Podcasts about payment reform

Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital. News sources for this episode: Elizabeth Williams et. al, “Putting $880 Billion in Potential Federal Medicaid Cuts in Context of State Budgets and Coverage,” March 24, 2025, https://www.kff.org/medicaid/issue-brief/putting-880-billion-in-potential-federal-medicaid-cuts-in-context-of-state-budgets-and-coverage/; KFF. Allison Orris & Elizabeth Zhang, “Congressional Republicans Can't Cut Medicaid by Hundreds of Billions Without Hurting People,” March 17, 2025, https://www.cbpp.org/research/health/congressional-republicans-cant-cut-medicaid-by-hundreds-of-billions-without-hurting#_edn2; Center on Budget and Policy Priorities. Madeline Ashley, “10 hospital closures already in 2025 – what's going on?” March 21, 2025, https://www.beckershospitalreview.com/finance/10-hospital-closures-already-in-2025-whats-going-on/?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8018I7467278H7C; Becker's Hospital Review. Chartis, “2025 rural health state of the state,” February 10, 2025, https://www.chartis.com/insights/2025-rural-health-state-state. Dustin Walsh, “Rural hospitals at risk for closure as financial pressure mounts,” March 11, 2025, https://www.crainsdetroit.com/health-care/rural-hospitals-risk-closure-financial-pressure-mounts; Crain's Detroit Business. Centers for Healthcare Quality & Payment Reform, February, 2025, “Rural Hospitals At Risk of Closing,” https://chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf. The National Resident Matching Program, “National Resident Matching Program® Releases the 2025 Main Residency Match® Results, Celebrates the Next Generation of Physicians,” March 21, 2025, https://www.nrmp.org/about/news/2025/03/national-resident-matching-program-releases-the-2025-main-residency-match-results-celebrates-the-next-generation-of-physicians/. Thank you for listening to another episode of Rural Health Today, the podcast where we connect you to what really matters in rural health. Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ruralhealthtoday.com.

On this week's episode, we look back another one of our listeners favorite episodes from August of 2024 with Harold Miller, President and CEO, Center for Healthcare Quality and Payment Reform. In this episode, Harold examines why as OB-GYN services go under, maternal and infant mortality rise, which is the result of a crisis that starts with inadequate payment models. Follow Rural Health Rising on Twitter! https://twitter.com/ruralhealthpod https://twitter.com/hillsdaleCEOJJ https://twitter.com/ruralhealthrach Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital https://www.twitter.com/hillsdalehosp https://www.linkedin.com/company/hillsdale-community-health-center https://www.instagram.com/hillsdalehospital/ Audio Engineering & Original Music by Kenji Ulmer https://www.kenjiulmer.com/

From a recent WEDI Virtual Spotlight, a presentation by Andrea Caballero, VP of Policy with Catalyst for Payment Reform. 

Over the past two decades, nearly 200 rural hospitals have closed, resulting in millions of Americans losing access to an emergency room, inpatient care, and other hospital services. And today, more than 700 rural hospitals in the U.S. – or approximately 1 in 3 – are at risk of closing due to financial problems, according to a report from the nonprofit Center for Healthcare Quality and Payment Reform.  All this comes at a time when rural health disparities are rampant. In the final episode of our rural health series, we consider solutions: What does it take to prevent rural hospital closures? What evidence-based solutions can policymakers consider to ensure all Americans have access to critical health services, regardless of where they live? Health Disparities podcast host Bill Finerfrock speaks with Harold Miller, president and CEO of the Center for Healthcare, Quality and Payment Reform and adjunct professor of public policy and management at Carnegie Mellon University.  Miller says many people assume that when a rural community loses a hospital, it's one of several options, when in reality, “in many small rural communities, the hospital is the only place to get any kind of health care. It is the only place where, not only where there is an emergency department, but because there's no urgent care facility in the community, there's no other place to get a lab test, there may not even be primary care physicians in the community.” When it comes to policy considerations to prevent rural hospital closures, Miller says there need to be a greater emphasis on the role private health insurance plans play in putting hospitals at risk. “The myth, unfortunately, is that the problem of rural hospital payment is all about Medicare and Medicaid, and that has led people to focus, I believe, inappropriately and excessively, on Medicare and Medicaid,” he says, “when what we have found is that the biggest problem for most rural hospitals is private insurance plans who don't pay the rural hospital even as much, in many cases, as Medicare or Medicaid does. … We need to start thinking about how to solve the real problems and to solve them now, rather than waiting until the hospital is faced with closure.” Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

I was talking to one health plan sponsor, and she told me if she sees any charges for value-based care anything on any one of the contracts that get handed to her, she crosses them off so fast it's like her superpower. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. What, you may wonder? Shouldn't employers and plan sponsors be all over value-based care–type things to do things preventatively because we all know that fee-for-service rewards, downstream consequences–type medical care, no money in upstream. Let's prevent those things from happening. Listen to the show with Tom Lee, MD (EP445); Scott Conard, MD (EP391); Brian Klepper, PhD (EP437). My goodness, we have done a raft of shows on this topic because it is such a thing. So, why wouldn't a plan sponsor be all over this value-based care opportunity? Now, I'm using the value-based care words and big old air quotes. Let's just keep that very much in mind for a couple of minutes here. I'm stressing right now that value-based care isn't a one-to-one overlap with care that is of value. So, let me ask you again, why wouldn't a plan sponsor be all over this air-quoted value-based care opportunity? Let me count the ways, and we'll start with this one. Katy Talento told me about this years ago. She said, it's not uncommon for dollars that a plan sponsor may pay to never make it to the entity that is actually providing the care to that plan sponsor's plan members. So, I'm a carrier and I say, I'm gonna charge you, plan sponsor, whatever as part of the PEPM (per employee per month) for value-based care or for a medical home, or pick something that sounds very appealing and value-like. Some of that money—not all of it, because the carrier's gonna keep some, you know, for administrative purposes—but whatever's left over could actually go to some clinical organization. Maybe it's the clinical organization that most of the plan's members are attributed to. Or maybe it's some clinical organization that the carrier is trying to make nicey nice with, which may or may not be the clinical organization that that plan sponsor's patients/members are actually going to. Like, the dollars go to some big, consolidated hospital when most of the plan's members are going to, say, indie PCPs in the community, as just one example. So, yeah, if I'm the plan sponsor in this mix, what am I paying for exactly and for how many of my members? I've seen the sharp type of plan sponsors whip up spreadsheets and do the math and report back that there ain't much value in that value-based care. It's a euphemism for, hey, here's an extra fee for something that sounds good, but … The end. Then I was talking to Marilyn Bartlett the other day and drilled down into some more angles about how this whole “hey, let's use the value-based care word to extract dollars from plan sponsors” goes down. Turns out, another modus operandi beyond the PEPM surcharge is for carriers to add “value-based fees” as a percentage increase or factor to the regular claims payments—something like, I don't know, 3.5% increase to claims. These fees are, in other words, hidden within billing codes. So, right, it's basically impossible to identify how much of this “value-based” piece of the action is actually costing. These fees are allowable, of course, because they're in the contract. The employer has agreed, whether they know it or not, to pay for value-based programs or alternative pay, even though the details are not at all, again, transparent. And that not at all transparent also includes stuff like, what if the health systems or clinical teams did not actually achieve the value-based program goals? What if they failed to deliver any value-based care at all for the value-based fees they have collected? How does anybody know if the prepaid fees were credited back to the plan sponsor, or if anything was actually accomplished there with those fees? Bottom line, fees are not being explicitly broken out or disclosed to the employers. Instead, they are getting buried within overall claims payments or coded in a way that obscures the value-based portion. So, yeah, charges for value-based care have become a solid plan to hide reimbursement dollars and make carrier administrative prices potentially look lower when selling to plan sponsors like self-insured employers. Justin Leader touches on this in episode 433 about the claims wire, by the way. Now, caveat, for sure, it's possible that patients can get services of value delivered because someone uses that extra money. And it's also possible that administrative costs go up and little if any value is accrued to patients, right? Like one or the other, some combination of both. It goes back to what Dr. Tom Lee talked about in episode 445. If there's an enlightened leader who gives a “shed,” then indeed, patients may win. But if not, if there's no enlightened leader in this mix, it's value based alright for carrier shareholders who take bad value all the way to the bank. Al Lewis quotes Paul Hinchey, MD, MBA, who is COO of Cleveland-based University Hospitals. And Dr. Hinchey wrote, “Value-based care has increasingly become a financial construct. What was once a philosophy centered on enhancing patient care has been reduced to a polarizing buzzword that exemplifies the lack of alignment between the financial and delivery elements of the healthcare system.” And then on the same topic, I saw William Bestermann, MD, he wrote, “The National Academy of Medicine mapped out a plan to value-based care 20 years ago in detail. We have never come close to value-based care because we have refused to follow the path. We could follow it, but we don't, and we never will as long as priorities are decided by businessmen representing stockholders. It is just that simple.” Okay, now. Let's reset. I'm gonna take a left turn, so fasten your seatbelts. Just because a bunch of for profit and not-for-profit, nothing for nothing, entities are jazz-handing their ways to wealth by co-opting terminology doesn't mean the intent of value-based care isn't still a worthy goal. And it also doesn't mean that some people aren't getting paid for and providing care that is of value and doing it well. There are, for sure, plenty of examples where an enlightened leader was able to operationalize and/or incentivize care that is of value. Occasionally, I also hear a story about a carrier doing interesting things to pay for care that is of value. Jodilyn Owen talked about one of these in episode 421. Justina Lehman also (EP414). We had Larry Bauer on the show (EP409) talking about three bright spots where frail elderly patients are getting really good care as opposed to the really bad care that you frequently hear about when you even say the words frail elderly patient. And all of these examples that he talked about were built on a capitated model or on a model that facilitated patients getting coordinated care and there being clinicians who were not worried about what code they were gonna put in the computer when they helped a patient's behavioral health or helped a patient figure out how they were gonna get transportation or help them access community services or whatnot. There are also employers direct contracting with health systems or PCPs and COEs (Centers of Excellence) and others, contracting directly with these entities to get the quality and safety and preventative attention that they are looking for. And there are health systems and PCPs and practices working really hard to figure out a business model that aligns with their own values. So, value-based care—the actual words, not the euphemism—value-based care can still be a worthy goal. And that, my friends, is what I'm talking about today with Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH). PBGH members are really focused on innovating and implementing change. We talk about some of this innovation and implementation on the show today, and it is very inspiring. Elizabeth argues for for-real alternative payment models that are transparent to the employer plan sponsors. She wants prospective payments or bundled payments, and she wants them with warranties that are measurable. She wants members to get integrated whole-person care in a measurable way, which most health plans (ie, middlemen) either cannot or will not administer. Elizabeth says to achieve actual care that is of value, cooperation between employers, employees, and primary care providers is crucial (ie, direct contracts). She also says that this whole effort is really, really urgently needed given the affordability crisis affecting many Americans. There's been just one article after another lately about how many billions and billions of dollars are getting siphoned off the top into the pockets of the middlemen and their shareholders. These are dollars partially paid for by employees and plan members. We have 48% of Americans with commercial insurance delaying or forgoing care due to cost. If you're a self-insured employer and you're hearing this, don't be thinking it doesn't impact you because your employees are highly compensated. As Deborah Williams wrote the other day, she wrote, “Co-pays have gotten high enough that even higher-income patients can't afford them.” And she was referencing a study to that end. So, yeah … with that, here is your Summer Short with Elizabeth Mitchell. Also mentioned in this episode are Purchaser Business Group on Health; Tom X. Lee, MD; Scott Conard, MD; Brian Klepper, PhD; Katy Talento; Marilyn Bartlett; Justin Leader; Laurence Bauer, MSW, MEd; Al Lewis; Paul Hinchey, MD, MBA; William Bestermann, MD; Jodilyn Owen; Justina Lehman; and Deborah Williams.   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), supports the implementation of PBGH's mission of high-quality, affordable, and equitable healthcare. She leads PBGH in mobilizing healthcare purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts. Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth also served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health, worked within an integrated delivery system, and was elected to the Maine State Legislature, serving as a state representative and chair of the Health and Human Services Committee. Elizabeth served as vice chairperson of the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's (NAM) “Vital Signs” Study Committee on core metrics and now on NAM's Commission on Investment Imperatives for a Healthy Nation, a Guiding Committee member for the Health Care Payment Learning & Action Network. She now serves as an appointed board member of California's Office of Healthcare Affordability. Elizabeth also serves as an advisor and board member for healthcare companies. Elizabeth holds a degree in religion from Reed College, studied social policy at the London School of Economics, and completed the International Health Leadership Program at Cambridge University. Elizabeth was an Atlantic Fellow through the Commonwealth Fund's Harkness Fellowship program.   10:36 What are members and providers actually asking for in terms of value-based care? 10:56 Why won't most health plans administer alternative payment models? 12:17 “We do not have value in the US healthcare system.” 12:57 Why you can't do effective primary care on a fee-for-service model. 13:30 Why have we fragmented care out? 14:39 “No one makes money in a fee-for-service system if people are healthy.” 17:27 “If we think it is not at a crisis point, we are kidding ourselves.”   You can learn more at PBGH and by connecting with Elizabeth on LinkedIn.   @lizzymitch2 of @PBGHealth discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation #vbc   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn, Dr Tom Lee, Paul Holmes (Encore! EP397), Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter

In this episode, Harold D. Miller, President and CEO of the Center for Healthcare Quality and Payment Reform, discusses the growing crisis of rural hospital closures. He sheds light on the underlying causes, common misconceptions, and the critical steps needed to preserve essential healthcare services in rural communities.

In this episode, Molly Gamble, VP of Editorial at Becker's Healthcare, discusses a critical report revealing that over 700 rural U.S. hospitals are at risk of closure. She shares insights from Harold Miller of the Center for Healthcare Quality and Payment Reform, highlighting the broader impact of these closures on communities, emergency services, and healthcare equity.

Rural America has faced hundreds of hospital closures over the past decade, but no service is more neglected than maternity care. As OB-GYN services go under, maternal and infant mortality rise, which is the result of a crisis that starts with inadequate payment models. On this week's episode, hosts JJ and Rachel talk with Harold Miller, President and CEO, Center for Healthcare Quality and Payment Reform. Follow Rural Health Rising on Twitter! https://twitter.com/ruralhealthpod https://twitter.com/hillsdaleCEOJJ https://twitter.com/ruralhealthrach Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital https://www.twitter.com/hillsdalehosp https://www.linkedin.com/company/hillsdale-community-health-center https://www.instagram.com/hillsdalehospital/ Audio Engineering & Original Music by Kenji Ulmer https://www.kenjiulmer.com/

For a full transcript of this episode, click here. Unintended consequences is a thing. ERCowboy wrote on Twitter a while back, “In any complex system, the likelihood of unintended consequences vastly outweighs the predictability of intended ones.” In this healthcare podcast, we're talking about two state laws where this is apropos: CON (Certificates of Need) laws and then COPA (Certificates of Public Advantage). Turns out, states actually have pretty much power to impact the competitive landscape in their state. They have a lot of levers they can pull. States really can make a difference in terms of improving real competition on value and on cost and quality. So, these two laws are, in a way, their attempt to do so. Before we kick into what's going on here, I think it is important to point out that these laws on their face aren't an obviously and overtly terrible mistake. This isn't like equivalent to accidentally putting ChapStick in the dryer. There were good people who spied a problem and had an idea for how to fix it. I'm reminded of something I read by Nicholas Kristof on a totally different topic, but he wrote, “The central problem is not so much that the effort was unserious as it's more focused on intentions than on oversight and outcomes.” And that pretty much sums up, I think, the gist of what's going on here. And I can say that because here we are in a position to Monday morning quarterback. So, I've invited Ann Kempski on the pod to point out what hindsight may reveal about these well-intentioned efforts, the CON and COPA laws. First up, let's talk about Certificate of Need laws, or the CONs. Currently, we have 35 states and Washington, DC, that operate CON programs with wide variations by state. The National Conference of State Legislatures has a good overview of each state's laws. Why did these laws originally get put into effect? They got put into effect to cut down on supply-driven demand that was considered to potentially raise total cost of care—because in healthcare, unlike Econ 101, more supply doesn't mean lower prices. In the real world, if you have more supply, volume goes up and total cost of care goes up, too. So, it could be considered good thinking to limit the amount of supply. Except there's four problems that wind up happening often enough, which is why some states are busy repealing these CON laws. We cover these four problems in the show that follows. Spoiler alert: What happens a lot of times is that the big get bigger. Consolidated entities have an upper hand, and we all know consolidated entities are generally not known for their competitive prices or their desire to rationalize volume. So, yeah … we dig into this and parse it out into, as I said, four main problems; but this is most commonly where it all winds up (ie, total cost of care does not go down). I have included links that Ann Kempski shared with me, including a statement from the Federal Trade Commission (FTC) and Department of Justice detailing the anticompetitive effects of state CON laws. There's also a document written by a former FTC commissioner that highlights how state CON laws can inhibit competition. And then lastly, a systemic review of 90 studies that find the costs of CON laws exceed their benefits. Okay, so let's move on to our number two state law that often does not go as planned; and this is the Certificate of Public Advantage, or the COPA, laws. Approximately 19 states have them, and these laws attempt to immunize hospital mergers from antitrust laws by replacing competition with state oversight. The idea here is that a state tells the FTC to stand down and gives their seal of approval to a merger to stop it from getting scrutinized for antitrust violations. So, like, a big dominant health system gets an okay to buy a rural hospital. Meanwhile, everybody realizes this will lead to a situation where there is a dominant health system and that dominant health system will reduce competition. But the state may choose to do this because … public advantage, as in the “PA” in COPA, Certificate of Public Advantage. But they'll do this because the state has decided that the public advantage of allowing the possibly problematic anticompetitive merger to move forward, the public advantage is a bigger advantage than having competition. Hmmm … what could go wrong here? Well, several things that Ann Kempski discusses in the show that follows. The Federal Trade Commission strongly advised the states against enacting these laws. Here is a link to this article that was on the FTC Web site. I was so thrilled to get the chance to chat with Ann Kempski, who knows so much about these topics. Ann Kempski is an independent healthcare consultant with a background in the labor movement, advocating for healthcare workers and purchasers for many years. Ann Kempski collaborates with clients to strengthen primary care, enhance union health funds, and reduce commercial prices. She often partners with academics from Johns Hopkins to analyze hospital transparency data for insights into market trends. Before we jump into the episode, we've had a loss in our community. We've had actually several, one of them being Marshall Allen, another one being Suzanne Delbanco. I know our guest today worked alongside of and really admired Suzanne. Ann Kempski says: “Suzanne was a kindred spirit and a real inspiration for me and many others. She founded two very influential nonprofit organizations: first, The Leapfrog Group and then, second, Catalyst for Payment Reform, which is dedicated to empowering purchasers to be more effective purchasers in the healthcare marketplace.” Additional Resources on State Laws and Policies That Promote Hospital Consolidation, Inhibit Competition Certificate of Public Advantage (COPA) Laws A recent story from Tennessee highlights the weak oversight and observed in COPA-related hospital mergers. Competition and Antitrust in Healthcare “Is There Too Little Antitrust Enforcement in the US Hospital Sector?” by Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, and Lev Klarnet, April 2024 Catalyst for Payment Reform publications and white papers The Great Reversal: How America Gave Up on Free Markets, by Thomas Philippon, 2019   Also mentioned in this episode are Nicholas Kristof; Marshall Allen; Suzanne Delbanco; Brian Klepper, PhD; and Gloria Sachdev, PharmD.   You can learn more by following Ann on LinkedIn.   Ann Kempski is an independent health policy consultant with 30 years of experience as an analyst, advocate, and strategist advancing health reforms related to coverage, quality, and payment in public programs and commercial insurance. She has served in leadership roles in several organizations, including Kaiser Permanente, SEIU (Service Employees International Union), and the State of Delaware. Ann currently supports organizations and efforts to strengthen primary care payment and transition away from fee for service, promote competition in commercial healthcare prices and coverage, and expand access to evidence-based behavioral health services. Ann is especially grateful to collaborate with and learn from talented graduate students and faculty at Johns Hopkins Bloomberg School of Public Health on research and policy analysis to understand commercial market and price dynamics and provider behavior. She has an undergraduate degree in economics from the College of William & Mary and a master's degree in industrial and labor relations from Cornell University.   06:20 Ann remembers Suzanne Delbanco. 06:55 EP224 with Suzanne Delbanco. 07:40 What are state Certificate of Need laws? 08:44 Why are states getting rid of these CON laws? 13:26 Why CON laws are created. 15:43 EP437 with Brian Klepper, PhD. 16:09 What are the conflicts of interest and problems that arise when CON laws are created? 20:55 What happens when states get rid of these CON laws? 24:10 How are Certificate of Public Advantage laws different from CON laws? 27:58 Why does the research show that COPAs don't usually accomplish their goals? 31:34 What encouraging current events are happening in the realm of COPA laws? 32:08 Gloria Sachdev, PharmD, of Employers' Forum of Indiana.   You can learn more by following Ann on LinkedIn.   @kempann discusses #COPA and #CON state #healthcarelaws on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson    

AMA Senior Vice President of Advocacy, Todd Askew, provides an update at the AMA Annual Meeting on the advocacy efforts of the AMA so far this year on the top priorities for physicians. American Medical Association CXO Todd Unger hosts.

In part two of this series, Dr. Willie Underwood, chair of the AMA Board of Trustees continues to lead our panel discussion on what's next in Medicare payment reform. Panelists include Dr. G. Ray Callas, president elect of the Texas Medical Association; Katie Orrico, senior vice president of Health Policy and Advocacy at the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and Todd Askew, senior vice president of Advocacy at the AMA. 

Dr. Willie Underwood, chair of the AMA Board of Trustees moderates this panel discussion on what's next in Medicare payment reform. Panelists include Dr. G. Ray Callas, president elect of the Texas Medical Association; Katie Orrico, senior vice president of Health Policy and Advocacy at the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and Todd Askew, senior vice president of Advocacy at the AMA. 

A protest is currently underway outside Leinster House over a Government proposal to reform disability payments. What does it mean for those living with a disability? Andrea was joined by Daniella and Margaret to discuss...

Medicare must change, and the AMA is fighting nonstop to make payment reform a reality. Chair of the AMA Board of Trustees Willie Underwood III, MD, MSc, MPH, joins to discuss the AMA's advocacy to fix Medicare now, including the campaign's wins to date and what's next. American Medical Association CXO Todd Unger hosts.

Policymakers are leaning into prescription drug pricing reform with the consumer in mind, aiming to lower costs and provide more payment options and transparency. Rachel Stauffer and Jeffrey Davis join the Breakroom to explore these recent efforts in both the legislative and regulatory arenas.

Reforming Medicare payment is the top advocacy priority for the American Medical Association. Joining to discuss the steps the AMA is taking and what's at stake is AMA President-elect Bruce Scott, MD. American Medical Association CXO Todd Unger hosts.

Hour 1 -  Good Tuesday morning! Here's what Nick Reed covers this hour: First son Hunter Biden's longtime business partner made more visits to both the Obama White House and then-Vice President Biden's official residence than previously known. Eric Schwerin dropped in at the executive mansion and the Naval Observatory in Washington on at least 36 occasions in total between 2009 and 2016. The Center for Healthcare Quality & Payment Reform reports 19 of Missouri's rural hospitals are at risk of closing, half of them immediately, due to their financial circumstances.

Harold Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform, he joined us today to talk about the importance of healthcare access for rural Missourians.

House Republicans want to reform Medicare's oft-criticized payment system in order to better compensate doctors and reduce their paperwork burdens, but Daniel Payne tells host Kelly Hooper that his reporting shows prospects for legislation this year are slim given competing legislative priorities and the complexity of the problem. 

Listen to this live podcast from the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting with Oncology Data Advisor and Lalan Wilfong, MD!

When KFF Health News' “What the Health?” podcast launched in 2017, Republicans in Washington were engaged in an (ultimately unsuccessful) campaign to “repeal and replace” the Affordable Care Act. The next six years would see a pandemic, increasingly unaffordable care, and a health care workforce experiencing unprecedented burnout. In the podcast's 300th episode, host and chief Washington correspondent Julie Rovner explores the past and possible future of the U.S. health care system with three prominent “big thinkers” in health policy: Ezekiel Emanuel of the University of Pennsylvania, Jeff Goldsmith of Health Futures, and Farzad Mostashari of Aledade. Click here for a transcript of the episode.Further reading by the panelists from this week's episode: Health Affairs' “Nine Health Care Megatrends, Part 1: System and Payment Reform,” by Ezekiel J. Emanuel.Health Affairs' “We Have a National Strategy for Accountable Care, So What's Next?” by Sean Cavanaugh, Mandy K. Cohen, and Farzad Mostashari. The Health Care Blog's “What Can We Learn From the Envision Bankruptcy?” by Jeff Goldsmith. Hosted on Acast. See acast.com/privacy for more information.

In this episode Scott Becker discusses how he thinks healthcare payment reform is missing the real problem.

In this episode Scott Becker discusses how he thinks healthcare payment reform is missing the real problem.

In this episode Scott Becker discusses how he thinks healthcare payment reform is not the answer.

Dr. Fred Rosenberg interviews Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, national policy center that works to improve healthcare payment and delivery systems. Mr. Miller discusses how our current health care model encourages consolidation and the challenges this creates for private practice physicians. Join Dr. Rosenberg and Mr. Miller as they explore different types of healthcare payment models, including a Patient-Centered Payment System, which would allow for patients to receive the services that will best address their specific health problems, and for physicians to receive adequate resources to support the cost of delivering services in a high-quality, efficient manner. Produced by Andrew Sousa and Hayden Margolis for Steadfast Collaborative, LLC Original score by Hayden Margolis Gastro Broadcast, Episode 46

Payment models are a hot topic for discussion, debate and development in the healthcare industry today. From consulting firms to associations and other industry influencers, various models are proposed, but they're not always designed with financial sustainability of rural hospitals in mind. So, how do we differentiate between payment models that could actually work versus rhetoric that won't? On today's episode, hosts JJ and Rachel talk with Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform about the variety of payment models being discussed today and which ones are actually viable. Follow Rural Health Rising on Twitter!  https://twitter.com/ruralhealthpod/  https://twitter.com/hillsdaleCEOJJ/  https://twitter.com/ruralhealthrach/ Follow Hillsdale Hospital on social media!  https://www.facebook.com/hillsdalehospital/  https://www.twitter.com/hillsdalehosp/  https://www.linkedin.com/company/hillsdale-community-health-center/  https://www.instagram.com/hillsdalehospital/  Audio Engineering & Original Music by Kenji Ulmer  https://www.kenjiulmer.com/

In this episode of Antitrust Matters, Constantine Cannon partner, Matthew L. Cantor, discusses economic and antitrust issues raised by the conduct of certain large hospital systems.  Joining him on the podcast as guests are Duke University Professor of Law, Barak Richman, and CEO of the policy group known as the Catalyst for Payment Reform, Suzanne Delbanco. 

Madera Community Hospital closed in December and has now filed for bankruptcy. The emergency room now sits empty, and labor and delivery services have stopped. The hospital's three rural clinics are also closed. Some 136 rural hospitals closed between 2010 and 2021, according to the American Hospital Association. According to a January report from the Center for Healthcare Quality and Payment Reform, about 600 hospitals are currently at risk of closing in the U.S.We traveled to Fresno as part of our Remaking America collaboration with six partner stations across the country, including KVPR in California's Central Valley. Earlier this month, we brought the community together to talk about the hospital closure, which has left more than 150,000 residents without an emergency room within 30 miles and has put a strain on emergency room departments in Fresno and Merced. This conversation is part of our Remaking America collaboration with six public radio stations, including KVPR in Fresno, California. Remaking America is funded in part by the Corporation for Public Broadcasting.

For well over a decade, rural hospitals have been in crisis. Since 2010, 141 hospitals in rural communities have closed. And although they've been struggling financially for years, the COVID-19 pandemic pushed them to the brink with a record 19 closures in 2020 alone.  And while pandemic-era federal aid stopped some of these rapid closures, much of that aid expired at the end of last year. The Center for Healthcare Quality and Payment Reform estimates that more than 600 rural hospitals – or nearly 30% of all rural hospitals in the country – are at risk of closing in the near future. The federal government tried to address this crisis with a plan called the Rural Emergency Hospital (REH) designation, but the plan comes with hard choices for many of these hospitals and would have a huge impact on the rural communities they serve. For more on the crisis at rural hospitals, we spoke with Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform. 

For well over a decade, rural hospitals have been in crisis. Since 2010, 141 hospitals in rural communities have closed. And although they've been struggling financially for years, the COVID-19 pandemic pushed them to the brink with a record 19 closures in 2020 alone.  And while pandemic-era federal aid stopped some of these rapid closures, much of that aid expired at the end of last year. The Center for Healthcare Quality and Payment Reform estimates that more than 600 rural hospitals – or nearly 30% of all rural hospitals in the country – are at risk of closing in the near future. The federal government tried to address this crisis with a plan called the Rural Emergency Hospital (REH) designation, but the plan comes with hard choices for many of these hospitals and would have a huge impact on the rural communities they serve. For more on the crisis at rural hospitals, we spoke with Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform. 

After an illuminating conversation last week with Harold Miller, CEO Center for Healthcare Quality and Payment Reform, we talk this week about our thoughts and reactions to the interview. We also discuss ways that rural hospitals can come together to help sway both public opinion and public policy regarding sufficient payment and reimbursement. Follow Rural Health Rising on Twitter! https://twitter.com/ruralhealthpod https://twitter.com/hillsdaleCEOJJ https://twitter.com/ruralhealthrach Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital https://www.twitter.com/hillsdalehosp https://www.linkedin.com/company/hillsdale-community-health-center https://www.instagram.com/hillsdalehospital/ Audio Engineering & Original Music by Kenji Ulmer https://www.kenjiulmer.com/

Nearly 30 percent of all rural hospitals in the United States are at risk of closure, including 10 percent at immediate risk of closure. Mixed payment models, fixes that made things worse, and the effect of inflation demand a new look on how rural hospitals are paid and sustained. This week, we welcome Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform to talk about alternative payment models across the rural health industry. Follow Rural Health Rising on Twitter! https://twitter.com/ruralhealthpod https://twitter.com/hillsdaleCEOJJ https://twitter.com/ruralhealthrach Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital https://www.twitter.com/hillsdalehosp https://www.linkedin.com/company/hillsdale-community-health-center https://www.instagram.com/hillsdalehospital/ Audio Engineering & Original Music by Kenji Ulmer https://www.kenjiulmer.com/

Learn how the AMA is #FightingForDocs and access resources from the AMA Recovery Plan for America's Physicians by visiting: https://www.ama-assn.org/recovery AMA Senior Vice President of Advocacy Todd Askew discusses Medicare payment cuts and how they will impact physicians and patients. American Medical Association CXO Todd Unger hosts. Stay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update: https://www.ama-assn.org/advocacy-news

Dr Kimberly Singletary joins Ethics Talk to discuss her article, coauthored with Dr Marshall Chin: “What Should Antiracist Payment Reform Look Like?”  Recorded November 11, 2022.  Read the full article at JournalofEthics.org.

The president signed the Inflation Reduction Act of 2022 into law earlier this week. We covered the relevant provisions of this new law on last week's edition of the Healthcare Happy Hour, so if you are interested in learning more about the healthcare components included in that package, please listen to last week's episode! On this week's episode of the Healthcare Happy Hour, we are joined by special guest Heather Meade, principal at Washington Council Ernest and Young and adjunct professor at Georgetown University Law Center, to raise a topic that we have yet to discuss on the podcast – site-neutral payment reform.

The president signed the Inflation Reduction Act of 2022 into law earlier this week. We covered the relevant provisions of this new law on last week's edition of the Healthcare Happy Hour, so if you are interested in learning more about the healthcare components included in that package, please listen to last week's episode! On this week's episode of the Healthcare Happy Hour, we are joined by special guest Heather Meade, principal at Washington Council Ernest and Young and adjunct professor at Georgetown University Law Center, to raise a topic that we have yet to discuss on the podcast – site-neutral payment reform.

The president signed the Inflation Reduction Act of 2022 into law earlier this week. We covered the relevant provisions of this new law on last week's edition of the Healthcare Happy Hour, so if you are interested in learning more about the healthcare components included in that package, please listen to last week's episode! On this week's episode of the Healthcare Happy Hour, we are joined by special guest Heather Meade, principal at Washington Council Ernest and Young and adjunct professor at Georgetown University Law Center, to raise a topic that we have yet to discuss on the podcast – site-neutral payment reform.

Suzanne calls up Bob Galvin, CMO of Blackstone and chairman of CPR's board of directors, to follow up on their previous discussion on the state of payment reform. So where are we at? Progress is slow, yet steady -- we've had rain delays, changing pitchers, changing managers, but the game isn't over. "It's hard getting through, inning by inning when you're creating something from a blank slate." All is not lost, "I could list 10 or 15 [hospital] systems where you really do have quality improvement, but I think where we've gotten hurt pretty much across the board is, we just haven't gotten at the affordability." So what's the answer? "Figuring out some ways to help regulate the market...government intervention in the market. I want to be quick to say that I'm not talking about a single-payer system, I'm not talking about price setting, but I'm talking about two things. I'm talking about one, making markets competitive...and doing something about price..."

S1E17: Resilience in Rural Healthcare with Angela Ammons, CEO Clinch Memorial Hospital. According to the Center for Healthcare Quality and Payment Reform, more than 800 rural hospitals are at immediate or a high risk of closure. Almost every state has at least one rural hospital at risk of closure and in one state all their rural hospitals are at risk of closing. Angela's hospital is a critical access rural hospital located in Southeast Georgia. Angela is a Nurse by Trade and a healthcare Problem Solver who took on the challenge of rural healthcare that remains challenged by geography and a host of other economic drivers that create headwinds that for many can be difficult to navigate and overcome. Your better pill to swallow Is to develop your resilience and leave no stone un-turned when seeking solutions and refusing to accept the current status quo, even when things are going really well. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Join Health Affairs Insider.Late last month, the Centers for Medicare & Medicaid Services (CMS) announced its redesign of its Global and Professional Direct Contracting Model to its now-branded Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model. The agency stated the redesign is meant to advance health equity and was in response to stakeholder feedback and participant experience.On today's episode of Health Affairs This Week, Harvard Medical School's Michael Chernew joins Health Affairs Forefront Editor Chris Fleming to talk about the new CMS model for ACOs, and where Medicare Advantage could improve.Related Links: Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model (CMS) The Case For ACOs: Why Payment Reform Remains Necessary (Health Affairs Forefront) Podcast: Michael Chernew Makes The Case for Payment Reform (Health Affairs This Week) Medicare Advantage, Direct Contracting, And The Medicare 'Money Machine,' Part 2: Building On The ACO Model (Health Affairs Forefront) Subscribe: RSS | Apple Podcasts | Spotify | Castro | Stitcher | Deezer | Overcast

AMA CXO Todd Unger talks with AMA Senior Vice President of Advocacy in Washington, D.C., about the AMA's latest advocacy efforts. Topics include surprise billing, prior authorization, Medicare physician payment reform and telehealth. Stay up to date on all the latest advocacy news by subscribing to AMA Advocacy Update: https://www.ama-assn.org/advocacy-news

Join Health Affairs Insider.This week on Health Affairs Forefront (formerly known as the Health Affairs Blog), Michael Chernew, director of the Healthcare Markets and Regulation Lab in the Department of Health Care Policy at Harvard Medical School, and Michael McWilliams, professor of medicine at Harvard Medical School, wrote a piece making the case for accountable care organizations (ACOs) and how fee-for-service payment models lack efficiency.Today on Health Affairs This Week, Michael Chernew joins Health Affairs Forefront Editor Chris Fleming to discuss the Forefront piece, ACOs, direct contracting, why health care payment reform remains necessary in 2022, and more.Related Links: The Case For ACOs: Why Payment Reform Remains Necessary (Health Affairs Forefront) Medicare Advantage, Director Contracting, And The Medicare 'Money Machine," Part 1: The Risk-Score Game (Health Affairs Forefront) Coding-Driven Changes In Measured Risk In Accountable Care Organizations (Health Affairs) Podcast: Matthew Trombley on Why Many Providers Run From Downside Risk In ACOs (A Health Podyssey) Subscribe: RSS | Apple Podcasts | Spotify | Castro | Stitcher | Deezer | Overcast

Our system for primary care payment was put in place a long time ago. And some people think that a new system is still light years away. But it doesn't have to be. We have the tools and systems now. Dr. Faisel Syed and Dr. Dan McCarter are joined by Ann Greiner from Primary Care Collaborative to outline the “Hyperdrive to Payment Reform.” Reform doesn't have to be so far far away. Being a doctor is your calling because you couldn't imagine doing anything else. Let's talk about your career goals in medicine. Connect with us and tell us how you dream of practicing medicine. Want to learn more about how we do healthcare? Visit our resource center and check out how we are transforming healthcare. Don't forget subscribe to ChenMed Rx to receive the latest news and articles from ChenMed.

Host Don Antonucci and Suzanne Delbanco, Catalyst for Payment Reform Executive Director, discuss alternative payment models, virtual care, creating standardized quality measures, and opportunities and challenges to transform health care delivery. Catalyst for Payment Reform is a nonprofit, member-based organization committed to big changes in the health care system with a mission to help employers and other health care purchasers get better value for their health care dollar. 

This week our medical experts will discuss Payment Reform. Join Zero's Chief Medical Officer, Stan Schwartz, and Andrea Caballero, Program Director of Catalyst for Payment Reform

Listen NowLargely with the exception of the 2010 passage of the ACA, federal legislative (and regulatory) efforts to reform health care over the past few decades has lagged.   This is the result of an increasingly dysfunctional Congress.  For example, Congressional productivity, measured by the number of enacted laws, has decreased every decade since 1990 by over 20 percent.  For this reason and because states are required to balance their annual budgets (with the exception of Vermont and possibly North Dakota and Wyoming as well), health care policy innovation has shifted substantially to the states.  For example, the 2019 legislative session resulted in 29 states passing Medicaid-related legislation, 13 states passing health insurance legislation and 10 states passing health care assignment and billing legislation. During this 24 minute conversation, Dr. Delbanco begins by briefly explaining the Catalyst for Payment Reform's mission and members.  She moreover discusses state policy reforms related to data (i.e., All Payer Claims Databases) and price transparency, efforts to improve state market competition, delivery and payment reforms, for example, reference pricing or benchmarking to Medicare reimbursement and she identifies states that are particularly noteworthy in their efforts to improve care delivery and lower spending growth.Dr. Suzanne F. Delbanco is the Executive Director of Catalyst for Payment Reform (CPR), an independent, non-profit corporation working to catalyze employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace.  In addition to her duties at CPR, Suzanne serves on the advisory board of the Blue Cross Blue Shield Institute.  Previously, Suzanne was the founding CEO of The Leapfrog Group.  Suzanne holds a Ph.D. in Public Policy from the Goldman School of Public Policy and a M.P.H. from the School of Public Health at the University of California, Berkeley. For information on CPR go to: https://www.catalyze.org/. Dr. Delbanco (and colleagues') recently published article, "The State of State Legislation Addressing Health Care Costs and Quality," is at: https://www.healthaffairs.org/do/10.1377/hblog20190820.483741/full/.Per Dr. Delbanco's reference to The Source, U. of CA Hastings College of Law's recently posted online database of state laws impacting health care cost and quality, go to: https://sourceonhealthcare.org/legislation/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowMedicare's Fee for Service Alternative Payment Models (APMs), a creation of 2015 MACRA legislation, currently 12 in number with participation largely voluntary, requires Medicare providers to assume financial risk, based on historical spending and quality measurement performance, beyond a "nominal amount."  The flagship APM is the ACA's Medicare Shared Savings Program, more commonly termed Accountable Care Organizations (ACOs).  Though in its 8th year, the ACO program, that currently provides care to over 10 million assigned Medicare beneficiaries, has not produced meaningful savings (estimates are 1 to 2% annually).  Nor have other APMs, largely bundled payment arrangements, produced substantial savings.  The Medicare Advantage program (with one-third of Medicare beneficiaries), defined as administrative pricing, does not formally score savings.  Over the past few years per capita Medicare spending has been limited, however, program growth or beneficiary enrollment (via the aging baby boomer population) is causing Medicare spending, in sum, to increase substantially.  In addition, the soon-to-be-published annual Medicare Trustee's report will show the program will become insolvent within the next few years. During this 26 minute discussion, Mr. Miller provides an overall assessment of APM performance to date.  He moreover discusses the shortcomings in APM design or the barriers APM providers face in improving care, e.g., as ostensibly Fee for Service APMs are not reimburse for valuable non-medical services such as social service supports and ways to improve these models.  We conclude the discussion with his views on the ACA-created PTAC (the Physician-Focused Payment Model Technical Advisory Committee), that has reviewed to date over 30 submitted APM proposals, none of which have been chosen by Secretary Azar for testing as a Medicare demonstration.    Mr. Harold D. Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform.  In this role he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms.  He is also currently one of eleven members of the PTAC.  He also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University.  Mr. Miller has written a number of widely-used papers and reports on health care payment and delivery reform.  He has assisted numerous professional organizations in developing alternative payment models designed to support better care for patients at lower cost.  From 2008 to 2013, Mr Miller served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), the national association of Regional Health Improvement collaboratives.  He served as a member of the Board of Directors of the National Quality Forum from 2009 to 2015.  From 2006 to 2010, Mr. Miller served as the Strategic Initiatives Consultant to the Pittsburgh Regional Health Initiative (PRHI).  In 2007, he served as the Facilitator for the Minnesota Health Care Transformation Task Force.  In previous positions, Mr. Miller served as the Director of the Pennsylvania Governors Office of Policy Development, Associate Dean of the Heinz School of Public Policy and Management at Carnegie Mellon University, Executive Director of the Pennsylvania Economy League - Western Division, Director of the Southwestern Pennsylvania Growth Alliance and President of the Allegheny Conference on Community Development.For information on the Center for Healthcare Quality and Payment Reform, go to: http://www.chqpr.org/ For information on the PTAC, go to: https://aspe.hhs.gov/ptac-physician-focused-payment-model-technical-advisory-committeePer my mention of Dr. Robert Berenson's recent (February) essay concerning improving the Medicare Fee for Service schedule, go to: https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05411 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

NAHU CEO Janet Trautwein joins the Healthcare Happy Hour to interview Suzanne Delbanco from the Catalyst for Payment Reform (CPR). Their conversation focuses on CPR's mission of catalyzing employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. Suzanne and Janet discuss the changing healthcare marketplace, the need for employers to shift towards value-based strategies, and what every employer (and their broker) should be doing to shift toward higher-value thinking.

(A previous series available on SoundCloud) Welcome to Health Pilots, where we interview people pursuing new solutions for health care in low-income communities. You'll hear about new technologies and workflows, human-centered design, and how to collaboratively innovate. Luke Entrup, head of special programs and innovation at West CountyHealth Center in Guerneville, CA, shares West County's creative culture and supportive leadership and how that fuels their experiments and adoption of new approaches to care. Key solutions Luke highlights are a cross-campus implementation of video visits, group visits, and connecting to community through Purple Binder.

Listen NowCalifornia has been long known for health care delivery and payment reform (think, for example, Kaiser Permanente).   With efforts nation-wide to better align health care quality and patient outcomes with reimbursement or savings efficiency, related efforts in California are carefully watched and studied.     During this 23 minute conversation Dr. Jill Yegian briefly outlines the work if the California Integrated Healthcare Association (IHA), provides an overview of the California healthcare payment reform landscape, discusses specifically IHA's value-based pay for performance work involving 10 health plans, 200 physician organizations and nine million Californians, discusses quality measurement including "resource use" and "total cost of care" and identifies lessons learned from IHA's activities.     Dr. Jill Yegian, is the Senior VP for Programs and Policy at the California Integrated Healthcare Association where she oversees IHA's work regarding care integration, performance measurement and reporting and payment innovation.   Previously, she co-directed the American Institutes for Research Health Policy and Research Group, a team of over 70 health services research professionals.   Prior still Dr. Yegian worked with the California Healthcare Foundation where her focus was on improving the state's healthcare financing and delivery system.  Dr. Yegian is the author of numerous peer-reviewed articles and is a frequent conference speaker.  She was graduated from the University of California at Berkeley with a Ph.D. in health services and she earned her undergraduate degree in human biology at Stanford. For more on IHA's work go to: www.iha.org This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com