Podnosis

With the longest government shutdown in U.S. history as a backdrop, for-profit providers and payers detailed the continued regulatory uncertainty and pressures on their businesses in the third quarter. In this episode of "Podnosis," Editor Dave Muoio and Senior Writer Paige Minemyer break down the key trends for the third quarter, including how insurers shed light on strategic priorities, the impact of the ACA subsidy conversation and why providers saw a surprise revenue windfall. To learn more about the topics in this episode: Insurers slammed by medical costs, regulatory pressures yet again in Q3Tax credit turmoil, cost pressures set stage for tumultuous ACA open enrollmentAmid shutdown, health IT vendors say hospitals are cutting back on spendingSee omnystudio.com/listener for privacy information.

In a recent episode of Podnosis, Dr. Jerilyn Morrissey, chief medical officer at CorroHealth, called for a strategic overhaul in how hospitals approach clinical documentation and payer denials. “Documentation has become the battlefield where clinical, financial and payer priorities collide,” Morrissey said. Tracing the evolution of medical records from ancient Egypt to modern electronic systems, she emphasized that while technology has enabled better data sharing, it has also introduced administrative overload and clinician disengagement. Morrissey challenged the common belief that denials stem from provider error. “Denials are a payer strategy,” she said. “They distract and delay, and they’re designed to do just that.” She urged healthcare leaders to shift from reactive to proactive strategies, focusing on clear expectations around reimbursement. Hospitals spend nearly $20 billion annually fighting denials, often by adding more staff or vendors. Morrissey cautioned against this approach, noting that more resources rarely yield better outcomes. She also questioned the effectiveness of AI-generated appeal letters, citing a low success rate and rapidly changing payer policies. Instead, Morrissey advocated for integrating technology earlier in the care process. “Denials don’t start when we submit a claim,” she said. “They start at the point of documentation and decision-making.” Looking ahead, Morrissey sees promise in AI for clinical support, pattern recognition and denial prediction. But she warned that trust in technology must be earned. “AI works most of the time, but not all of the time,” she said. “We’re not yet at a point where we can remove the human from the loop.” Her advice to healthcare executives: embrace innovation with creativity and collaboration, and aim to be “constructively destructive” in reshaping the system. See omnystudio.com/listener for privacy information.

Florida is among the fastest-growing states in the U.S. Demand for healthcare is also growing. Predicting community needs can help organizations be better prepared to serve patients. To understand what health systems in Florida are thinking about when it comes to architecture and design, Senior Writer Anastassia Gliadkovskaya talks to Michael Compton, director of healthcare, Florida, at Barge Design Solutions. Compton shares the projects he takes on as a board-certified healthcare architect and predicts what the next few design trends might be in the state. To learn more about the topics in this episode: 'We can't do this alone': Hospitals share lessons from Hurricane Helene to prepare for extreme weather eventsKaiser Permanente launches renewable energy microgrid at California hospitalFlorida health system tackles expansion challenges to meet growing demandSee omnystudio.com/listener for privacy information.

The hype around artificial intelligence in healthcare has yet to fizzle out. The technology offers a significant opportunity for healthcare organizations to reduce complexity and inefficiencies in the system. However, there are plenty of risks to navigate, too. In this episode of "Podnosis," Senior Writer Paige Minemyer sits down with Sandeep Dadlani, CEO of Optum Insight and former chief technology officer at UnitedHealth Group, to discuss how the industry giant is deploying AI today and the guardrails that are necessarily in place to keep patient data safe. To learn more about the topics in this episode: UnitedHealth taps Sandeep Dadlani to lead Optum Insight unitAI Pulse: Microsoft rolls out updated 'Copilot for health' feature; athenahealth embeds agentic AI into athenaOne platformAMA launches initiative in bid for AI policy leadershipOptum unveils new AI-powered claims processing platformSee omnystudio.com/listener for privacy information.

In this sponsored episode of Podnosis, host Chris Hayden speaks with Dr. Jigar Patel, Chief Medical and Product Officer at Claritev, about one of healthcare’s biggest financial blind spots—revenue leakage. Dr. Patel explains why hospitals often lose up to 15–25 cents of every revenue dollar through inefficiencies, under-optimized contracts, and fragmented data systems. He shares how lack of analytics expertise and opaque reimbursement models especially impact community and rural hospitals, and how initiatives like price transparency are beginning to level the playing field. Dr. Patel also introduces Claritev’s CompleteVue, a solution that helps CFOs and revenue leaders identify leakage points, benchmark reimbursement rates, and strengthen contract negotiations. Tune in to learn how health systems can use data to improve reimbursement integrity, reduce administrative waste, and sustain financial health in an increasingly complex payer landscape. See omnystudio.com/listener for privacy information.

There is a newer wave of middlemen in the self-insured market: alternative funding programs. The for-profit vendors claim to help employers save money on expensive specialty medications by obtaining them for free or at a steep discount through alternative sources. While they may sound promising, some healthcare experts describe them as sneaky, harmful to patients and in a gray zone ethically and legally. Last week, Fierce Healthcare published an investigation into the business model and consequences of alternative funders. In this episode, Senior Writer Anastassia Gliadkovskaya describes her reporting process and findings with Executive Editor Heather Landi. To learn more about the topics in this episode: A new wave of middlemen offers 'alternative funding' for specialty drugs. Patients bear the risks As large employers back away from self-insurance, small- and medium-sized ones embrace it: EBRI Out-of-pocket spending on prescriptions grew even after accounting for rebates: study See omnystudio.com/listener for privacy information.

Amid a breakneck pace of regulatory changes under the Trump administration, healthcare stakeholders are scrambling to keep up. Experts are sharing learnings and doing their best to understand how the policies of today affect the sector. Senior Writer Anastassia Gliadkovskaya chats with two executives with a front-row seat to those conversations: Maria Ghazal, CEO of the Healthcare Leadership Council; and Robert Andrews, CEO of the Health Transformation Alliance. Both organizations recently had meetings with their members to debrief on policies like President Donald Trump’s One Big Beautiful Bill Act, Most Favored Nation and more. To learn more about the topics in this episode: White House announces new prescription drug website, TrumpRxHow the shutdown impacts healthcare: Reductions in force begin at HHS, with some hiccups at CDCNew Medicaid federal work requirements mean less leeway for statesFederal government enters shutdown, virtual care programs expireSee omnystudio.com/listener for privacy information.

Millions of Americans are affected by cancer each year. For many, hair loss is among the most distressing side effects of chemotherapy treatment, causing some to put off or refuse chemo. A revolutionary technology exists: scalp cooling, which involves wearing a cold cap during treatment to restrict blood vessels and reduce how much chemo reaches the hair follicles. Rossalynn Ripper, a breast cancer survivor, was able to use scalp cooling to prevent hair loss during her treatment. Now, she advocates for her home state of Maryland to pass a bill requiring insurers to cover the treatment. Senior Writer Anastassia Gliadkovskaya talks to Ripper and her oncologist, Young Lee, M.D., of Luminis Health, about why scalp cooling is important to treatment access and what barriers remain. To learn more about the topics in this episode: CMS rolls out new payment model on improving cancer treatmentsAccelerating solutions to cancer through impact investingMore patients are surviving cancer, but incident rates rising among women and younger adults: ACS reportSee omnystudio.com/listener for privacy information.

Payment integrity is top of mind as insurers face growing pressure to eliminate fraud, waste and abuse. Successful programs require investment in technology and expertise to analyze trends and identify abnormalities. The team at Optum Insight works closely with insurers across the healthcare system to examine this data In this episode of "Podnosis," Fierce Healthcare senior writer Paige Minemyer sits down with Steve Yurjevich, CEO of the payer market at Optum Insight, to discuss the challenges and solutions in this space. To learn more about the topics in this episode: 'Well-intentioned, poorly executed waste': How tech companies aim to reduce billions in wasteful spendingNew Mountain Capital merges Apixio, Varis and The Rawlings Group in $3B dealCMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial toolIndustry Voices—We need to fight fraud the right waySee omnystudio.com/listener for privacy information.

The Democratic Women’s Caucus, a coalition of 96 lawmakers, advocates for women’s economic prosperity, healthcare access and safety. In this week’s episode of "Podnosis," Fierce Healthcare staff writer Emma Beavins speaks with Rep. Teresa Leger Fernández of New Mexico and Rep. Kelly Morrison of Minnesota about their policy agenda, including the impact of Medicaid cuts, the fight for abortion and birth control access, and efforts to work with Republicans on healthcare reform. To learn more about the topics in this episode: Fighting maternal and infant health inequitiesUnitedHealth report: Disparities persist in maternal, infant healthMost states saw hospital obstetric service shutdowns from 2010-2022, with rural states hit hardestGates Foundation invests $2.5B to spark women's health innovationsThe business case for investing in women’s healthCMS selects states for Medicaid maternal health modelMaternal mental health in the spotlightSee omnystudio.com/listener for privacy information.

Lawmakers are turning up the heat on pharmacy benefit managers, with more than 1,500 bills introduced this year targeting drug costs, utilization rules and pharmacy networks. In the latest episode of Podnosis, Wes Hill, senior director at RxBenefits, said rising drug prices and pressure from constituents are driving the surge. While federal movement has been limited, states are advancing legislation at a rapid pace, creating new compliance challenges for PBMs and plan sponsors. Hill said employers—who shoulder much of the cost of pharmacy benefits—need to make their voices heard. By tracking legislation, assessing its impact and working with advisors, they can help shape reforms and protect their health plans. To hear more about the legal battles and what’s ahead for PBMs, listen to the full Podnosis episode. See omnystudio.com/listener for privacy information.

Medication nonadherence is not new, but it remains a persistent, complex problem. Adherence rates hover near 50%—roughly the same as two decades ago—as companies explore new ways to engage patients and help them stick to treatment regimens. AdhereHealth combines technology with care navigators to identify at-risk patients and help them consistently access their prescriptions. In this episode of "Podnosis," Fierce Healthcare Senior Writer Anastassia Gliadkovskaya speaks with Chandra Y. Osborn, Ph.D., M.P.H., chief experience officer at AdhereHealth, about how the company takes on risk to drive outcomes and why it keeps a human in the loop. To learn more about the topics in this episode: Healthcare 'flying blind': Medication nonadherence and how remote therapeutic monitoring can helpOut-of-pocket spending on prescriptions grew even after accounting for rebates: studyPatchRx to integrate medication adherence data with virtual care platformsScriptology acquires RxLive to build out its tech stackSee omnystudio.com/listener for privacy information.

What are the main challenges hospitals face today? And how can they begin to get their arms around them while centering patients in their decision making? In this episode of "Podnosis," Senior Writer Anastassia Gliadkovskaya speaks to Janina Beilner, SVP of healthcare at Siemens, about how the company helps hospitals use technology in a thoughtful way to improve their infrastructure, operations and ultimately the patient experience. To learn more about the topics in this episode: How health systems are reshaping their strategies in the face of federal policy uncertaintyHuman-centered design in healthcareHow Nvidia-backed Artisight is taking smart hospitals to the next level with AI and computer visionBreathing better: Hospitals begin to phase out major pollutants in patient careSee omnystudio.com/listener for privacy information.

Hope, when applied with purpose and action, can be a powerful force for driving change in healthcare. That’s the philosophy of Eugene Woods, CEO of Advocate Health and a 2025 Fierce 50 honoree, who joins Ayla Ellison, Editor-in-Chief of Fierce Life Sciences & Healthcare, to share how he puts “Applied Hope” into practice. Woods explains how this approach combines optimism with action and why it’s become a guiding strategy for one of the nation’s largest nonprofit health systems. In their conversation, Woods discusses leading through massive organizational change, cultural transformation and the rapid adoption of new technologies. He offers insights on improving quality and affordability, investing in both rural communities and urban neighborhoods and preparing for a future shaped by AI and more human-centered healthcare delivery. To learn more about the topics in this episode: Fierce 50 of 2025 Eugene A. Woods—Fierce 50 Leadership Honoree See omnystudio.com/listener for privacy information.

Corporate venture capital is gaining traction across industries. From 2014 to 2024, it accounted for nearly half of all VC deal value. Healthcare is no exception: dozens of health systems now have venture arms or invest directly in healthcare startups. Arizona-based Banner Health is one of them, taking a strategic approach to equity deals and joint ventures. To unpack that strategy, Senior Writer Anastassia Gliadkovskaya spoke with Mark Garvin, former senior vice president of partnership and venture development at Banner Health. This episode was recorded before Garvin departed from Banner. He no longer represents the organization, but his insights remain highly relevant. To learn more about the topics in this episode: Banner Health boosts investment in AI-powered automation tech to maximize operating roomsWhat’s next for digital health investing in 2025?Ardent Health execs eye outpatient expansion, see nonprofits' headwinds as growth opportunitySee omnystudio.com/listener for privacy information.

Transitions of care—moving patients from one care site to another—continue to be a major challenge in healthcare. Nearly 1 in 5 Medicare patients discharged from a hospital—approximately 2.6 million seniors—are readmitted within 30 days, at a cost of more than $26 billion every year, according to the Centers for Medicare & Medicaid Services. Salman Ali, CEO and co-founder of Kouper, saw opportunities to take a tech-based approach to care transitions, using generative AI to ensure patients don’t fall through the cracks after hospital discharge. As executive-in-residence at venture capital group General Catalyst, Stephen Klasko, M.D., has a front-row seat to the latest innovations in AI. And as former CEO of Jefferson Health in Philadelphia, Klasko understands the value of using technology to tackle operational pain points at health systems. In this episode of “Podnosis,” Ali and Klasko dig into Kouper’s approach to improving care transitions and why they see AI at a true inflection point. They talk about how hospitals can deploy AI without adding to staff burden and why trust matters more than technology in winning over health system leaders. To learn more about the topics in this episode: Kouper is tackling transitions of care armed with $10M from General Catalyst, 25Madison and CVS' venture armOhio attorney general approves sale of Summa Health to General Catalyst's HATCo, with some conditionsCommure raises $200M in growth financing from General CatalystSee omnystudio.com/listener for privacy information.

The first half of 2025 was decidedly mixed for many publicly traded healthcare companies, and they’re facing murky waters in the back half of the year amid policy and cost upheaval. In this episode of "Podnosis," Fierce Healthcare Associate Editor Dave Muoio and Senior Writer Paige Minemyer break down the topline takeaways from another round of corporate earnings calls, including a look at executive commentary on the “big, beautiful” policy environment. To learn more about the topics in this episode: Elevated Medicare Advantage, ACA marketplace costs sting insurers in mixed Q2HCA Healthcare raises 2025 guidance on strong Q2, says Medicaid changes should be 'manageable'UnitedHealthcare to exit certain Medicare Advantage markets as costs balloon, impacting 600K enrolleesCommunity Health Systems attributes Q2 volume stumble to low consumer confidence, immigration fearsOscar Health misses estimates in Q2, plans layoffs and inks Hy-Vee-branded ICHRA planAetna turnaround is a 'top priority' at CVS Health, CEO says, as Wall Street buoyed by insurance unit's reboundWith buyouts looming, Humana improves outlook as revenue beats estimates in Q2Cost pressures limit Molina Healthcare during Q2 earnings as stock dipsArdent Health has no qualms about losing exchange volumes, execs sayCigna's solid Q2 results boosted by Evernorth revenue growth, limited exposure to elevated medical costsUniversal Health Services addresses behavioral volume slip by targeting outpatient, downplays Medicaid cutsElevance Health CEO Gail Boudreaux says company taking 'concrete steps' to address cost pressuresTenet Healthcare raises 2025 outlook on Q2 overperformance; concerns linger over ACA subsidies, slowed admissionsCentene slashes 2025 guidance as it navigates ACA marketplace headwinds'Humming on all cylinders': Alignment Healthcare CEO inks profit milestone, eyes growthSee omnystudio.com/listener for privacy information.

Research shows that women impacted by domestic abuse are significantly more likely to experience chronic health conditions. Survivors often live with untreated pain, anxiety and fear—and many never disclose their experiences to a healthcare provider. At Endeavor Health Swedish Hospital in Chicago, a new pilot program is rethinking how care teams engage survivors of gender-based violence. The initiative aims to improve how clinicians identify, respond to, and connect patients with trauma-informed care and critical resources. Senior Writer Anastassia Gliadkovskaya talks to Mariá Wilburn, a certified crisis counselor and manager of the Pathways Program at Endeavor Health, about the unique approach and why it’s important. To learn more about the topics in this episode: Some sexual assault survivors face huge hospital bills if they seek emergency careHalf of women skip or delay care due to 'triple threat' of factors, report findsUnique generational mental health needs highlight demand for personalized care, survey findsSee omnystudio.com/listener for privacy information.

As healthcare costs continue to climb, employers are searching for new ways to support their workforce while managing spend. One potential solution: direct contracting, where employers partner directly with care providers instead of going through traditional insurers. In this episode of "Podnosis," senior writer Anastassia Gliadkovskaya chats with Nick Stefanizzi, CEO of Northwell Direct, the direct-to-employer arm of Northwell Health. He explains how the organization partners with employers through Northwell’s broad provider network, why even competitors are joining the effort and what he sees as the future of employer-sponsored healthcare. To learn more about the topics in this episode: Employers embracing direct contracting and bypassing insurers: surveyIndustry Voices—Healthcare disruption is here and employers are driving itBuyers of digital health plan to up their investment next year, survey findsSee omnystudio.com/listener for privacy information.

Chronic kidney disease (CKD) affects more than 35 million Americans, and up to 9 in 10 adults with the condition don’t know they have it. Often called a “silent killer,” CKD is typically diagnosed in later stages, when treatment becomes more complex and costly. In this episode, Fierce Healthcare Senior Writer Anastassia Gliadkovskaya speaks with Carney Taylor, M.D., associate chief medical officer at Interwell Health, about why CKD is ripe for value-based care, how early interventions can improve outcomes, and what it takes to shift kidney care upstream. To learn more about the topics in this episode: CMMI to cut participation in payment models, estimates $750M in savingsHumana finds value-based care leads to fewer hospital admissions for kidney patientsHumana cuts 13-state kidney disease management deal with Interwell HealthInterwell Health finalizes $2.4B kidney care merger to combine tech, value-based care capabilitiesSee omnystudio.com/listener for privacy information.