Podnosis

In this sponsored episode of Podnosis, CVS Caremark Senior Vice President and Chief Growth Client Success Officer James Margiotta joins host Chris Hayden for an in‑depth look at the rapidly changing pharmacy benefits landscape. Drawing on more than 35 years across payer, PBM, pharmacy and healthcare delivery roles, Margiotta shares what employers and plan sponsors need most in 2026 and beyond: strategic partnership, transparency, affordability and a seamless member experience. The conversation explores how accelerating drug costs, GLP‑1 utilization, specialty spend and biosimilars are forcing a new, more integrated approach to benefit design. Margiotta highlights how CVS Caremark is leading with technology, AI, clinical rigor and deep connections to the provider ecosystem—helping plan sponsors navigate disruption while improving outcomes and reducing friction for members. Tune in to learn what meaningful transparency looks like, which cost‑management strategies actually work, and how data and digital innovation are redefining the future of pharmacy benefits. See omnystudio.com/listener for privacy information.

Emergency departments are required by law to treat anyone who comes through the door. But the financial model behind that guarantee is under strain. In this episode of "Podnosis," Fierce Healthcare and Life Sciences Editor-in-Chief Ayla Ellison talks with Tony Cirillo, M.D., president of the American College of Emergency Physicians, about the business of emergency medicine—who pays, how much, and what happens when the math stops working. To learn more about the topics in this episode: Without new financial support, emergency departments, physicians struggle to meet rising demand: RANDOp-ed: What if the ER is the emergency?Op-ed: Emergency physicians are holding the line, but we can't do it aloneSee omnystudio.com/listener for privacy information.

Fierce Healthcare's Fierce 15 is one of our favorite projects each year. Now in its eighth year, the list highlights companies bringing new ideas and innovation to some of healthcare’s most persistent challenges. In this episode, members of the Fierce Healthcare editorial team discuss the Fierce 15 of 2026 and the trends shaping this year’s honorees—from AI-powered clinical tools to companies tackling insurance denials, behavioral health integration and early cancer detection. The conversation also looks at what these companies reveal about the direction of healthcare, including the growing role of AI, the push for accountability across the system and the different paths startups are taking to build sustainable businesses. To learn more about the topics in this episode: Fierce Healthcare's Fierce 15 of 2026Fierce Healthcare highlights Fierce 15 of 2026 honorees at NYSESee omnystudio.com/listener for privacy information.

Healthcare earnings season is offering a mixed picture of the industry. In the latest episode of "Podnosis," Fierce Healthcare's Dave Muoio and Paige Minemyer break down the highlights from fourth-quarter earnings, where providers signaled growth while payers warned of financial headwinds amid a shifting policy landscape. The episode also features an interview from the Lake Nona Impact Forum, where Fierce Healthcare’s Anastassia Gliadkovskaya spoke with Jeff DiLullo, head of Philips North America, about how health systems are thinking about AI, technology and the push to bring care closer to home. To learn more about the topics in this episode: UnitedHealth Group was the most profitable payer in a difficult 2025 for the industryAfter 2025's volumes shortfall, Universal Health Services says capacity, headcount investments will pay off in 2026Community Health Systems' hospital divestiture streak likely isn't overTenet Health outperforms in Q4, projects solid 2026 despite ACA exchange headwindsHCA Healthcare unveils bullish 2026 guidance despite $600M-$900M ACA exchanges hitLake Nona Impact Forum: There can't be longevity without techPhilips to invest $150M in US manufacturing base, including ultrasound site expansionPhilips rolls out major AI upgrades for cardiac ultrasound platformsPhilips launches new point-of-care ultrasound system for critical careSee omnystudio.com/listener for privacy information.

In five to 10 years, a hospital room could look very different. Advocate Health is beginning to build that room of the future today. The concept integrates advanced artificial intelligence capabilities, virtual nursing and audio, video and sensor data for intelligent patient monitoring, creating an extra set of eyes and ears for care teams. Nurses and clinicians can respond more quickly and proactively, while patients receive real-time assistance. Virtual technology also allows family members to participate in care from outside the room. Advocate Health is piloting the room of the future at two hospitals in Charlotte, North Carolina, and Fierce Healthcare got a firsthand look at the initiative. On site, Executive Editor Heather Landi spoke with Molly McColl, Advocate Health’s vice president of virtual health and clinical transformation, about how the tech-enabled hospital room supports care teams, improves the patient experience and expands access to care, particularly in rural communities. To learn more about the topics in this episode: A conversation with Eugene Woods, the architect of 'Applied Hope'See omnystudio.com/listener for privacy information.

Measurement-based care is increasingly referenced in conversations across the behavioral health industry. Providers recognize the value of patient-reported outcomes as a way to track progress. Yet there are important considerations in doing measurement-based care well. To understand what those are, Senior Writer Anastassia Gliadkovskaya speaks with Two Chairs’ Chief Clinical Officer Colleen Marshall about the company’s approach to clinician training, its internal culture of measurement and the outcomes it has seen. To learn more about the topics in this episode: Employers can do more to track the efficacy of mental health benefits, study says How tech, incentives could push measurement-based care in behavioral healthA closer look at the impact of measurement-based care in behavioral health See omnystudio.com/listener for privacy information.

Dermatology may not be a specialty traditionally associated with high costs, but that is changing, in part because of the rise of new biologic drugs. Specialty medications are rapidly driving up dermatology spending, with some estimates showing utilization growing more than 30% year over year, a pace that rivals other high-cost therapeutic areas. Could strong health outcomes be achieved with a less expensive approach? Zest Health is a value-based dermatology startup that treats skin conditions as chronic diseases and aims to align care with long-term patient needs. The company emphasizes education, lifestyle changes and over-the-counter interventions, while using high-cost biologics more selectively when clinically appropriate. To explore how dermatology arrived at this moment, and what a different model could look like, Senior Writer Anastassia Gliadkovskaya sits down with Olivia Deitcher, founder and CEO of Zest Health. To learn more about the topics in this episode: Fueled by new launches, US drug prices poised to continue trending upward: Cowen reportChampioning equity in skin of color dermatologySee omnystudio.com/listener for privacy information.

Dual-eligible members are often described as the most complex population in health care, and many health plans continue to struggle with how best to support them. In this sponsored episode of Podnosis, Darin Buxbaum, co-founder and CEO of Wider Circle, joins host Chris Hayden to discuss why traditional engagement and enrollment models frequently miss the mark. Buxbaum explains how a lack of trust, fragmented Medicare and Medicaid alignment, and broker-driven approaches contribute to high churn and poor member experiences. He also outlines why community-based, peer-led engagement can be more effective, citing published research and real-world results that show stronger retention and lower inpatient utilization. The conversation explores the growing urgency created by CMS rules requiring exclusively aligned enrollment and what those changes mean for Medicare Advantage and Medicaid managed care organizations. Health plan leaders will gain insight into how to stabilize members, prepare them for alignment and build trust-based relationships that support better care and stronger performance. Listen to the full interview to learn how community can become a strategic advantage. See omnystudio.com/listener for privacy information.

The buzz around artificial intelligence in healthcare hasn’t waned, and for major companies to keep up, they must invest in key applications. For the biggest firms, that translates to hundreds of use cases in practice and testing. At Elevance Health, that work is grounded in a key mantra: keep the member at the center. In this episode of "Podnosis," Senior Writer Paige Minemyer sat down with Ratnakar Lavu, chief digital information officer at Elevance Health, to discuss where the insurer is seeing success and how it’s building ethical guardrails for AI development. To learn more about the topics in this episode: A look inside Elevance Health's artificial intelligence strategyElevance Health offers employees AI skills training in collaboration with OpenAIECRI flags misuse of AI chatbots as a top health tech hazard in 2026CMS wants to speed up tech innovation and AI for patients, setting major goalposts in 20262026 Outlook: Setting the standard for health AI programsSee omnystudio.com/listener for privacy information.

Colorectal cancer rates are rising rapidly among young people worldwide. Experts expect it to become the leading cause of cancer death among people ages 20 to 49 by 2030. Younger patients are also more likely to be diagnosed at later stages. In 2019, Dana-Farber Cancer Institute launched its Young-Onset Colorectal Cancer Center. The center is pioneering a specialized model of care to address and study the unique needs of younger cancer patients. To break down the clinical and research offerings at the Young-Onset Colorectal Cancer Center, senior writer Anastassia Gliadkovskaya talks to Kimmie Ng, M.D., the center’s founding director. Ng is also associate chief of GI Oncology at Dana-Farber Cancer Institute and professor of medicine at Harvard Medical School. To learn more about the topics in this episode: More patients are surviving cancer, but incident rates rising among women and younger adults: ACS report As colorectal cancer patients get younger, governments need to boost awareness, screening: report Cancer death rate continues to decline but new cases expected to top 2 million this year, study findsSee omnystudio.com/listener for privacy information.

With all the talk about generative AI over the past few years, the conversation in healthcare has largely shifted away from less flashy use cases, such as automating administrative tasks. But doing the basics well remains key to minimizing missed appointments, delayed treatments and lost revenue. PocketHealth automates nonclinical workflows for providers, from image release and scheduling to patient communication. Co-founder and CEO Rishi Nayyar argues that providers still have a long way to go before mastering this type of automation. Senior Writer Anastassia Gliadkovskaya speaks with Nayyar about the different types of AI, how advances in the technology have enabled faster integrations and what the future of automation could look like. To learn more about the topics in this episode: Physicians and administrators view AI as key to reduce professional burdens: InnovaccerEconomic pressure, consumer behavior will push providers to speed up AI adoption in 2026Adoption of AI for hospital RCM surges, but cost, operational constraints slow progressSee omnystudio.com/listener for privacy information.

On January 1, CMS launched its latest alternative payment model: TEAM, the Transforming Episode Accountability Model. The mandatory program requires hundreds of acute care hospitals to participate in episode-based payments for five common, high-cost surgeries. TEAM's goal is central to value-based care: improve quality while reducing Medicare spending. But the model has faced industry resistance. Critics argue it puts smaller, less-resourced hospitals at risk and should be voluntary. CMS maintains that the model builds on past voluntary programs and aligns with recommendations from federal partners. To understand TEAM and what it demands of hospitals, senior writer Anastassia Gliadkovskaya talks with Jeff Gleason, M.D., the new chief medical officer of Navvis, a value-based care enablement company. He argues that hospitals that don't prepare now will struggle later. To learn more about the topics in this episode: Hospitals rail against 'inadequate' pay bump, mandatory TEAM participation in IPPS commentsHospitals, health systems expect to ramp up value-based care in 2026, 2027CMMI to cut participation in payment models, estimates $750M in savings See omnystudio.com/listener for privacy information.

Employers are in a tough spot. Healthcare costs are rising, while insurance plan options may seem overwhelming or inadequate. The need for real value has never been more apparent. What if there were a way to optimize an existing provider network for quality? Garner Health helps employers address these pain points. By finding the best-performing doctors in a given network and incentivizing members to see them, Garner claims to help clients save costs and achieve better health outcomes. To break it down, Fierce Healthcare's Anastassia Gliadkovskaya talks to Garner Health founder and CEO Nick Reber. To learn more about the topics in this episode: Employers brace for 6.7% increase in health benefits costsReport: Payers need to do more to demonstrate value to plan sponsorsIndustry Voices—Maximizing your benefits investment: Why health insurance literacy is the missing linkSee omnystudio.com/listener for privacy information.

Since the Trump administration took office in January, healthcare policy has been moving quickly, with changes touching Medicaid funding, ACA subsidies, hospital finances and the federal government’s approach to health technology. This week on "Podnosis," we’re bringing you a recording from a live roundtable at the Fierce Health Payer Summit on Dec. 4, where members of the Fierce Healthcare editorial team unpacked the policy and funding shifts already underway. The discussion covers Medicaid cuts and coverage losses, how hospitals are preparing for reduced government funding, CMS’ new health tech ecosystem and where PBM reform stands after years of scrutiny. To learn more about the topics in this episode: Crapo, Cassidy introduce ACA subsidy plan that leans on HSAsAHIP presses for ACA subsidy extension, further program integrity measuresMedicaid work rules exempt the 'medically frail.' Deciding who qualifies is trickyWhen the hospital leaves townMany urban safety-net hospitals threatened by OBBBA's Medicaid cuts: analysisIndustry Voices—3 major changes to Medicare Part B payment policies coming for 2026'Come fight with me'—Oz courts physicians skeptical of Medicaid cuts, MAHA's criticismsKFF: States brace for increasing Medicaid costs even as enrollment stays flatAll 50 states submit applications for $50B Rural Health Transformation ProgramThe policies top of mind for healthcare stakeholders right nowHospital M&A continues to rebound as policy uncertainty clearsSee omnystudio.com/listener for privacy information.

Each year, Fierce Healthcare’s Women of Influence special report asks a simple question: Who is actually reshaping healthcare from the inside? This year brought a record number of nominations and a list that reflects how broad that influence has become, across health systems, payers, tech, policy and advocacy. In this episode, Fierce Healthcare's Heather Landi and Paige Minemyer talk about why this recognition still matters, even as women make up nearly half of managerial and executive roles but remain scarce in CEO positions. They get into what the nomination surge tells us about where change is happening, how roles and titles are evolving and why so many of the most interesting ideas in healthcare are being led by women who are still fighting for a true share of power. To learn more about the topics in this episode: Fierce Healthcare's Women of Influence 2025 See omnystudio.com/listener for privacy information.

It’s been a buzzy few years for prescription digital therapeutics, marked by bankruptcies, reimbursement policy changes and AI advancements. At their best, DTx solutions can offer a more personalized, convenient and cost-effective care experience. But barriers to adoption remain. What are they, and what’s being done about them? Senior Writer Anastassia Gliadkovskaya explores these questions with Joseph Perekupka, CEO of Freespira, and Andy Molnar, SVP of industry affairs for the American Telemedicine Association. To learn more about the topics in this episode: Access to Prescription Digital Therapeutics Act reintroduced in CongressHow companies use scientifically informed music to impact health outcomesCMS puts forward meager offering for digital health in final Medicare physician fee schedule ruleAmerican Telemedicine Association's lobbying division acquires Digital Therapeutics AllianceSee omnystudio.com/listener for privacy information.

Conduent is leaning into artificial intelligence to help clients navigate budget constraints, improve service quality and streamline operations, according to Mandy Huckaby, vice president and general manager of customer experience management. Speaking on Fierce Healthcare’s Podnosis podcast, Huckaby said the company is focused on helping clients “do more with less” by integrating AI across customer-facing and back-office functions. She emphasized that AI is not new to Conduent, which has used the technology for more than a decade. “AI is literally just having technology augment an interaction,” Huckaby said. “We’ve been doing technology augmentation with chat, digital landscaping and other services for a long time.” Conduent’s AI strategy targets three areas: pre-engagement automation to help customers self-serve, agent support tools to improve response speed and quality, and back-office enhancements such as document processing and legal text analysis. In healthcare, Huckaby said AI is being used to support nurses and HR representatives, among others. The company also partners with vendors like Microsoft to deliver sentiment analysis and quality audits. Huckaby said clients are increasingly looking for creative problem-solving and authentic customer advocacy. “It can’t just be reading off a script,” she said. “Our customers are looking for empathy and understanding.” As industries face rapid technological change, Huckaby said Conduent encourages its teams to remain agile and forward-thinking. “Change is inevitable,” she said. “It’s our ability to be flexible and agile through that change.” See omnystudio.com/listener for privacy information.

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.