Эпизоды
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As the Federation of American Hospitals (FAH) prepares for a pivotal year ahead, this special episode takes a moment to reflect on the progress made in health care policy and the challenges and opportunities on the horizon. Join host Chip Kahn as he sits down with retiring Executive Vice President of Policy, Steve Speil, to discuss his nearly four decades of experience in health care policy and his reflections on his remarkable 27-year tenure at FAH.
Steve’s career has spanned transformative decades in health care, from his early days in Massachusetts state health planning to tackling the evolving complexities of hospital policy in Washington, D.C. His insights in health care policy and the hospital community's resilience shine a light on how far we've come—and the work still ahead to ensure patients have access to 24/7 care.In this episode, Chip and Steve discuss:
Steve's Career Journey Leading to FAH: From a Master in Public Health to law school and a career spanning Massachusetts state health planning, the Dukakis administration, AdvaMed, and ultimately the Federation of American Hospitals.Early Days at FAH: A look back at the early years of Steve’s time at FAH, navigating key regulations like IPPS and legislation including the Balanced Budget Act.Changing Landscape of Health Policy: Steve reflects on accomplishments during his tenure and insights into how hospital policy has evolved, now facing increased burdens.Opportunities Ahead: Steve discusses the continued resilience of hospitals in the face of challenges and the critical role of organizations like FAH in supporting hospitals and the communities they serve.Guest bio:
In his capacity as Executive Vice President of Policy, Steve Speil manages the Federation’s broad portfolio of payment policy issues. He serves as the association’s chief liaison on these issues with the Centers for Medicare and Medicaid Services and the Medicare Payment Advisory Commission. Working closely with the senior finance and policy executives in the Federation’s member companies, Steve develops and carries out both issue-specific and general strategic plans designed to advance the finance and payment related regulatory and legislative interests of the FAH.
Prior to joining the Federation, Steve served as Associate Vice President, Policy Coordination and Communication for the Health Industry Manufacturers Association (now AdvaMed), the national trade group representing the medical technology industry. Before moving to Washington, Steve held a succession of increasingly senior management and policy positions in Massachusetts. During his time in the Bay State, Steve served as Legal Counsel to the Lieutenant Governor, Legislative Counsel for the Executive Office of Health and Human Services, Executive Director of the Disabled Persons Protection Commission, and Legal Counsel and Policy Director in the Office of State Health Planning. Steve also taught health law and policy as an Assistant Professor at Simmons College Graduate Program of Health Administration.
At the federal level, Steve served in the Food and Drug Administration’s Office of Legislative and Congressional Affairs. He also worked in the Environmental Protection Agency’s Office of General Counsel.
Steve earned a J.D. degree from American University’s Washington College of Law; a Master in Public Health degree in Health Administration from the University of North Carolina School of Public Health; and a Bachelor of Arts degree in Anthropology/Zoology from the University of Michigan.
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In this episode of Hospitals in Focus, host Chip Kahn explores the digital renaissance revolutionizing health care—a golden age of pioneering technologies not seen since the 1960s, when computers first standardized medical records and diagnostics. Today, with nearly everything digitized, organizations are actively discussing the regulatory and ethical frameworks necessary to navigate these advancements, while protecting against the increasing prevalence of cyber threats.
The future of health care looks promising thanks to new innovations, but thoughtful implementation is crucial, and Ardent Health is leading the way forward.
Joining Chip on the episode is Anika Gardenhire, Ardent Health’s inaugural Chief Digital and Information Officer, to explore how Ardent is thoughtfully embracing digital innovation with reason and purpose.
In this episode, Chip and Anika discuss:
Conceptual Frameworks for Digital Transformation: The importance of leveraging data to drive innovation and improve patient outcomes.Use Cases at Ardent Health: Examples where Ardent Health is implementing digital solutions to enhance operational efficiency and patient care.Cybersecurity and Protecting Patient Information: Strategies for safeguarding patient data against cyberattacks in an increasingly digital landscape.Guest Bio:
As chief digital information officer, Ms. Gardenhire oversees the development and implementation of Ardent's digital strategy across the organization. She is responsible for ensuring digital initiatives are fully integrated into Ardent's strategic plan with a focus on leveraging data to support digital transformation. Ms. Gardenhire also oversees Ardent’s IT infrastructure and systems, as well as data strategy and governance.
An experienced caregiver and clinical informatics leader, Ms. Gardenhire joined Ardent in September of 2023, and has previously served as chief digital officer and regional vice president of digital and clinical systems at Centene Corporation. She also held various roles at Intermountain Healthcare, including assistant vice president of digital transformation. Ms. Gardenhire holds a bachelor of science in nursing from the University of South Carolina’s Mary Black School of Nursing and master’s degrees in clinical informatics and management from Duke University.
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Пропущенные эпизоды?
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In this episode of Hospitals in Focus, we’re pulling back the curtain on an often-overlooked yet truly “critical” aspect of our health care system—the supply chain. It’s the backbone of our hospitals, ensuring that essential medical supplies reach patients in need. But what happens when that chain breaks?
Host Chip Kahn is joined by Ed Jones, President and CEO of HealthTrust Performance Group, to discuss recent events that exposed vulnerabilities in this intricate network. Following Hurricane Helene’s catastrophic impact on a major manufacturing facility for IV solutions, hospitals nationwide faced a sudden, alarming shortage. This crisis underscores that our health care supply chain is a fragile, interconnected network, frequently dependent on a limited number of suppliers and manufacturers.
An introduction to Group Purchasing Organizations (GPOs), and how they help hospitals secure reliable supplies at fair prices. Pandemic and Disaster Preparedness: How the COVID-19 pandemic and Hurricane Helene revealed and accelerated shifts in our supply chain, and what parallels these events share. The Role of GPOs in Drug Supply: An examination of how GPOs respond to shortages and their impact on supply and pricing. International Reach and Recovery: How global supply chains influence our health care systems. HealthTrust’s Unique Approach: What sets HealthTrust apart from other GPOs in its approach to building a resilient and cost-effective supply chain.
In this episode, Chip and Ed discuss:Guest Bio:
As President and CEO of Healthtrust Performance Group, Ed has overall responsibility for a broad set of capabilities focused on supporting healthcare providers. His primary focus is providing the strategic direction and leadership of a comprehensive spend management and performance improvement business based in Nashville, Tennessee. Jones oversees all dimensions of a $52B portfolio; directs all consulting, managed services and outsourced relationships/alliances, including accountability for HCA Healthcare supply chain, sourcing contingent labor, facility management and clinical education.Jones’ leadership encompasses several HealthTrust/HCA Healthcare business ventures that strengthen provider performance and competitive advantage, including:
HealthTrust Workforce Solutions - The clinical labor staffing and consulting company including a proprietary program called StaRN (extensive training program for all new nurses) HCA Healthcare Center for Clinical Advancement - Responsible for providing continual education for over 90,000 nurses at HCA Healthcare through a team of approximately 800+ educators and several simulation labs HealthTrust Europe, which provides sourcing and supply chain services to HCA U.K. and sourcing services to 39 provider trusts in the U.K. HealthTrust Global Sourcing Office in Shanghai, China Galen College of Nursing Group purchasing organization that delivers clinically integrated solutions and savings across all sites of careHe has 40 years of experience within the Healthcare industry, serving in his current role for the last 11 years and serving previously as the Chief Operating Officer of HealthTrust Performance Group with responsibility for strategic sourcing, clinical operations, custom contracting, supplier diversity, and regional operations. Prior to that, Jones served in several leadership positions within HCA Healthcare for 20 years following front-line roles at a hospital for seven years.
Jones is a founding board member of the Health Sector Supply Chain Research Consortium, and a member and subcommittee leader of the Federation of American Hospitals. He also serves on the board of Galen College of Nursing and is the chairman of the finance committee. Jones also serves on the board of CoreTrust. Previously, he served as board chair on the Healthcare Supply Chain Association (HSCA). He holds a Bachelor of Science degree from Virginia Commonwealth University. -
With over nine million veterans enrolled, the Department of Veterans Affairs (VA) is well known for its health care services. However, the VA’s support extends beyond medical care, helping veterans navigate life after military service. The VA has undergone a significant transformation since the establishment of the Veterans Experience Office in 2015, focusing on improving veterans’ experiences through the use of qualitative and quantitative veteran-customer service data.
In this episode, Dr. Carolyn Clancy, Assistant Under Secretary for Health at the VA, shares insights on the organization’s evolving approach to health care and the patient experience by discussing:
The role of the VA and its evolution in approaches to health care; Transformation through leadership and the creation of the Veterans Experience Office; Holistic attitude to health care through the ‘My life, my story’ project; and, Broader applications of VA initiatives in other health care settingsGuest Bio:
Dr. Clancy serves as the Assistant Under Secretary for Health (AUSH) for Discovery, Education & Affiliate Networks (DEAN), Veterans Health Administration (VHA), effective July 22, 2018. The Office of the DEAN fosters collaboration and knowledge transfer with facility-based educators, researchers, and clinicians within VA, and between VA and its affiliates.
Prior to her current position, she served as the Acting Deputy Secretary of the Department of Veterans Affairs, the second-largest Cabinet department, with a $246 billion budget and over 424,000 employees serving in VA medical centers, clinics, benefit offices, and national cemeteries, overseeing the development and implementation of enterprise-wide policies, programs, activities and special interests. She also served as the VHA Executive in Charge, with the authority to perform the functions and duties of the Under Secretary of Health, directing a health care system with a $68 billion annual budget, overseeing the delivery of care to more than 9 million enrolled Veterans. Previously, she served as the Interim Under Secretary for Health from 2014-2015. Dr. Clancy also served as the VHA AUSH for Organizational Excellence, overseeing VHA’s performance, quality, safety, risk management, systems engineering, auditing, oversight, ethics and accreditation programs, as well as ten years as the Director, Agency for Healthcare Research and Quality.
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Before the Change Healthcare cyberattack, hospitals were already grappling with insurers' tactics of delaying and denying payments for patient care. The cyberattack only amplified the challenges providers face—not just in delivering care, but also in getting reimbursed for that care. Despite the crisis, insurers continued to use these tactics. Now, six months later, Matt Szaflarski, a director and revenue cycle intelligence leader at Kodiak Solutions, and his team have uncovered something alarming: a surge in insurers’ initial Request for Information (RFI) claim denials.
Kodiak’s latest report, “Death By A Thousand Requests,” highlights the growing trend of payors denying initial claims due to RFIs, creating an enormous administrative burden on hospitals and providers. In 2024 alone, these tactics are projected to cost hospitals $4.6 billion. Szaflarski returns to the show to explain the impact of these denials on the hospital revenue cycle, which ultimately impacts the hospital’s ability to provide care.
In this episode, Szaflarski discusses:
Updates on the Change Healthcare cyberattack;Rising trends in claim delays and denials, particularly RFI denials;Revenue cycle data insights;Medicare Advantage, the two-midnight rule, and observation stay challenges; andRecommendations for improving processes between insurers and providers. -
In June, the Supreme Court issued a 6-3 decision in Loper Bright Enterprises v. Raimondo, overturning the 40-year-old legal precedent known as the "Chevron doctrine." This doctrine had allowed federal agencies to interpret ambiguous statutes within their jurisdiction. The ruling marks a significant shift in the regulatory landscape, with major implications for how federal agencies operate and how regulations are enforced—particularly in health care. The decision presents both challenges and opportunities for the health care industry, making it crucial for policymakers, health care leaders, and businesses to understand the evolving regulatory environment.
Joining Hospitals in Focus to unpack the potential effects of this ruling on health care policy making is Thomas Barker, a partner at Foley Hoag and former General Counsel at CMS and Acting General Counsel at HHS.
In this episode, we explore:
Impact on Congress: How does the ruling affect Congress’s legislative process and its relationship with federal agencies? Will the ruling force Congress to write more precise laws?
Changes for Federal Agencies: What does the ruling mean for federal agencies, like CMS and HHS, which have relied on Chevron deference to implement and enforce regulations?
Judicial Implications: Will courts, particularly lower courts, take on a larger role in interpreting statutes? How could this influence future rulings on health and business regulations?
Business and Regulatory Implications and Challenges: What will be the effect on businesses, especially those operating in highly regulated sectors like health care, and what are the potential retroactive effects of the Loper Bright decision? -
The work, dedication, and resilience of hospital providers and staff is centered on providing high-quality care for their patients. In this special episode of Hospitals in Focus, we spotlight two compelling stories of patient care from the frontlines, offering unique perspectives from both a health care provider and patient.
Join us as we hear firsthand from Amy Capella Smith, CEO of Foundations Behavioral Health, a UHS hospital in Doylestown, Pennsylvania, as she navigates the challenges and rewards of providing behavioral health services to children, adolescents, and young adults.
We also share Jenna Tanner’s story, who survived what is often called the “widow maker,” a massive heart attack, while home alone. Jenna was able to call 911 and get the emergency medical help she needed at Hillcrest Hospital, an Ardent Health hospital, where she received lifesaving care. Her experience serves as a universal message about heart health and the importance of recognizing the early signs of a heart attack. -
Today, we are celebrating the 59th anniversary of Medicare and Medicaid being signed into law by President Lyndon B. Johnson and discussing the profound effect these programs have had in providing health care coverage to the country’s most vulnerable populations.
Medicare and Medicaid laid the foundation for public health insurance in the United States, ensuring that the elderly, low-income families, and individuals with disabilities receive essential health care services. The Affordable Care Act (ACA), enacted in 2010, built upon this foundation by expanding Medicaid eligibility, providing subsidies lower-income individuals and families to purchase private insurance on exchanges, and implementing protections for people with pre-existing conditions. Medicare, Medicaid, and the ACA have created a more comprehensive safety net for millions of Americans, significantly reducing the uninsured rate and improving access to care.
Our guest, Larry Levitt, oversees policy work on Medicaid, Medicare, the ACA, and the health care marketplace for one of the nation’s leading health policy organizations. Larry’s extensive knowledge will guide us through the following topics:
· Medicaid Coverage: Expansion and post-pandemic redeterminations in the states;
· Evolution of the ACA: The development and impact of enhanced subsidies;
· ACA Challenges: Addressing concerns about bad actors and program issues; and
· Future of Coverage: Insights on the upcoming election and its implications for health care coverage.
More:
Larry Levitt is the executive vice president for health policy, overseeing KFF’s policy work on Medicare, Medicaid, the health care marketplace, the Affordable Care Act, racial equity, women’s health, and global health. He previously was editor-in-chief of kaisernetwork.org, which was KFF’s online health policy news and information service and directed KFF’s communications.
Prior to joining KFF, Levitt served as a senior health policy adviser to the White House and the Department of Health and Human Services, working on the development of the Clinton Administration’s Health Security Act and other health policy initiatives. Earlier, he was the special assistant for health policy with California Insurance Commissioner John Garamendi, a medical economist with Kaiser Permanente, and served in a number of positions in Massachusetts state government.
Levitt holds a bachelor’s degree in economics from the University of California, Berkeley, and a master’s degree in public policy from the Kennedy School of Government at Harvard University.
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Measles, eradicated in the United States in 2000, is making a comeback. Meanwhile, an estimated 300,000 people died from COVID-19 in cases that could have been prevented through vaccination. Why are we seeing an uptick in conspiracy theories, misinformation, and outright science denial? The consequences of losing trust in science are harmful and even deadly.
Dr. Reed Tuckson, MD, FACP, has dedicated his career to restoring public confidence in scientific research and health care. He joins Chip on the latest episode of Hospitals in Focus to explore the current social climate influencing science denial and how it is exacerbated by those who seek to sow mischief and discontent.
Topics discussed include:
• Tribalism and the “Us vs. Them” mentality;• Social media’s role as a dissemination mechanism;
• Patient-level impacts on health, particularly on society’s most vulnerable; • Covid-19 and the mistakes made with the best intentions; and
• Bridging the gap to regain trust and promote science literacy.
More/Dr. Tuckson’s Bio:
Reed V. Tuckson, MD, FACP, is Managing Director of Tuckson Health Connections, LLC, a vehicle to advance initiatives that support optimal health and wellbeing.
Currently, Dr. Tuckson’s focus is on his role as a Co- Convener of the Coalition For Trust In Health & Science, which is dedicated to bringing together the entire health related ecosystem to address mistrust and misinformation. In addition, he continues to advance his work as a co-founder of the Black Coalition Against COVID, a multi-stakeholder and interdisciplinary effort working to mitigate the COVID-19 pandemic in Washington D.C. and nationally by coordinating the four historically Black medical schools, the NMA, the National Black Nurses Association, the National Urban League, and BlackDoctor.org. -
Artificial intelligence (AI) is dominating headlines and conversations, from how it will change our day-to-day routines to the debate on how far regulation of the ever-changing technology should go. AI's impact on health care is profound, promising advancements in diagnostics, treatment plans, and patient care, but also raising questions about privacy, bias, and the role of human oversight.
Our guest, Dr. Michael Schlosser, MD, MBA, Senior Vice President, Care Transformation and Innovation at HCA Healthcare, is a leading expert in AI applications within the health sector. In this episode, he and Chip delve into the multifaceted world of AI. Dr. Schlosser's insights will guide us through the complexities of integrating AI into medical practices, highlighting both the transformative benefits and the critical safeguards needed to ensure ethical and effective use.
Topics discussed include:
Defining AI – whether we should anticipate a better future or be worried Leveraging AI – use cases in health care A human-centric approach – understanding risks and ways to mitigate harm and biasThe federal government – finding the sweet spot for regulation Future of AI – the benefits of incorporating AI into health care for providers and caregiversMore:
Michael Schlosser, MD, MBA, is Senior Vice President, Care Transformation and Innovation for HCA Healthcare. Reporting directly to the CEO of HCA, he is responsible for leading care delivery innovation and transformation for the enterprise. His department’s vision is to design, develop, integrate, implement, and optimize technology and processes that drive care delivery with the common goal of improving the experience and outcomes for HCA Healthcare's leaders, care teams, and patients. As part of this strategy, he leads the implementation and optimization of HCA Healthcare’s electronic health record systems, the data science and data strategy teams, and the enterprise Responsible AI program.
Prior to this role, he served as group Chief Medical Officer, leading the clinical operations for 100 HCA hospitals, overseeing quality, patient outcomes, and clinical strategy. He has also previously served as the chief medical officer for Healthtrust.
Dr. Schlosser is a neurosurgeon and completed his residency and fellowship at Johns Hopkins, has served as a medical officer with the FDA, and holds a degree in chemical engineering from MIT and an MBA from Vanderbilt.
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Maryland’s 50-year experiment with the hospital rate-setting system stands out as a unique and long-lasting initiative – but has it accomplished its goal of reducing health care costs? This rate-setting scheme has been sustained due to additional Medicare funds supplementing the model, an additional $20.6 billion through 2017. It’s also inspired CMS’s All-Payer Health Equity Approaches and Development (or AHEAD) pilot program.
The Maryland model has come under scrutiny with a paper published in HFM Magazine entitled “Maryland’s example is no solution to healthcare’s true crises.” It finds that the state’s health costs remain higher than the national average, even though the system was designed to reduce hospital and overall health care costs.
Our guest is the author of the paper and president of Health Futures, Inc. - Jeff Goldsmith. In this episode, we'll discuss the history of the Maryland model, the findings of his paper, the impact on hospitals and health care costs, and propose alternative solutions for reducing costs.
Topics discussed include:
Implications for the state – findings from Goldsmith’s paperEmulating the scheme – feasibility of replicating the Maryland model elsewhere and cautionary notes for policymakersRefocusing health care goals – what solutions to access and cost should CMS be considering instead?What’s next – the future for hospitalsMore:
Jeff Goldsmith is the President of Health Futures, Inc. He speaks on the future of health care- covering topics like technology, economics, leadership health care trends and policy analysis. Goldsmith is also a strategist and mentor to leaders in the health care industry. He has also taught at several prestigious universities and worked in the private sector as a consultant.
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Cybersecurity is a central part of every nation’s infrastructure – especially when it comes to health care.
The availability and free flow of health information is critical to providing care. Unfortunately, patient information isn’t just valuable to caregivers, it’s also becoming a primary target for criminals across the globe.
In this special episode, Chip Kahn moderates a panel of cybersecurity experts, with significant experience in the health care sector, from around the world.
The discussion, entitled 'Navigating Today's Cyber Threats for Tomorrow's Healthcare,' was organized by Future of Health, a group made up of thought leaders from hospital systems, academia, policymaking, payers and patient advocacy.
Topics discussed include:
Current state of cyber defenses today – vulnerabilities, variabilities across the worldGoals of cybercriminals targeting health care entities – money, data, or mayhem Paying ransom – views from different countriesPolitical implications – how to react when cyber breaches become geopolitical events Proper role of governments in cyber defense and attack mitigation – the role of mandates and the threat of penaltiesLasting advice – the one thing health care entities must do to protect themselves.The virtual panel:
US: Meredith Griffanti, Senior Managing Director, Global Head of Cybersecurity & Data Privacy Communications, FTI ConsultingUK: Dr. Saif Abed, Director of Cybersecurity Advisory Services, The AbedGraham Group and Cybersecurity Consultant, World Health Organization Singapore: Kim Chuan, Group Chief Information Security Officer, SingHealthIsrael: Alon Rozen, CEO of Elements Group, and former Chief of Staff at the Israeli Ministry of Defense and Director General of the Israeli Homefront Defense MinistryMore:
Established in 2018, Future of Health's diverse membership represents the foremost health organizations and thought leaders from hospital systems, academia, policymaking, payers, industry, and patient advocacy. Each year, FOH members address, through discussion and research process, pivotal issues facing health care across the world. From this process FOH develops insights and recommendations disseminating findings through published papers which serve as a blueprint for a common vision for the future of health.
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With zero-dollar premiums, caps on out-of-pocket costs, and perks that range from meal delivery to gym memberships – even loaded debit cards – membership in Medicare Advantage (MA) plans is surging in enrollment and popularity among seniors.
In fact, earlier this year, enrollment in Medicare Advantage plans surpassed enrollment in traditional Medicare, with more than 50 percent of eligible seniors now choosing this privatized version of coverage.
However, aggressive marketing campaigns and a lack of transparency in coverage often hide the downsides of Medicare Advantage, which include limited networks and strict prior authorization policies that make it harder for millions of seniors to quickly get the care they need. As we explore in this episode, these downsides also impact care providers, like hospitals, as well as the taxpayers who are footing the bill.
Our guest, Tricia Neuman, is the executive director of KFF’s Program on Medicare Policy and has been with the organization for almost 30 years. She looks back on the creation of MA, discusses the program’s unexpected rapid growth, examines its impact on the health care system, and shares what she thinks comes next for seniors’ coverage.
Topics discussed include:
Evolution of Medicare Advantage – popularity and benefitsFlooding the airwaves – impact of overzealous marketingWhat’s in it for insurers? – how insurers game the system Impact on patients– from narrow networks to excessive prior authorizations Problems for providers – limitations on care from denials and delays Taxpayers pay the price – MA now spends more per beneficiary than Traditional MedicareWhat’s next – the future of Medicare AdvantageMore:
KFF is an independent source for health policy research, polling, and journalism. Its stated mission is to serve as a nonpartisan source of information for policymakers, the media, the health policy community, and the public.
KFF has four major program areas: KFF Policy; KFF Polling; KFF Health News (formerly known as Kaiser Health News, or KHN); and KFF Social Impact Media, which conducts specialized public health information campaigns. -
The recent cyberattack on Change Healthcare exposed fissures in the American health care system that are still reverberating - impacting patients and providers alike months after it was exposed.
As hospitals, physicians, and other providers get back on their feet, they're also improving their cyber defenses to stay one step ahead of increasingly persistent hackers.
This crisis also sparked conversations among policymakers weighing the implementation of new regulations on health care entities, including potential penalties for those who have been victimized.
In this episode, Lynn Sessions looks at the cyber-security issues facing hospitals and health care organizations, from evolving threats to how we need to think about mitigation and resiliency. Lynn is a partner at the law firm BakerHostetler and leads the Healthcare Privacy and Compliance practice, where she has handled more than 1,000 health care data breaches and ransomware attacks.
Topics discussed include:
Evolving efforts of hospitals to increase cybersecurity protectionsThe anatomy of a health care cyberattack – effects of ransomware vs. malwareVulnerability of 3rd party entities in health care – like Change HealthcareRole of the federal government – protecting hospitals, penalizing bad actorsMoving forward – fighting the next generation of cybercriminalsMore:
BakerHostetler has a diverse team with wide experience in counseling health systems, physician groups, insurers and employers across the country regarding risk assessments, developing comprehensive incident response plans, and responding in a timely and accurate manner to privacy and security incidents, from lost paper files and laptops to the largest cyber incident ever reported involving medical information.
More here - https://www.bakerlaw.com/services/digital-assets-and-data-management/healthcare-privacy-and-compliance/
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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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