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Good health care depends on good health coverage, particularly for the most vulnerable. The Affordable Care Act expanded Medicaid eligibility and created exchanges where many Americans could access health insurance, often at a subsidized price. These new pathways to affordable coverage led to the uninsured rate dropping to record lows.
Unfortunately, those recent gains in coverage and access now face new hurdles. After the end of the Covid public health emergency, states began a process of redetermining Medicaid eligibility which caused tens of millions to lose coverage. Many were forced to find a new source of insurance coverage, or lost it completely.
The passage of the Inflation Reduction Act created enhanced subsidies for individuals seeking insurance on the ACA marketplace exchanges, leading to a record high enrollment this year. Those subsidies are set to expire in 2025. Unless Congress steps in, this could increase premiums, making coverage too expensive for many, threatening access to health care.
In this episode, Stan Dorn, who has worked on coverage issues for almost 40 years and currently serves as the Director of the Health Policy Project at UnidosUS, explains what these dual threats to coverage mean for individuals and their families.
Topics discussed include:
Current state of the Medicaid redetermination process and its impact on coverage for recipientsCongressional action needed to avoid looming marketplace coverage cliff Long-term policy changes that will improve the ACA by protecting Medicaid expansion and continuing affordability in the exchange marketplaceMORE:
UnidosUS, previously known as NCLR (National Council of La Raza), is the nation’s largest Hispanic civil rights and advocacy organization. Through a unique combination of expert research, advocacy programs, and an Affiliate Network of nearly 300 community-based organizations across the United States and Puerto Rico, UnidosUS simultaneously challenges the social, economic, and political barriers that affect Latinos at the national and local levels. When it comes to health care, the group is focused on ensuring access to affordable coverage with an emphasis on helping people through the Medicaid unwinding process and enrolling them in exchange plans.
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The Change Healthcare cyberattack on February 21st upended a huge slice of the U.S. health care system, virtually crippling all aspects of the patient care continuum when the clearinghouse’s services were hacked. That is because Change Healthcare processes 15 billion claims totaling more than $1.5 trillion a year and may handle 50 percent of all medical claims in the country. The impact has been devastating for many patients, hospitals, and providers, particularly those already operating under financial constraints.
Having an understanding of the size and scale of this cyberattack has been critically important to ensuring lawmakers and regulators understand the outsized impact on providers. Enter Matt Szaflarski, a revenue cycle intelligence leader at Kodiak Solutions. In the aftermath of the attack, Matt has become a leading voice in clarifying the role, scale, and impact within the care continuum and quantifying its impact.
In this episode, Szaflarski discusses:
The role of a clearinghouse in patient care from start to finish;A breakdown of the Change Healthcare cyberattack and subsequent fallout, including the effect on patients and loss of provider safety nets; andFuture of health care and recovering from the hack.More:
Kodiak Solutions is a leading technology and tech-enabled services company that simplifies complex business problems.
Kodiak has built a high-performing business for healthcare provider organizations revolving around a proprietary net revenue reporting solution, Revenue Cycle Analytics, and expanded to a broad suite of software and services in support of CFOs. Kodiak’s 400 employees engage with more than 1,850 hospitals and 250,000 practice-based physicians across all 50 states.
Learn more here: https://www.kodiaksolutions.io/
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There are two Americas - rural and urban – particularly when you look at access to health care.
With roughly 60 million people, or one in five Americans, living in small communities from coast to coast, how do we ensure patients have access to the care they need when they need it? And what policies can help bridge the gap?
Former Senator Heidi Heitkamp has dedicated her life to representing the interests of rural America and fighting to save this way of life. She currently serves as founder and board chair of the One Country Project, an organization dedicated to advancing rural America through and ensuring its priorities and values are represented and reflected in Washington, D.C.
In this episode, Sen. Heitkamp discusses the issues facing small communities and how lawmakers can help solve health inequities between rural and urban areas.
Topics include:
Unique health care challenges faced by rural Americans Hospital closure crisis Impact of public programs like Medicare, Medicaid, and the Affordable Care Act Threat of funding cuts to rural health care programs, like site-neutral, low-volume and Medicare-dependent hospitals Unintended consequences of Medicare Advantage Mission of the One Country ProjectMORE:
The One Country Project is dedicated to reopening the dialogue with rural communities, rebuilding trust and respect, and advancing an opportunity agenda for rural Americans. Its mission is to ensure rural America’s priorities and values are heard, understood, well-represented and reflected in policy in Washington.
Learn more here: https://onecountryproject.com
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GUEST:
Dr. Jonathan Perlin, President and CEO, The Joint Commission
IN THIS EPISODE:
The Joint Commission is possibly the most impactful health care quality and performance organization in the world. With the rise of AI and concerns growing over issues like environmental sustainability, its mission has never been more critical.
Dr. Jonathan Perlin, in his second year at the helm of The Joint Commission, is on a quest to reshape safety and performance measurement and its impact on care delivery for hospitals and other settings.
In this episode, Dr. Perlin outlines his H.E.L.P agenda and explains how the acronym is a guide for the organization as it aims to better ensure patients’ safety and effective hospital care.
H.E.L.P Agenda includes:
Health EquityEnvironmental Sustainability Learning Health Care/AIPerformance Improvement and IntegrationMORE:
The mission of The Joint Commission is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.
It aims to accomplish this goal by setting quality standards, evaluating an organization’s performance, and providing an interactive educative experience that provides innovative solutions and resources to support continuous improvement.
Learn more here: https://www.jointcommission.org/
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IN THIS EPISODE:
For the past 15 years, drug shortages have been a persistent problem for hospitals and the
patients they serve – and extreme cases can even lead to rationing, delaying, or canceling
treatments or procedures.Tackling the drug shortage crisis is a complicated issue requiring creative solutions. That’s where
Civica comes in – a non-profit pharmaceutical company created by hospitals and health systems
to address these critical shortages.In this episode, Chip speaks with Civica’s Senior Vice President for Public Policy Allan Coukell
The state of hospital drug shortages in the US todayTaking the bull by the horns: how a non-profit company created by hospitals is helpingpatients.The success of Civica's model:Long-term purchase and supply contracts directly with hospitals that add stability
about why the company was formed, the challenges they are tackling, and how it plans to help
patients into the future. Topics include:
to the market.Maintaining an approximately 6-month buffer inventory of every drug.US sourcing whenever possible.Intensive quality oversight of suppliers.A single cost-plus price, available to every purchaser.How the company got into drug production.Policy solutions to ease drug shortages.GUEST:
Allan Coukell, Senior Vice President. Public Policy, Civica Inc.MORE:
Civica currently delivers 80+ drugs, all chosen by US hospitals for being at risk of shortage, with
more than 140 million containers delivered to hospitals over five years, serving 60 million
patients.It currently works with 1,500+ hospitals from 55-member health systems, like HCA Healthcare,
Mayo Clinic, Common Spirit & US Department of Veterans Affairs.Learn more here: https://civicarx.org/
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Guest:
Phillip Morris, Partner & Leads Strategic Insights Practice, LSGIn this episode:
It is only January, but the campaign season is already in full swing. From the White House to
control of Congress - power in Washington is up for grabs. In this episode, Chip Kahn talks with
Phillip about what issues matter most to voters and where health care fits into that list of
priorities.Topics they examine include:
Most important issues to likely voters in this year's election - inflation, the economy, and immigration.Views on health care – voters point to big insurance and pharmaceutical companies as the main reasons for rising costs and lack of pricing transparency.Growing concern over Medicare Advantage plans delaying and denying doctor-ordered care for seniors.Voter’s view hospitals favorably and consider them among the most essential providers of health care in their communities.Overwhelming support for lawmakers ensuring hospitals have the necessary funding to provide 24/7 care.Political trends for 2024 and into 2025.MORE:
Phillip Morris and his firm, LSG. recently conducted a poll on behalf of FAH and found wide support for hospitals and hospital funding among likely voters. The survey also discovered the vast majority are concerned about cuts to Medicare and abuses by Medicare Advantage plans, including denials and delays of care through prior authorization, denied payments for necessary treatments, and network restrictions limiting provider choice.Key findings include:
Voters view hospitals favorably and consider them among the most essential providers of health care in their communities.Nearly three-quarters (72%) of likely voters view hospitals favorably.The vast majority (82%) believe the federal government should provide adequate funding to ensure hospitals serving rural and underserved communities remain open.Lawmakers’ positions on hospital funding will affect voters’ actions at the ballot box.Seventy percent of voters would be less likely to vote for a Member of Congress who supported cuts to hospitals that threatened their ability to stay open.An overwhelming majority (89%) would be willing to take action to support policies that would ensure access to hospital care.Voters are concerned about the impact of Medicare Advantage practices on consumers’ access to health care.The vast majority (78%) of voters are concerned about the trend of Medicare Advantage plans delaying or denying access to care for seniors.A majority (56%) of voters believe there should be more regulation and oversight of Medicare Advantage plans.Likely voters blame health insurers most for the lack of transparency in health care costs.You can learn more here.
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Chip and Dr. Liz Fowler, Deputy Administrator of CMS and Director of the agency’s Center for
CMMI’s successes over the last decade and what programs have resonated most.Controversial CBO report that says CMMI’s programs have increased federal spending –
Medicare and Medicaid Innovation (CMMI), discuss CMMI’s mission to improve health
outcomes, overcome the obstacles to health equity, and reduce care costs. They look back on
what CMMS has accomplished in its first 10 years, what we have learned from this
experimentation, and the future of care and payment innovation.
Topics they examine include:
not lowered it.Performance of CMMI bundled payments and rationale behind a new mandatory bundled
payment program.Goals of the newly announced state-based AHEAD model and how it will interact with
other ACO and value-based care programs.Dealing with the challenges created by massive growth in Medicare Advantage.How CMMI is addressing the broad issue of health equity.MORE:
Dr. Fowler has the unique role of leading an agency she helped create. From 2008-2010, she was
Chief Health Counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where
she played a critical role in developing the Senate version of the Affordable Care Act. The
framework for the CMMI was embedded in the law – so now, after several roles in the private -
In this episode:
As we recognize Rural Hospital Week 2023, Chip and Alan Morgan, CEO of the National Rural Health Association, discuss the importance of having medical care 30 miles or 30 minutes away and the battle to maintain patients’ access to vital services in small communities across the country. They also examine the ways lawmakers can throw a lifeline to hospitals struggling to keep their doors open. Topics include:
Growing health care workforce shortage in rural areasRural hospital closure crisisImpact so-called site-neutral policies would have on access to careUnintended consequences of the rapid growth of Medicare Advantage Importance of extending government assistance through the Low-Volume Hospital and Medicare Dependent Hospital programsGUEST:
Alan Morgan, CEO, National Rural Health AssociationMORE:
With more than 30 years experience in health policy at the state and federal level, Alan Morgan is one of the nation’s leading experts on rural health policy.Alan has been CEO of the National Rural Health Association since 2001 and he sat down with Chip to talk about the current state of health care access in small communities across the country, with a focus on hospitals.
According to the Sheps Center for Health Care Research at the University of North Carolina, there have been 149 rural hospital closures since 2010 – and COVID only made the situation worse. These facilities are grappling with lower reimbursement rates from programs like Medicare Advantage and chronic underpayment from Medicare and Medicaid.
Alan also highlights actions Congress can take to maintain critical hospital care in rural areas across the nation.
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In this episode:
COVID-19’s lasting impact on nursingUsing innovative care models and virtual nursing to improve patientcare Ways to increase enrollment at nursing schoolsPrioritizing nurse retention and caregiver continuityFuture of nursing
Chip and Dr. Sammie Mosier, SVP & Chief Nurse Executive at HCA Healthcare, discuss the growing health care workforce crisis in health systems – from how it is affecting care at the bedside to developing cutting-edge programs aimed at training the next generation of nurses. Topics they examine include:
GUEST:
Dr. Sammie Mosier, SVP & Chief Nurse Executive at HCA HealthcareDr. Mosier started her career at HCA Healthcare in 1996 as a medical-surgical nurse at Frankfort Regional Medical Center in Frankfort, Kentucky and last year she was promoted to the role of Chief Nurse Executive where she oversees approximately 93,000 registered nurses.
Her time as a floor nurse has shaped her leadership style and gives her a unique perspective on the issues and opportunities facing the field.
In this episode, Dr. Mosier explains the challenges facing the nursing workforce in hospitals as it rebounds after the COVID-19 pandemic and how to use new technology, like AI, to improve patient care.
She also highlights programs HCA is using to retain current nurses, while training new caregivers through the Galen School of Nursing, which the company owns and operates.
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In this episode:
Chip and Marty Bonick, President and CEO of Ardent Health Services, discuss how cutting-edge technology is reshaping the health care system - by treating patients like consumers, and doing it while improving quality and cutting costs. Topics they examine include:
Prioritizing patient centered care and cost containment Embracing disruptors - Using technology to make care more accessible Impact of AI, machine learning on the patient experienceTransforming from a hospital system to a health service organizationUtilizing virtual nursing to mitigate current workforce shortage and support care in different waysGUEST:
Marty Bonick, President & CEO, Ardent Health Services
FAH Board Member, Past Chair
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Marty Bonick has been a leader in the health care field for more than 25 years, but when he was recently injured in a bicycle accident – he was transformed into a patient.
His experience reshaped the way he views the care continuum and the way Ardent treats patients.
Under his guidance, Ardent Health Services is using technology, like AI and virtual nursing, to improve care quality, along with the patient experience.
Marty also explains both how these innovations can help by reducing costs for everyone, and the importance of treating patients more like consumers.
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Chip and Dr. Lynn Blewett put a spotlight on Medicaid, which is now the largest government-funded health program in the nation – covering more people than even Medicare. Crucial topics they discuss include:
The current state of the Medicaid program and where it is headed in the future.Medicaid redetermination has led to more than a million people being disenrolled from the program. What is the redetermination process and why has it risen to such importance this year?Significance of health plans’ role in Medicaid redetermination and the effects it will have on hospitals, as well as patients’ access to care.Implications of work requirements for Medicaid coverage and discussion of results from states where it has been used. Importance of Medicaid Disproportionate Share Hospital Payments (DSH Payments) for patients and providers.Guest:
Dr. Lynn Blewett, founding Director of State Health Access Data Assistance Center (SHADAC), Professor at the University of Minnesota, School of Public Health
More:
In this episode, we will look at the Medicaid program, which now covers over 86 million of the most vulnerable Americans - ranging from young mothers and babies to seniors in nursing home care.
Currently the largest government-funded health program in the nation, Medicaid has been in the headlines consistently this year as policy makers on state and federal levels debate ways to manage enrollment and bring spending under control.
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In this episode:
Chip sits down with Wendell Primus, former Senior Policy Advisor on Budget and Health Issues to Speaker Nancy Pelosi, to discuss:
The current state of the Affordable Care Act – have the effects met the expectations when the law passed 13 years ago? The lasting impact of recently passed drug reform legislation on Medicare and beneficiaries Many are pushing for health care price transparency – will it be transformative? How insurer consolidation – both vertical and horizontal – will affect the nation’s health care system. Ramifications of Medicare Advantage’s explosive growth - both for patients with increasing coding abuses and overuse of prior authorization and for the Medicare program where predicted savings aren’t being realized. True effects of work requirements on the Medicaid program and its beneficiaries. Tackling the growing health care workforce shortage – especially when it comes to nurses.Guest:
Wendell Primus, served for 18-years as Senior Policy Advisor on Budget and Health Issues to Speaker Nancy Pelosi
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We take a deep dive into the current and past state of health care policymaking on Capitol Hill with one of the central players of the last many decades - Wendell Primus. The pair discuss a few of the major health policy accomplishments of recent years as well as a look to the future. Wendell gives his preview on what could be coming as the Republican majority in the House and its Democratic counterpart in the Senate settle in and start to consider legislation.
Wendell just wrapped up an unprecedented and impactful career on Capitol Hill serving for 18-years as Senior Policy Advisor on Budget and Health Issues to Speaker Nancy Pelosi – where he played a keystone role in the passage of the Affordable Care Act – and just about every other important piece of health care legislation for the past two decades.
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In this episode:
What is prior authorization and how does the process work in the real-world.Startling results of a recent American Medical Association physician survey highlighting the negative impact of prior authorization on patient care:94% of physicians report that prior authorization delayed access to necessary care for patients;89% report prior authorization had a negative impact on patient outcomes – sometimes even leading to death. Effects of additional administrative burden prior authorization places on caregivers and hospitals.Efforts to pushback against insurers and stop the harmful overuse of the prior authorization process. Impact of new CMS rules aimed at reforming prior authorization and what it could mean for patients.Guest:
Todd Askew, Senior Vice President of the Advocacy Group for the American Medical Association -
In this episode:
Why non-compete clauses are important in health care setting.How proposed rule from Federal Trade Commission (FTC) banning employers from using non-compete clauses on employees could impact patients’ access to care.The additional burden new non-compete rule could have on tax-paying systems.Effect of FTC’s increased scrutiny on health systems integration.Repercussions of slowing integration on access to hospital care in rural areas.Guest:
Dr. Subbu Ramanarayanan chairs NERA’s Health care Antitrust practice and is an adjunct Associate Professor of Competitive Strategy at UCLA Anderson School of management. Dr. Ramanarayanan has extensive experience advising clients on antitrust reviews of proposed mergers and acquisitions before the Federal (FTC and DOJ) and state antitrust agencies across a variety of settings in health care including hospital services, health insurance, physician services, medical devices, and Healthcare IT services.
The Federal Trade Commission’s recent activity to end noncompete clauses has potential to cause severe ramifications for health care systems. At the same time, the FTC is taking a dim view of important hospital system integration.
Each of these things can have an immediate and powerful impact on the health care landscape.
The latest controversial proposed rule – which would ban employers from imposing noncompete clauses on their employees - would make it more difficult for health care systems to staff up while also increasing already high workforce costs --- all potentially effecting access to patient care and available services.
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In this episode:
What are the prospects of McCarthy Speakership? Functionality of Washington with divided government? Comparing similarities/differences between the House in the late 1990s and now. Discuss Speaker Gingrich’s experience leading a Republican House and how he dealt with health care while balancing the budget and attempting to reform entitlements. Speaker Gingrich’s outlines his vision for the future of American health care. How hospitals can prioritize preventative care and aging. The role hospitals play for the future of health. What policymakers can do to support and elevate health care innovation.There are very few people who know more about the House, navigating divided government or developing major budget legislation than former Speaker Newt Gingrich. Chip has known Gingrich for more than 50 years and in this episode, the Speaker shares his perspective and provides deep insight into the current House majority and looming policy debates – especially when it comes to health care.
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In this episode:
What is Medicare Advantage (MA)? We examine the roots of this supplementary private health insurance coverage for seniors and its explosive growth, which now includes almost half of all Medicare beneficiaries (more than 28 million people). There are increasing cases of abuse by insurance companies in charge of MA plans. Reports show they are denying and delaying doctor’s requests for necessary – and in some cases lifesaving - care. We discuss how this harms patients and burdens the hospitals caring for them. We dive into how COVID-19 compounded the issues with MA as insurers continued adding barriers to care for seniors during surges. How can we address MA issues? We highlight bipartisan efforts in Congress to fix the problem, like the Improving Senior's Timely Access to care Act. Important to note - not long after our recording - CMS released two separate proposed regulations that address some aspects of prior authorization in Medicare Advantage, as well as Medicaid and ACA private plans. The two rules address some of the challenges highlighted in this podcast and the proposals may help to ameliorate certain of the abuses directly affecting patients that you will hear outlined. The proposed regulations are open for public comment.Guest: Sunitha Reddy, MBA, MPH, FACHE Chief Revenue Officer & Vice President, Operations, Prime Healthcare
Medicare Advantage (MA) is on a growth path to become the dominant part of Medicare in many states across the country. This means that many of our most vulnerable seniors will, on one hand, receive the added benefits and discounts that these plans offer up front, but may find pathways to receive care more difficult than they bargain for – as insurance companies delay or even deny necessary care. Chip speaks to Sunitha Reddy about how this can be more than an inconvenience for patients – it can be harmful.
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In this episode:
We’ll discuss the major stresses and challenges facing rural hospitals, including geography, patient mix, a growing workforce crisis, and funding shortfalls. Since 2010, 140 rural hospitals have closed, including 25 since the start of the pandemic. Congressional support helped keep that number from being even higher, but what happens now as COVID-19 relief runs out? What’s the impact on a small, rural community when a hospital closes?Congress needs to take actions to preserve funding for rural hospitals during Lame Duck session. What will be the impact on access to care if Medicare Dependent Hospital and Low-Volume Hospital programs aren’t extended and lawmakers don’t waive PAYGO?How will divided government affect rural hospital policy moving forward in 2023? Is there room for bipartisan compromise?Guest: Brock Slabach, Chief Operating Officer, National Rural Health Association.
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In this episode:
The Joint Commission’s role in working to reduce the health care workforce shortage.How TJC is addressing health equity moving forward.How hospital measurement is used to assure patients that their hospitals are safe and providing quality care.Guest: Dr. Jonathan Perlin, M.D., Ph.D., M.S.H.A., M.A.C.P., F.A.C.M.I., President and CEO, The Joint Commission
The Joint Commission is celebrating its 70th anniversary this year; at the helm is Dr. Jon Perlin, previously of HCA Healthcare. Chip talks to Dr. Perlin about his vision for the future of The Joint Commission and the ways the organization can confront issues like social determinants of health and providers impact on climate change.
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In this episode:
How the Sarah Cannon Cancer Center’s integrated care model allows for high quality patient care close to home. The research being done at Sarah Cannon, including finding the potential cure for sickle cell disease. Hospitals are safe and patients should not put off cancer screenings – they save lives.Guest: Dr. Dax Kurbegov, Vice President and Physician-in-Chief of Clinical Programs of the Sarah Cannon Cancer Center
The Sarah Cannon Cancer Center offers patients the unique opportunity to receive world class cancer care without traveling far from home. Dr. Dax Kurbegov joined Chip to discuss the benefits of the center’s integrated structure for patients, the research they are working on, and the importance of patients being regularly screened for cancer from their providers.
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The overturning of Roe V Wade has far reaching implications for hospitals and health care providers. Hospitals have a duty to care for every patient that walks through their emergency room, however that care may create a gray area that conflicts with new state laws on abortion.
Hospitals are in every community across the country and will continue to care for women with very real and dangerous conditions in need of care.
Tom Barker is a partner at Foley Hoag and focuses his practice on complex federal and state health care legal and regulatory. He was previously General Counsel for the Center for Medicare and Medicaid Services and Acting General Counsel for the Department of Health and Human Services. He joins the conversation today to highlight the critical questions that need to be addressed as the fallout from the SCOTUS decision continues.
- Visa fler
