay connected with us through our: Church Alive Website: https://churchalive.tv Instagram: https://www.instagram.com/churchalivenj/?hl=en Facebook: https://www.facebook.com/ChurchAliveNJ/ Plan your next in-person visit. We are located at: The Williams Center 15 Sylvan St, Rutherford NJ

On this episode of The Health System CXO Podcast, Jackie Kimmell, Sr. Director - Member Insights at The Health Management Academy, discusses Medicare Advantage (MA) and its impact on health system executives. She also discusses the growth and significance of MA in the healthcare industry, the profitability for payers, the benefits and challenges for beneficiaries, and the struggles health systems face. She also highlights the regulatory changes and headwinds that have affected the profitability of MA plans, leading to decreased margins for payers and lower yields for health systems. Lastly - she shares the insights Strategy Executives need to know regarding the variations in MA penetration across different markets and the importance of understanding the MA landscape for healthcare executives.Key Takeaways-Medicare Advantage (MA) is a major topic of concern for health system executives due to its significant impact on the healthcare industry.-Payers have prioritized MA and have seen high profit margins, but regulatory changes and headwinds have affected their profitability.-MA offers benefits such as low premiums and supplemental benefits, but there may be hidden downsides and challenges for beneficiaries.-Health systems have contracted with MA plans to benefit from higher reimbursement rates, but they face challenges such as claims denials and lower yields.-Understanding the MA landscape is crucial for healthcare executives to navigate the changing market and ensure financial sustainability.Chapters00:00 Introduction and Podcast Evolution00:27 The Significance of Medicare Advantage for Health System Executives03:02 Medicare Advantage: Profitability and Challenges07:38 Regulatory Changes and Headwinds in Medicare Advantage09:31 Variations in Medicare Advantage Penetration Across Markets12:23 Challenges Faced by Health Systems in Medicare Advantage Contracts17:21 Navigating the Medicare Advantage Landscape as a Healthcare ExecutiveWelcome to the Health System CXO Podcast, sponsored by The Health Management Academy, featuring content designed for Health System Nurse Executives, Health Equity Officers and Strategy Executives provided by our company SME's - Anne Herleth, Jasmaine McClain, Ph.D. and Jackie Kimmell. Subscribe today and receive the latest insights from the country's leading Health System CXO experts regularly, helping you remain current and guide your health system strategy with thought leadership and success.The Health System CXO Podcast activates health system leaders towards outcomes and scalable solutions you can implement now.About The Health Management Academy:Since 1998, The Health Management Academy has cultivated the premier community of healthcare's most influential changemakers from the top U.S. health systems and innovative industry partners. We power more than 2,000 health system senior executives and 200 industry organizations through exceptional peer groups, original market insights, world-class leadership development programs and novel member alliances. Our industry-leading programs and solutions enable members to facilitate meaningful relationships, navigate strategic transformation and address critical industry issues. To learn more, visit hmacademy.com and follow The Health Management Academy on ...

The US healthcare landscape is undergoing significant changes as the Centers for Medicare & Medicaid Services (CMS) continues to implement the Inflation Reduction Act (IRA). One key stakeholder group affected by the IRA drug price negotiations and Medicare Part D redesign are health insurance companies. In this episode of Connected with Latham, we delve into how these payers are responding to the IRA, including the new ability for Part D beneficiaries to spread their cost-sharing equally across the plan year. Amanda Forys from Magnolia Market Access joins Washington, D.C. partner Chris Schott and associate Danny Machado to discuss the findings of a recent survey on payer trends. Beyond discussing the broader effects of the IRA on the healthcare industry, the conversation also touches on possible Part D premium increases and how payers might be shifting new IRA obligations onto manufacturers.   This podcast is provided as a service of Latham & Watkins LLP. Listening to this podcast does not create an attorney client relationship between you and Latham & Watkins LLP, and you should not send confidential information to Latham & Watkins LLP. While we make every effort to assure that the content of this podcast is accurate, comprehensive, and current, we do not warrant or guarantee any of those things and you may not rely on this podcast as a substitute for legal research and/or consulting a qualified attorney. Listening to this podcast is not a substitute for engaging a lawyer to advise on your individual needs. Should you require legal advice on the issues covered in this podcast, please consult a qualified attorney. Under New York's Code of Professional Responsibility, portions of this communication contain attorney advertising. Prior results do not guarantee a similar outcome. Results depend upon a variety of factors unique to each representation. Please direct all inquiries regarding the conduct of Latham and Watkins attorneys under New York's Disciplinary Rules to Latham & Watkins LLP, 1271 Avenue of the Americas, New York, NY 10020, Phone: 1.212.906.1200

Join us for this monthly series that we streamed live with Revenue Cycle Leaders. We will dive into a number of topics that leaders are faced with today including: Payers, Automation, Technology, Talent Shortages, Cost Takeout, etc. This will be an interactive session with questions from people who join. Our third episode brings my good friend Jen Snyder who leads the Automation Program at Colorado Medicine.  This series is sponsored by Tarpon Health.  A community of providers that are tackling automation as a strategy.  Check us out at Tarpon.health

Join us for this monthly series that we streamed live with Revenue Cycle Leaders. We will dive into a number of topics that leaders are faced with today including: Payers, Automation, Technology, Talent Shortages, Cost Takeout, etc. This will be an interactive session with questions from people who join. Our third episode brings my good friend Surya who is VP Revenue Cycle at Marshfield Clinic. This series is sponsored by Tarpon Health.  A community of providers that are tackling automation as a strategy.  Check us out at Tarpon.health

Anyone who has paid rent before relates to the struggle of spending all this money month after month and having nothing to show for it. But what if you could be rewarded for shelling out all that cash every month? Founder and CEO of Bilt Rewards Ankur Jain sits down with Liz to discuss how he developed a first-of-its-kind loyalty program for renters. He shares that from a young age, observing his parents' quest for the 'American Dream' inspired him to become an entrepreneur, he candidly expresses the struggle it took to pitch Bilt Rewards, and reveals why the number one quality he looks for in his employees is 'hyper-curiosity.' Learn more about your ad choices. Visit megaphone.fm/adchoices

In episode 3 of our 5-episode series, “Insight Unpacked: American Healthcare and Its Web of Misaligned Incentives,” we explain how insurance companies became everybody's favorite villain. On this episode, we talk to Kellogg faculty members Craig Garthwaite, David Dranove, and Paul Campbell, alongside Wharton School professor Robert Lawton Burns. Visit the episode page for supplementary materials.

The US is a global leader in introducing new medical products, but the ability to generate evidence to inform clinical practice in postmarket settings must improve. Insurers may have an important role to play. Robert M. Califf, MD, of the US Food and Drug Administration, discusses why and how payers could support evidence generation with JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS. Related Content: Why Evidence Generation Should Matter to Payers and How They Can Help