Episódios
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Employers have been saying for years that they can’t absorb any more cost growth for health insurance; health plans feel like they’ve squeezed about as much juice as possible out of traditional cost mitigation levers. Both are looking for creative alternatives to curb rising health costs. Enter ICHRAs.
Usually, when we talk about the health insurance landscape, we focus on Medicare, Medicaid, or employer-sponsored insurance. But roughly 21 million people in the US are covered by individual marketplace plans, and in 2020, a new type of plan hit the individual market, moving health insurance from a “defined benefit” to a “defined contribution” in an effort to curb employer health costs.
In this episode, host Abby Burns invites Advisory Board health plan expert Morghen Philippi to shed light on what Individual Coverage Health Reimbursement Arrangements, or ICHRAs, actually are, how employers, plans, and providers are responding to their rise, and what leaders need to keep an eye on when it comes to these plans.
Note: This episode was recorded prior to the 2024 elections. Given the results, it is unlikely that the enhanced subsidies referenced in this episode will be renewed, which will affect the health of the individual marketplace. If enhanced subsidies expire at the end of 2025, you can expect it to have a direct impact on the individual market and on ICHRA viability, specifically. That said, because of the first Trump administration’s role in establishing the ICHRA model, the incoming administration may work to support ICHRA growth.
Links:
Is the cost of employer-sponsored insurance at a tipping point?Market outlook for individual and small group health insuranceEp. 176: Test, fail, and test again: Morgan Health's approach to employer costsEnhanced subsidies propelled ACA marketplace enrollment. What’s next?What health system growth will look like in 2025
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A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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Last week on Radio Advisory, we broke down what healthcare leaders need to know for 2025 and beyond following the recent elections. But before we move on from 2024 completely, we have to acknowledge that there’s been a lot moving in the policy space this year, and frankly, there have probably been a few important policy areas on your radar that we haven’t discussed.
That’s why this week, host Abby Burns invites Advisory Board experts Gina Lohr, Sarah Roller, and Paul Trigonoplos to dive into three major policy areas of the last year: Medicare drug negotiations, changes to physician employment and payment, and an emerging mandatory bundled payment model called TEAM. The experts unpack how these policies are affecting the industry, how the elections outcomes may impact them, and, critically, how much attention leaders should be paying them going forward. In other words, should leaders consider each policy a big deal, a little deal, or no deal?
Links:
Ep. 230: Elections results are in: What healthcare leaders need to knowState-level healthcare ballot measures that passed (and failed)CMS’ TEAM payment model is here. How should hospitals prepare?Transforming Episode Accountability Model (TEAM)Your guide to CMS' 14 value-based payment modelsMedicare announces 10 new drug prices following negotiationsA federal judge just blocked FTC's noncompete banThe Hospital Benchmark GeneratorMarket Scenario Planner(Correction: An earlier version of this episode misstated that there is a $200 out-of-pocket cap on drug spending going into place. That number is $2,000 and references the Medicare Part D out-of-pocket cap set to begin in 2025. We have removed the number from the audio.)
Get exclusive, early access to Advisory Board’s annual “What CEOs need to know” briefing.
2 ways labs can embrace innovation to drive revenue and accelerate growth
Market Scenario Planner
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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(Note: This episode was recorded on November 7, 2024)
The results of the 2024 elections are in: Donald Trump will be the 47th President of the United States, and we are all but certain to have a Republican trifecta at the federal level. Admittedly, there’s a lot we don’t know about what healthcare will look like under a second Trump administration—a lot will depend on who is appointed to key leadership positions overseeing federal health agencies and Congressional committees. But while we wait for those appointments, what can we anticipate based on President-elect Trump’s first term, campaign, and the Republican platform?
This week, hosts Rachel (Rae) Woods and Abby Burns invite Advisory Board experts Natalie Trebes and Ben Palmer to break down the implications of a second Trump term on the healthcare industry. They unpack how power dynamics have shifted since the first administration, and what we’re likely to see on issues like the ACA, enhanced subsidies, Medicaid, drug pricing, abortion, and more.
Links:
What the 2024 elections mean for healthcareThe election is over. Here's how to talk to your team today.Ep. 206: 24th Secretary of HHS Alex Azar shares his vision on healthcare transformationState-level healthcare ballot measures that passed (and failed)Why healthcare leaders should look to their state elections more than the national raceJoin 165,000+ healthcare leaders and get the industry’s most important news in your inbox—every day.
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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Conversations around GLP-1s in today’s healthcare market are mixed. Some stakeholders are thrilled with their potential, while others are filled with questions and even anxiety about how these powerful and popular drugs will impact their business. Many in the industry have been asking for months: “What can GLP-1s do?” But maybe this is the wrong question. Leaders should be asking “What CAN’T GLP-1s do?”
To answer that question, live from HLTH 2024, host Rachel (Rae) Wood invites Rob MacNaughton, CEO of lifestyle intervention and obesity management organization Calibrate, Rita Glaze-Rowe, President at life sciences research organization Real Chemistry, and Dr. Spencer Nadolsky, lipid and obesity specialist and founder to break down the cross-industry perspective on GLP-1s and how the healthcare leaders should be thinking about both the potential and limitations of these novel therapies. In a market that is buzzing around the novel medications, these experts suggest a new focus on comprehensive weight management programs.
Links:
Treating Obesity At Scale: Real-World Outcomes Using Medication And Intensive Lifestyle Intervention | CalibrateReal Chemistry - AI and Ideas Transforming HealthcareEp. 222: It's not just GLP-1s; here's what comprehensive weight management looks likeEp. 159: Ozempic, Wegovy, and our questions on weight management drugsHow 3 health systems provide comprehensive care for obesity4 key elements of comprehensive obesity care (and how they look in practice)Join 165,000+ healthcare leaders and get the industry’s most important news in your inbox—every day.
What the 2024 elections mean for healthcare
[Webinar, 10/24] How the 2024 elections could impact the healthcare industry
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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Remote patient monitoring (RPM) has a surprisingly long history in healthcare. As technology improves, RPM can expand physician capacity, better manage complex patients, and improve total cost of care. Despite RPM’s potential, leaders often struggle to root RPM in a clear business case, or they underinvest in implementation, never fully integrating RPM into existing workflows and systems.
This week, host Rachel (Rae) Woods invites Advisory Board RPM expert Lauren Woodrow and Advisory Board cardiovascular expert Kristin Strubel to break down why RPM technologies aren’t being properly utilized, guide leaders on where to place their strategic bets, and share use cases for how RPM can improve quality and finances across service lines.
Links:
How 4 specialty service lines are embracing remote patient monitoringThe rise of remote patient monitoring: Ensuring accessibility3 strategies to unlock the potential of remote patient monitoringHow Frederick Health saved $2.3M through remote patient monitoringWhat the 2024 elections mean for healthcare
Mapped: Key healthcare-related ballot measures to watch
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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For years, the best word to describe Medicare Advantage (MA) was “untouchable.” Hugely popular among seniors, profitable for health plans—the hybrid public-private payment model grew to the point that it now covers more seniors than traditional Medicare. But in the past few years, the tide has started to change. And if you’ve been paying attention in recent months, you’ll have seen headlines announcing that payers that are scaling back their MA offerings and providers are exiting MA contracts. The MA market has gone from “untouchable” to “volatile.”
The question is: why is this happening, and what does it mean for payers, providers, and seniors moving forward? In this episode, hosts Rachel (Rae) Woods and Abby Burns invite health plan experts Max Hakanson and Chelsea Needham to dissect what is going on in MA and how plans and providers are—or should be—navigating the changing tide.
Links:
Ep. 203: Value series: Is the future of VBC in specialty care? Zing Health & Strive Health say yes.Ep. 149: Senior Care (Part 1): Specialized primary care for an aging populationEp. 150: Senior Care (Part 2): The rapid growth of Medicare Advantage3 traits health plans want in a provider partner4 traits providers want in a health plan partnerAround the nation: CMS releases Medicare Advantage Star Ratings[Webinar, 10/24] How the 2024 elections could impact the healthcare industry
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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As care delivery becomes more complex and new disruptors join the scene, one thing has become clear: operational excellence is now table stakes in ensuring your organization’s financial sustainability and winning patients.
In this episode, recorded live from Advisory Board’s 2024 Strategy Summit, guest host and Managing Director of Physician and Medical Group Research at Advisory Board, Sarah Roller, invites Dr. Mary Jo Cagle, CEO of Cone Health and Dr. Cynthia Horner, Chief Medical Officer of Amwell and President of Amwell Medical Group, to unpack what it takes to achieve operational excellence, why adaptive leadership is essential to success, and why true operational excellence does not have to be as daunting as it seems.
Links:
Cone Health | We're Right Here With YouHybrid Care at Scale | Amwell8 lessons for facility planners from our recent strategy summitPivots for a sustainable futureProvider operationsPivots for a Sustainable Future Virtual Summit
Join 165,000+ healthcare leaders and get the industry’s most important news in your inbox—every day.
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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For years, health systems have been holding their breath to see if patient volumes would finally return to pre-pandemic levels. Because—per conventional wisdom--if volumes return, then so will operating margins. Right? Not so fast.
In this episode, host Abby Burns invites Advisory Board experts Sebastian Beckmann and Elizabeth Orr to explore why with the positive volume forecast we see in our projections won’t automatically translate to a healthy financial outlook. Later, Optum Advisory expert Alex Kist joins the group to share what it’s looked like to help one health system put their local data into action to achieve the kind of differentiated growth our experts have been touting.
Links:
Market Scenario Planner3 ways Boulder Community Health became a provider of choice for CV careRevolutionizing cardiology at Boulder Community HealthEp. 221: How will health system growth look different in 2025 and beyond?Healthcare Consulting Services | Optum AdvisoryAdvisory Board's 7 key factors for future volume growthCharted: The financial gap between rich and poor hospitals growsIf you are looking for hands-on support, email us at [email protected] or learn more about how Advisory Board can help.
Join 165,000+ healthcare leaders and get the industry’s most important news in your inbox—every day.
Strategic Planner's survey 2024
Survey insights: 6 priorities for health system strategists in 2024
Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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Two weeks ago on Radio Advisory, we told our listeners that the number one area of focus for health system growth is operational excellence, and a major part of that is capturing all of the revenue on the table from your medical group. Healthcare organizations have spent the last decade buying up medical groups and physicians, in part because of the “promise” of downstream referrals. It is a long-held belief that physician employment leads to higher referral integrity. But according to an Advisory Board data analysis, that doesn’t hold true - just 55% of total referral revenue attributed to employed PCPs is realized in-network.
This week, host Rachel (Rae) Woods invites Advisory Board physician experts Eliza Dailey and Colleen Wagner to unpack where referral leakage actually happens and share the real (and relatively easy) steps organizations can take to reduce referral leakage.
Links:
Tools to reduce referral leakage in the medical groupAre employed PCPs more likely to refer within their health systems?Ep. 221: How will health system growth look different in 2025 and beyond?Medical group integration3 shifts impacting medical groups: 2024 update on the physician landscapeStrategic Planner's survey 2024
Survey insights: 6 priorities for health system strategists in 2024
Digital surgery: A way for orthopaedic programs to set themselves apart
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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In the midst of the COVID-19 pandemic, The Centers for Medicare & Medicaid services released the Acute Hospital Care at Home payment waiver. The action was expected to usher in a new era of home-based care. But while it’s certainly grown in recent years, frankly, that massive shift hasn’t happened. The question is, why?
This week, host Abby Burns invites Dr. Matthew Richards, Senior Medical Director of home-care enablement company Medically Home, to explore the role that home-base care could play in the future of healthcare, and to unpack the misconceptions that prevent home-based care from playing a larger role in the healthcare ecosystem today.
Links:
Home - Medically Home5 trends (re)shaping site-of-care shiftsThe future of the acute care at home modelEp. 64: Why Contessa's CEO believes hospital at home benefits everyone (including hospitals)Strategic Planner's survey 2024
Survey insights: 6 priorities for health system strategists in 2024
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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(This episode originally aired on September 26, 2023.)
Value-based care has been dominating industry conversations in recent years. Here on Radio Advisory, we talk a lot about best practices, how to make the right investments, and how to best prepare leaders for the future of value-based care. But given all this momentum, we want to spend time asking the question: what are the misconceptions or misaligned expectations that leaders have around value-based care?
In this episode, host Rachel (Rae) Woods invites Advisory Board value-based care expert Daniel Kuzmanovich and Optum Advisory Service's SVP of value-based care, Erik Johnson, to discuss the mindset shifts they think leaders should be making when pursuing a sustainable value-based care strategy. Throughout the conversation they discuss what leaders are currently getting wrong, how myths about value-based care are impacting the industry, and more.
Links:
Our Value-based Care playlistEp. 172: Build a value-based enterprise: Live from 2023 Value-Based Care SummitEp. 126: [Bonus content] Commercial risk is possible—here's howHow Health Plans Can Support Providers in RiskThe climb to value-based care3 strategies for a successful sleep apnea therapy program: Lessons from ENTTX's ASC partnership
Strategic Planner's survey 2024
Survey insights: 6 priorities for health system strategists in 2024
Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.
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In the last few years, all eyes have turned to GLP-1s as an industry-altering answer to obesity treatment and weight management. But the fact is, these drugs can’t – and shouldn’t – work in a vacuum. There is a fear that attention on GLP-1s may even blind leaders to the other services that go into providing effective obesity care. So, what should leaders be thinking about when designing and and delivering effective obesity care?
To answer that question, host Abby Burns invites Advisory Board experts Chloe Bakst, Payton Grimes, and Atticus Raasch to unpack what comprehensive weight management programs look like in practice, and why—if done well— they can benefit patients, clinicians, and health systems.
Links:
4 key elements of comprehensive obesity care (and how they look in practice)How 3 health systems provide comprehensive care for obesityEp. 181: Does healthcare's approach to obesity harm patients?Ep. 159: Ozempic, Wegovy, and our questions on weight management drugsLearn more about On-demand Courses
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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When we talk about “health systems,” it can sound like we’re talking about a monolith. But in reality, the $1.4 trillion dollar health system sector is made up of a diverse range of players. Academics and safety nets; urban and rural systems; 1,000-bed systems and 25-bed critical access hospitals. The question is, especially as systems emerge from the financial hardships of the past few years, how do those differences translate to the ways systems are running at growth?
In this episode, the third and final installment in our series leading up to Advisory Board’s Strategy Summit, host Abby Burns invites Advisory Board health system experts Elizabeth Orr and Marisa Nives to unpack how leaders across the health system sector are thinking differently about growing in 2025 and beyond.
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Hospitals' top strategic priorities — and what they mean for development leadersEp. 220: Why AI in healthcare is more than just ChatGPTEp. 219: The business case for going greenEp. 218: [Encore + bonus content] Site-of-care shifts: It's time to go on offenseCharted: The financial gap between rich and poor hospitals growsJoin us at the Pivots for a Sustainable Future Summit on September 10-11, 2024.
Learn about Advisory Board Fellowship
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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We’ve talked a lot about AI on Radio Advisory, with a particular emphasis on generative models and their capabilities. But are there other models of AI that are flying under the radar? Today’s episode focuses on computer vision and its potential to shift how we think about the use of technology in healthcare.
For the second episode in our series leading up to Advisory Board’s upcoming Strategy Summit, host Abby Burns invites digital health experts Ty Aderhold and Elysia Culver to break down why computer vision should be on our minds, arguably just as much as generative AI.
Links:
Ep. 185: AI adoption: why you can't afford to "wait and see"10 ways computer vision can transform the future of healthcareComputer vision in healthcareJoin us at the Pivots for a Sustainable Future Summit on September 10-11, 2024.
Register for the How to harness the potential of digital experience in healthcare webinar on September 17.
Learn more about Advisory Board Sponsorship.
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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It's no secret that climate change has had a massive effect on population health, but it’s also impacting healthcare business. Did you know that energy costs have gone up by 28% in the past five years? Health systems in particular can shave percentage points off their annual costs by reducing their energy consumption—but there is both a knowledge gap and an action gap keeping leaders from taking advantage of the opportunity.
Advisory Board’s Strategy Summit on September 10-11 is all about the pivots health systems need to make for a sustainable future – no better way to kick off our lead-up to the event than by taking that quite literally and talking about environmental sustainability.
In this episode, host Abby Burns invites Advisory Board expert Miles Cottier to break down how and why health business leaders need to prioritize environmental sustainability. They explore the financial case for moving to renewable energy sources, how regulatory pressures may (or may not) shape the future of environmental action, and what leaders can do today to support their green initiatives.
Links:
Green financing for health systemsClimate change is affecting heart health. Here’s what you can do.Ep. 119: How health leaders can address climate changeEp. 164: Boston Medical Center's path to sustainability (and how they're funding it)Join us at the Pivots for a Sustainable Future Summit on September 10-11, 2024
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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This week, host Abby Burns invites Advisory Board expert Sebastian Beckmann back to Radio Advisory to provide an update—as promised—on what his team has uncovered about site-of-care shifts in the six months since he first brought this research to the pod. Hint: there’s about $50B at play.
This episode is a modified encore of Episode 195: Site-of-care shifts: It’s time to go on offense.” In that episode, Sebastian and fellow Advisory Board expert Nick Hula joined Abby to break down how health systems should be thinking about site-of-care shifts as a part of their growth strategies, including making the transition from a “defensive” mindset to prevent volume shifts, to an “offensive” mindset to capture them.
The original episode will play almost in its entirety, with interjections from Abby and Sebastian to dig deeper into what the site-of-care shift opportunity—or risk—actually looks like across markets and services.
Links:
Seize the $50 billion site-of-care shift opportunityInteractive maps: See where site-of-care shifts are having the biggest impactSite-of-care shifts: Healthcare’s $50B opportunityYour guides to volume growth in 6 key service lines4 takeaways from our updated provider volume forecast5 trends (re)shaping site-of-care shiftsWhat’s happening with joint replacement volumes?Ep. 193: Is health system growth still possible?Learn more about On-demand Courses
Use the Market Scenario Planner
A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.
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(This episode originally aired on September 12, 2023.)
With rising costs and tightening margins, the industry is continually looking for ways to "bend the cost curve" while maintaining, or even increasing, quality and performance. One stakeholder in particular, employers, are feeling significant pressures from inflation, hospital consolidation, the rise of high-cost drugs, and more. While many legacy cost-saving strategies have focused on reducing employer costs, it may be time to shift focus to lowering costs for employees as well.
In this episode, host Rachel (Rae) Woods invites Advisory Board payer expert Max Hakanson and Innovation lead at JPMorgan's Morgan Health Rivka Friedman to discuss what employers can do to rein in healthcare costs, both for themselves and their employees. Throughout the discussion, they discuss why legacy cost-sharing strategies may be insufficient, and what new innovations are showing promise in the market.
Links:
Home | Morgan HealthEp. 165: Employer series: Is the cost of employer-sponsored insurance unsustainable?Investigating the high costs in employer-sponsored insurance5 health benefits strategies for self-funded employers3 things to know about ESI (that you won't find in a benefits survey)Learn more about Advisory Board Sponsorship
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(This episode originally aired on March 12, 2024.)
The relationship between health plans and providers has always included an element of friction, but lately, it seems like the temperature is rising. And you've probably noticed – public contracting disputes increased by 69% between 2022 and 2023.
That's why, in this episode, host Abby Burns invites Advisory Board experts Max Hakanson and Eileen Fennell to discuss why the state of affairs seems to be getting worse, how key flashpoints are fanning the flames, and what each stakeholder says they need to see from their partners in order to mend the relationship. Plus, Advisory Board digital health expert Ty Aderhold makes a cameo appearance to help answer the question: Is AI the solution here?
Links:
7 things we want to fix in 2024 (and how to get there)A new era of payer-provider relationshipsThe new era of provider enablementAI in healthcare: Insights from 10 C-suite executivesLearn about the Advisory Board Fellowship
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Healthcare leaders have dozens of priorities on their plates, and achieving innovation is not as simple as just buying a new technology or implementing a new care model. Frankly, it can be overwhelming not just to see innovations through, but even to get started. So, what does it really take to innovate? And how do you align your organization’s challenges with the solutions or innovations that are being presented to you?
In this special episode, live from Advisory Board’s 2024 Clinical Innovation Summit, guest host and Advisory Board digital health expert John League invites Dr. Ayo Ajaiyeoba from Blue Cross Blue Shield of Kansas City, and Elliot Green, cofounder and CEO of Dandelion Health, to dive deep on the realities of innovation. Throughout the discussion, they explore what it takes to get started, how to act in the face of ambiguity, and how you should be thinking about tools like data and partnerships to achieve your goals.
Links:
Blue Cross Blue ShieldDandelion HealthTop 5 takeaways from our Clinical Innovation Summit4 imperatives for the future of healthcare innovationTruly personalized care is possible. Here's how to make it a reality.More upcoming events from Advisory Board
Learn more about Advisory Board On-Demand Courses
A transcript of this episode as well as more information and resources can be found on radioadvisory.advisory.com.
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It seems like a no-brainer for healthcare organizations to allocate time and attention to a health condition that is guaranteed to affect 50% of adults during their midlife years—but that hasn’t been the case.
We’re seeing momentum around making menopause mainstream—from the White House directing research funding, to Hollywood stars talking openly about menopause, to the rise of femtech companies geared toward helping consumers navigate the clinical and social effects of menopause. But though 100% of women in midlife will experience this clinical event, the reality is that most women’s health programs are primarily focused on what our guests have referred to in the past as the “bikini approach” to women’s health, and have largely ignored the needs of women in the post-reproductive years. From a clinical and financial standpoint, this is a missed opportunity. And given 80% of the healthcare workforce is women, and one-third of those women are in midlife, it’s also a competitive vulnerability.
That’s why this week, host Rachel (Rae) Woods invites Advisory Board women’s health experts Kara Marlatt and Gaby Marmolejos to explore how provider and employer leaders can build systems that account for and address women’s health needs “beyond the bikini.”
Links:
5 ways employers can support women's health during midlifeFive women leaders on the shifting landscape of women's health, per UnitedHealthcare (beckerspayer.com)Ep. 188: The business case for investing in women's healthThe business case for investing in women’s specialty careWomen’s health opportunity: Menopause symptom care[Webinar, Aug. 13] Your guide to the lab and diagnostics market landscape in 2024
A transcript of this episode as well as more information and resources can be found on radioadvisory.advisory.com.
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