The FLATLINING Podcast from Fulcrum Strategies

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss the news that UnitedHealth Group posted a $1.4 billion loss in quarter 1 of 2024 following the Change Healthcare cyber attack. They talk about whether or not providers should care about news such as this. Then, they discuss a new law going into effect in California that ups the minimum wage for healthcare workers to $25 an hour. There could be some very dramatic setbacks to healthcare quality, access, and affordability. Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net. Articles mentioned in this program: UnitedHealth posts $1.4B loss in Q1 following Change cyberattack - Becker's Payer Issues California health workers may face rude awakening with $25 minimum wage law - KFF Health News Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. Fulcrum Strategies is a health care consulting firm specializing in payer contract negotiation and strategic planning for physician practices. Learn more about what we can do for your practice at fsdoc.com.

Today on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley take a look at some of the latest healthcare news. First, they discuss changes to the Medicare Advantage rates published by the Centers for Medicare and Medicaid Services; they explain why insurers are saying out of pocket expenses will go up for seniors. Ron and Matthew also discuss Home Depot’s decision to appeal a settlement with BlueCross BlueShield to the Supreme Court; why wasn’t $2.67 billion enough for Home Depot? Finally, they talk about why a bill to reduce prior authorizations in Kentucky falls flat. Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net. Articles mentioned in this program: CMS finalizing 2025 Medicare Advantage rates – Becker’s Payer Issues Health insurance shares tumble on CMS news – Bloomberg 🔒 Home Depot asks SCOTUS to rule on BCBS anti-trust lawsuit – Becker’s Payer Issues Kentucky gold card prior authorization bill dies – Becker’s Payer Issues

Today on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon have a conversation with Matthew Stephens, MD, a board certified radiologists at Radiology of Indiana. Dr. Stevens, Matthew, and Ron discuss the exciting topic of artificial intelligence in healthcare, particularly AI's influence in radiology. They discuss what some of the pitfalls are of using the new technology and what might be coming next. -- Dr. Matthew Stephens is a board-certified Body Imager with a cardiothoracic radiology specialty who joined Radiology of Indiana in 2023. He received his B.S. in Chemistry from Indiana University, Bloomington, IN. He also received his M.S. in Computer Science from Purdue University, Indianapolis, IN, along with another M.S. in Physiology from Indiana University, Indianapolis, IN. His medical degree is from Indiana University School of Medicine. He also finished a fellowship in Medical Informatics from the Regenstrief Institute, Indianapolis, IN. -- Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn.

In this episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss Congress’ late fix to eliminate part of the cut to Medicare physician fee schedule. They also discuss a recent report about a whistleblower case that alleges major accountable care organization Aledade engaged in serious Medicare fraud. -- Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. -- Articles mentioned in this episode: Congress nixes part of the Medicare cut - Matthew Handley at FLATLINING.netAledade accused of Medicare fraud in whistleblower lawsuit - Modern HealthcareAledade’s statement on whistleblower lawsuit — A previous version of this episode had an inaccurate title and an inaccurate description of a former executive at Aledade. Those errors have been corrected. This episode has also been updated to include a statement from Aledade.

Medicare Advantage continues to be one of the most profitable sectors of the health insurance industry, yet a lobby group backed by the nation's largest payers has claimed the federal government isn't paying them enough. Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss this. Plus, Elevance-owned Anthem BlueCross BlueShield in New Hampshire has royally screwed up their mail-order pharmacy benefits for NH's retired employees. Matthew and Ron also discuss why UnitedHealthcare and UNC Health are possibly going to go non-par on April 1. Subscribe wherever you get your podcasts or at www.FLATLINING.net.Follow Matthew on X: @radioHandley --- Articles mentioned in this program: Payers urge 'stability' from CMS on Medicare Advantage - Becker's Payer IssuesAnthem under fire for 'massively screwed-up' Medicare Advantage contract implementation - Becker's Payer Issues UnitedHealthcare, UNC Health near split date - Becker's Payer Issues

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a proposal in Washington to remove the site of service differential. Removing that change would pay doctors the same regardless if a procedure is performed at a hospital or an office. Ron and Matthew also discuss if the Medicare fee schedule is going to change, a PhRMA's lawsuit against the Biden administration over drug price negotiations, and a Florida health plan that now owes the Federal Trade Commission $195 million. Listen wherever you get your podcasts or subscribe at FLATLINING.net. --- Articles mentioned in this program: In Fight Over Medicare Payments, the Hospital Lobby Shows Its Strength - KFF Health NewsJudge tosses PhRMA lawsuit over Medicare power to negotiate drug prices - STATFTC obtains $195M judgment against Florida payer, imposes healthcare ban over 'bogus' product - Becker's Payer Issues

On today's episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a current US Supreme Court case that is looking at COVID-19 misinformation and free speech. Namely, the justices are evaluating if misinformation is protected speech. Matthew and Ron discuss what this could mean for physicians who think they are giving their medical opinion to patients or to the public on social media. Plus, Ron and Matthew discuss a new list from JUST Capital that lists Cigna and Elevance as two of the nation's most "just" companies. What does that even mean? Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. Articles mentioned in this episode: Supreme Court to weigh whether Covid misinformation is protected speech - STAT News2024 Overall Rankings - JUST Capital2 payers among the 'most just' companies - Becker's Payer Issues

In our continuing series on prior authorization, Ron Howirgon and Matthew Handley discuss a press release from Cigna detailing all the "good" reasons big insurers like it use prior authorizations. They claim it is to save patients money but ultimately, it saves patients' lives. But a new law in New Jersey seems to fly in the face of that saying in its introduction that prior authorizations can be detrimental to patient health in the name of saving money. Matthew and Ron explain. Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net. Articles mentioned in this episode: Prior authorizations help keep patients safe, improve health, and make care more affordable - Cigna HealthcareNew Jersey signs prior authorization reform bill into law - Becker's Payer IssuesBill Text: NJ A1255- Legiscan.com

This week on the FLATLINING Podcast, Matthew and Ron talk about a new Centers for Medicare and Medicaid Services rule that requires insurance companies to respond to prior authorization requests for certain products within seventy-two hours. Those products include Medicare, Medicaid, CHIP, and Obamacare plans. Unfortunately, commercially insured patients are left out in the cold. Ron shares his concerns with the rule but acknowledges it's a step in the right direction. Plus: An update on the 2024 Medicare fee schedule - Is the cut still happening? Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net. Articles mentioned in this episode: Biden administration cracks down on prior authorization - The HillCMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process - CMS.gov

This week on the FLATLINING Podcas from Fulcrum Strategies, Matthew and Ron discuss the current situation with the Medicare fee schedule. Unfortunately, a cut was not removed by Congress and doctors are now being paid (on average) 3% less to see Medicare patients. Ron shares his insights into what he thinks will change in the next few weeks. Then, Matthew and Ron discuss a story that was previously shared on Matthew's Friday Pulse Check newsletter (subscribe at FLATLINING.net). The Pennsylvania Department of Insurance has launched a new website that allows patients to submit claims they believe were improperly denied by their insurance company. Matthew and Ron share who is eligible for this service and whether or not this is a step in the right direction to combat massive claim denials. Read the original story here: PA launches website for patients to dispute denials - Matthew Handley

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howirgon discuss the failed Cigna / Humana merger and why Wall Street analysts thought it was a bad idea from the start. They also talk about the potential buyer for Cigna's Medicare Advantage business and why it doesn't really matter in the grand scheme of Medicare Advantage plans. Matthew also asks Ron what he's looking at in 2024. The FLATLINING Podcast is a production of Fulcrum Strategies, a provider-focused healthcare consulting company that specializes in making sure providers are being paid fairly by the insurance companies. Learn more at FSDOC.com. Articles mentioned in this episode: Cigna abandons pursuit of Humana, plans $10 billion share buyback - ReutersCigna pulls out of blockbuster deal to create insurance giant with Humana - The Financial TimesCigna Nears Deal to Offload Medicare Business - The Wall Street JournalCigna, HCSC near deal on Medicare Advantage business: WSJ - Healthcare Dive

Our most listened to episode of 2023: In 2023, the nation’s largest health insurers saw several lawsuits brought against them for refusing to cover care under the guise that it was not medically necessary or that physicians did not comply with prior authorizations. This happened to otolayrngologist Dan Hurley and Matthew had the opportunity to interview him for the FLATLINING Podcast from Fulcrum Strategies before he died in August. A medical director at his insurance company denied PET scan for being “not medically necessary” as Dr. Hurley and his physician were fighting to figure out how to best treat his cancer. Tragically, that decision may have cost him his life. Appropriately, as we continue to work to better our healthcare system in his memory, our most listened to episode of 2023 was Matthew's interview with Dr. Dan Hurley. New episode next week!

We are continuing the Best of 2023 series on FLATLINING Podcast from Fulcrum Strategies. Weight loss drugs got a lot of hype this year as more were approved by the FDA with very promising results. But, as has been noted by several lawmakers and activists, insurance companies are still refusing to cover the drugs. Ron and Matthew discussed the new drug from Novo Nordisk called Wegovy and how it could change America’s public health. Next week: the most popular episode of 2023.

This week on the FLATLINING Podcast, we start our best of 2023 countdown with our third most popular program of the year. Ron and Matthew discussed a bill that was proposed in the Indiana state legislature that attempted to regulate how hospitals can do business in the state. That bill was later signed into law by Indiana Governor Jonathan Jennings. Ron and Matthew also discussed statistics that showed just how many physicians died during the COVID-19 pandemic and what that means for our healthcare system going forward. Next week, Matthew shares the second most popular episode of the year.

This week on the FLATLINING Podcast from Fulcrum Strategies, economist and CEO Ron Howrigon and Matthew Handley discuss the recent news that health insurance giants Cigna and Humana may merge. They discuss why Cigna's stock price has failed to rebound since the news and why Ron thinks this deal will be approved by the FTC. They also discuss, briefly, former President Donald Trump's statements that he is “seriously looking at alternatives” to the Affordable Care Act. Follow Ron on LinkedIn. Follow Matthew on X and LinkedIn. Articles mentioned in this program: Reports of Cigna and Humana merger - Matthew Handley at FLATLINING.netThe 543-word editorial that may have just upended the presidential campaign - POLITICO

We are continuing our series on the FLATLINING Podcast which takes a look at the healthcare policies of the presidential candidates. One of the Republicans who has some concrete ideas is former United Nations Ambassador and former South Carolina Governor Nikki Haley. Haley has proposed: Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss Haley's proposals, their viability, and how they might affect American healthcare. Follow Matthew on X.Follow Ron on LinkedIn. --- Pulse Check on Robert F. Kennedy, Jr.Pulse Check on Perry Johnson --- Articles mentioned in this program: Nikki Haley is coming for your retirement - Paul Krugman in the New York TimesNikki Haley's Medicare Advantage - The Editorial Board of the Wall Street JournalNikki Haley Calls For Eliminating 'Certificate of Need' Bills [sic] to Lower Medical Costs - Timcast

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss recent reporting that the American Medical Association may lobby to ban corporate medicine. Corporate medicine is the practice of entities owning physicians, such as an insurance company or a large hospital system. They also discuss the potential cuts to the Medicare fee schedule in 2024. Articles mentioned in this episode: The AMA Debates a Federal Ban on Corporate Medicine - The American Prospect --- Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. Subscribe and find more at FLATLINING.net.

Yesterday, Reuters reported that Cigna is in talks to sell its Medicare Advantage line of business. Upon the release of the news, Cigna's stock price was down nearly 4% at points and ended the day down 3.85%. As other insurers (namely Humana) aim to get out of their commercial business because Medicare Advantage was much more profitable, how is it that Cigna was unable to make their plans as profitable as they would have liked? Matthew Handley and Fulcrum Strategies CEO Ron Howrigon (also a former Cigna executive) discuss. Reuters - Cigna explores shedding Medicare Advantage Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. Subscribe and have every episode delivered to your email inbox!

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss UnitedHealthcare's new variable co-pay product called Surest. They talk about these questions providers and patients may have about the product: Follow Matthew Handley on X.Subscribe and have each episode delivered to your email inbox!

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss a recent move by BlueCross BlueShield of North Carolina to purchase the NC locations of retail healthcare chain FastMed. What does that mean for patients and nieghboring providers? Then, they dive into a recent LinkedIn post by Ron that discussed a call he had with a managed Medicaid payer who wanted one of his clients to take on a lot of risk for Medicaid patients. What does risk mean in the healthcare world and should providers take on risk? BCBS North Carolina to purchase more than 50 FastMed urgent care clinics - Becker's Payer IssuesFollow Matthew Handley on X.Subscribe and have each episode delivered to your email inbox!