Value Health Voices

Is the rapid rise of artificial intelligence a threat to medicine or its greatest hope? In this episode, we tackle the massive hype and complex reality of AI in oncology with one of the leading voices in the field, Dr. Sanjay Juneja, also known as TheOncDoc. We break down what this technological revolution truly means for cancer patients, doctors, and the healthcare system at large. From uncovering hidden patterns in cancer data that defy human intuition to the practical challenges of implementation, we explore how AI is set to transform everything we thought we knew about medicine.Join us as we separate fact from fiction in the world of medical AI. Dr. Sanjay Juneja, a medical oncologist and VP of Clinical AI Operations at Tempest, shares his journey from social media educator to a trailblazer in health technology. We dive deep into how AI can address the "unwarranted variation in care" that leads to inconsistent patient outcomes across the country. Dr. Juneja explains how machine learning models can analyze vast datasets to find novel insights, much like Google's AlphaGo made a move in the game of Go that was inconceivable to human grandmasters. This episode explores the incredible potential of the future of AI in healthcare, from AI scribes developed to combat AI and physician burnout to new diagnostic tools that can predict hyperglycemic events from the sound of your voice or determine a tumor's molecular features from a simple pathology slide.However, the conversation doesn't shy away from the serious challenges ahead. We confront the "garbage in, garbage out" problem, discussing how biases in training data can lead to flawed or inequitable conclusions. A core part of our discussion focuses on the critical need for validating AI models in medicine before they are widely deployed, ensuring that these powerful tools are both safe and effective. We also explore the nuanced impact of AI and the doctor-patient relationship, debating whether an algorithm can truly be more empathetic than a human physician and what happens to trust when patients suspect their doctor's messages are AI-generated. Finally, we unpack one of the biggest hurdles to adoption: the issue of liability for AI in healthcare. When an AI model makes a mistake, who is responsible—the developer, the hospital, or the clinician who acts on its recommendation? This is a must-watch for any clinician, patient, or technologist seeking to understand the real-world implications of AI in oncology today and in the near future.About Our Guest:Dr. Sanjay Juneja (@TheOncDoc) is a triple board-certified medical oncologist who has become a leading global authority on the application of AI in medicine. He serves as the Vice President of Clinical AI Operations at Tempest, is a contributing writer for Forbes, and was credentialed by Harvard Medical School's inaugural "AI in Healthcare" executive program. Through his massive social media presence and podcast, Dr. Juneja has a unique talent for simplifying complex medical and technological topics for a broad audience.Timestamps / Chapters:(00:00) Introduction: Separating Hype from Reality in AI and Oncology(02:41) From Social Media Influencer to AI Trailblazer: Dr. Juneja's Journey(06:14) Tackling Unwarranted Variation in Cancer Care with AI(10:35) The Devil's Advocate: Bias, "Garbage In, Garbage Out," and AI's Flaws(19:10) Real vs. Hype: Current AI Applications Changing Medicine Now(24:22) Systemic Hurdles: Data Privacy, Reimbursement, and AI Adoption(33:30) Can an AI Be More Empathetic Than Your Doctor?(41:35) AI in the Clinic: Improving Workflow and Reducing Physician Burnout(47:15) Who's to Blame? Unpacking the Liability of AI in Healthcare(52:06) The 2-to-5-Year Future of AI in OncologyEpisode Resources:Follow Dr. Sanjay Juneja on LinkedInFollow Dr. Sanjay Juneja on InstagramFollow Dr. Sanjay Juneja on TikTokFollow Dr. Sanjay Juneja on YouTubeCheck out Dr. Juneja's Podcast

From a government shutdown halting FDA approvals to the looming expiration of ACA subsidies threatening to raise insurance premiums for millions, the American healthcare system is facing a perfect storm. These mounting US healthcare policy challenges are creating unprecedented uncertainty for patients, providers, and innovators alike. In this episode, we're joined by healthcare regulation and policy expert Matt Wetzel, a partner at Goodwin Procter LLP, to dissect the interconnected crises plaguing Washington, D.C. and what they mean for the future of your healthcare.We connect the dots between the federal shutdown, expiring ACA enhanced premium tax credits, clandestine pharmacy benefit manager (PBM) practices, and Medicare's latest payment cuts. Why can't Washington compromise, and who is feeling the most pain? We explore the real-world consequences, including delays for companies seeking approvals for new drugs and devices, the degradation of hospital payer mix due to rising uninsured rates, and the political maneuvering that leaves everyday Americans caught in the middle. This discussion on US healthcare policy challenges uncovers the systemic dysfunctions, from legislative gridlock to the "wrecking ball" approach to policymaking that prioritizes disruption over stability.This episode provides a comprehensive breakdown of the most pressing issues in healthcare today. We uncover the truth behind Pharmacy Benefits Managers (PBMs) and the bipartisan push for PBM reform, exposing their fundamental conflicts of interest, the dirty tricks of "spread pricing" on generic drugs, and why their business model drives up costs for everyone. We also analyze the controversial Medicare efficiency adjustment included in the latest Medicare Physician Fee Schedule—a "lazy" blanket cut that penalizes specialists and creates further uncertainty in the medical technology market. If you want to understand the forces driving up your insurance costs and creating chaos in the US healthcare system, this is a must-watch conversation that unpacks the complex US healthcare policy challenges we all face.About Our Guest:Matt Wetzel is an attorney and Partner at Goodwin Procter LLP, based in Washington D.C. He is a leading expert in medical device and healthcare regulation, working with numerous biotech, medtech, and digital technology companies. As a seasoned health policy commentator, Matt provides deep insights into the administrative and regulatory hurdles impacting the healthcare industry, from the FDA and CMS to the NIH.Timestamps:(00:00) Introduction: A System in Crisis(01:55) The Government Shutdown's Widespread Impact on Healthcare(05:05) How the Shutdown Halts FDA Approvals for New Drugs & Devices(09:25) The Crushing Weight of Uncertainty on the Healthcare Business Community(11:34) The Looming Expiration of ACA Enhanced Premium Tax Credits(14:28) Why Can't Congress Agree on Extending ACA Subsidies?(20:09) The Hidden Bureaucracy Driving Up Health Insurance Costs(26:15) Decoding PBM Reform: Conflicts of Interest and Hidden Costs(33:24) The PBM Conflict of Interest: Serving Two Masters(37:50) PBM Trick Explained: What is "Spread Pricing"?(41:00) The "Halloween Surprise": Unpacking the Medicare Efficiency Adjustment(49:09) What's Next? Biotech, National Security, and Future Healthcare LegislationLearn More From Our Guest / Episode Resources:Learn more about Matt Wetzel's work at Goodwin Procter LLP

One of America's largest pharmacy benefit managers (PBMs) just announced they'll stop taking rebates from drug manufacturers. The Senate's response? "Not impressed." Why? Because rebates are just one of five profit driving "tricks" PBMs use to quietly inflate your drug costs. In this episode, Dr. Anthony Paravati breaks down the real money flow behind prescription drug pricing, how a system designed to reduce costs does the exact opposite You'll learn: The 7-player money map that explains where every healthcare dollar really goes The 5 PBM "tricks" that turn generics into goldmines How "spread pricing" means employers (and ultimately you) pay huge markups on actual drug cost Why regulatory capture keeps this system legal And why this reform moment in Washington matters right now If you're an employer, benefits consultant, or policymaker, this episode will change how you see pharmacy costs forever. If you're a patient, you'll finally understand why your prescriptions keep getting more expensive. Because every dollar diverted to middlemen is a dollar not going to care, wages, or innovation. 🎧 Listen now to understand the role PBMs have played to drive annual healthcare spend in the US to a ridiculous $4 trillion.

The 340B drug pricing program was created to help safety-net hospitals and clinics stretch their resources to care for low-income and uninsured patients. But has it spiraled out of control? Originally a modest plan, the program has exploded into a $130 billion market, leading to a fierce debate over who truly benefits from the massive discounts. Is it the patients, as intended, or are for-profit corporations, PBMs, and large hospital systems capturing the profits? In this episode, we unpack the controversy and explore the future of 340B. Joined by two of the nation's leading experts on the topic, we dissect the complex mechanics of the 340B drug pricing program and the powerful financial incentives that drive it. We explore how the program has grown exponentially, fueled by rising drug costs and the explosion of 340B contract pharmacies. This discussion sheds light on the central question: who benefits from the 340B program? Our guests break down how pharmacy benefit managers (PBMs) and major chains like CVS and Walgreens have become major players, diverting funds that were meant for patient care. We provide a clear, step-by-step example of how the money flows for a single prescription, revealing the winners and losers in this system. A significant focus of our conversation is on 340B in oncology, where high-cost drugs create enormous financial spreads for participating hospitals, often without any direct savings for the cancer patient. This raises critical questions about whether the program encourages the use of more expensive drugs and consolidates cancer care into large hospital systems. We also dive deep into the push for 340B program reform, covering the recent Senate hearings, the legal battles over state laws restricting manufacturers, and the debate over moving oversight from HRSA to CMS. We analyze proposals like a rebate model and increased transparency requirements to understand what the future may hold for this vital, yet deeply flawed, healthcare program. About Our Guests: Ted Okon: As the Executive Director of the Community Oncology Alliance (COA), Ted Okon is a nationally recognized voice on the policy and politics of cancer care. He is a frequent presence on Capitol Hill, advocating on critical issues like drug costs, Medicare reimbursement, and the changing economics of oncology. Amanda Smith: Amanda is Counsel at K&L Gates in their healthcare and FDA practice, with a specialized focus on the federal 340B drug pricing program. She advises clients on complex regulatory, legislative, and litigation matters related to the program and previously served as a healthcare law clerk for the U.S. Senate Committee on Finance. Timestamps / Chapters: (00:20) Understanding the 340B Drug Pricing Program (07:24) How the 340B Program Really Works (09:29) Who Truly Benefits from 340B Discounts? (12:03) The Financial Impact: How 340B Influences Drug Prices (16:33) Navigating the Regulatory Landscape: HRSA's Role and Limitations (22:03) The Rise of 340B Contract Pharmacies & PBM Influence (25:26) The Legal Battleground: State Laws and Lawsuits (30:21) FOLLOW THE MONEY: A $10,000 Drug Example (36:11) Hospital Eligibility and the Lack of Transparency (44:26) The Future of 340B Program Reform: Rebates, CMS Oversight & More (59:45) PREDICTIONS: What Will 340B Look Like in 2 Years? Learn More From Our Guests / Episode Resources: Learn more about the Community Oncology Alliance (COA) Learn more about K&L Gates' Healthcare Practice Subscribe to our channel Follow us on TikTok Follow us on LinkedIn

How do we deliver high-quality cancer care in a system under pressure? Meagan O'Neill, Executive Director of the Association of Cancer Care Centers (ACCC), joins us to talk about workforce empowerment, technology as a multiplier, and building sustainable oncology systems for the future. Meagan shares her journey from oncology business consulting to national advocacy, shaped by her own personal experience with cancer care. With two-thirds of U.S. cancer programs in its network, ACCC plays a pivotal role in driving change across the oncology landscape. In this episode, we discuss: Why personal experience can reshape how we design cancer care Strategies to address workforce shortages through empowerment Using technology to amplify—not replace—clinical teams Building upstream cancer care capacity to improve community health Making value-based care real in oncology practices Interoperability and integrated models for better patient outcomes The role of diversity in improving adherence and patient engagement Key Takeaways Workforce empowerment is essential to meet rising patient needs. Technology should act as a force multiplier for clinicians. Patient-centered care must be prioritized at every level. Interoperability and upstream investment are critical for sustainable oncology systems. About the Guest Meagan O'Neill is the Executive Director of ACCC, which represents more than two-thirds of U.S. cancer programs. She previously worked in oncology business consulting and brings both professional and personal perspectives to driving systemic change in cancer care. Chapters 00:00 – Introduction to ACCC and Meagan O'Neill 04:58 – A Personal Cancer Journey 12:11 – Workforce Empowerment in Oncology 20:19 – Building Capacity in Cancer Care 25:25 – Patient-Centered Care 26:12 – Data-Driven Approaches 28:10 – Expanding Capacity with Nursing and APPs 30:37 – Leveraging Technology 34:36 – Navigating Claims and Denials 37:18 – Interoperability and Integrated Care 39:02 – Tailoring Oncology Models 43:09 – Telehealth and E-Consults 45:39 – Designing Future Oncology Care 51:35 – Reflections on ACCC's 50th Anniversary Keywords ACCC, cancer care, oncology, workforce empowerment, technology in healthcare, patient experience, healthcare systems, cancer treatment, healthcare innovation, patient-centered care, value-based care, interoperability, nursing, APPs, telehealth

Dr. Bobby Mukkamala, President of the American Medical Association and practicing ENT surgeon in Flint, Michigan, joins Value Health Voices to discuss the critical challenges facing American healthcare from both the physician and patient perspective. As a solo practice physician treating cancer patients while leading the nation's largest physician organization, Dr. Mukkamala provides unique insights into the policy battles affecting healthcare delivery. The conversation covers prior authorization barriers that delay cancer care, the Medicare payment crisis with 25 years of declining physician reimbursement, and the collapse of independent medical practices due to site neutrality issues. Dr. Mukkamala also addresses Medicare Advantage's aggressive denial tactics, the physician workforce shortage, and dangerous trends toward independent nurse practitioner practice without physician oversight. The discussion includes the AMA's role in CPT coding and RUC valuation, as well as Dr. Mukkamala's personal cancer journey and its impact on his advocacy for NIH research funding. This episode reveals how physician advocacy organizations fight for both healthcare providers and patients as the system faces mounting pressures. Dr. Mukkamala's dual perspective as practicing physician and cancer patient offers invaluable insights into what's really happening in American healthcare. About the Guest: Dr. Bobby Mukkamala is President of the American Medical Association, a practicing otolaryngologist in Flint, Michigan, and graduate of University of Michigan Medical School. He previously served on the AMA Council on Science and Public Health while maintaining his solo practice. Value Health Voices makes healthcare policy and finance accessible through engaging discussions with industry leaders, policymakers, and practitioners working to transform care delivery.

The presidents of ASTRO and ACRO provide focused analysis of CMS's 2026 proposed rules and their specific implications for radiation oncology practice. This executive briefing examines key policy changes without background context, concentrating on immediate implementation concerns and the September 12 comment period. Key Topics Covered: Critical APC "crosswalk" methodology issues affecting new treatment delivery codes CMS's new "efficiency adjustment" reducing procedural service payments by 2.5% Transition from survey-based valuations to hospital cost data methodology Image guidance and port film bundling into treatment delivery codes Surface radiation therapy coding updates and valuation changes RUC committee dynamics and specialty representation challenges Strategic considerations for the comment period ending September 12, 2025 Technical Analysis: Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) and Drs Paravati and Rewari explain how CMS may have assigned new radiation therapy codes to incorrect ambulatory payment classifications. The analysis suggests CMS deleted separate IMRT codes but may not have recognized that IMRT services are now bundled into new level 2 and level 3 treatment codes, potentially resulting in significant undervaluation. Policy Context: The discussion examines how radiation oncology's 21% decline in relative value over 20 years, combined with these proposed changes, affects practice sustainability. Freestanding centers face particular challenges with a 32% reimbursement reduction since 2015. About Our Guests: Dr. Sameer Keole serves as President of ASTRO and practices radiation oncology in Arizona. Dr. Brian Lally is President of ACRO and practices at an academic center in South Carolina. Both provide extensive expertise in healthcare policy and specialty society leadership. This focused analysis provides healthcare leaders with essential technical information for participating in the rulemaking process. Note: This is a condensed version of our full Episode 18 analysis, focusing specifically on radiation oncology implications. Subscribe & Connect: Follow Value Health Voices Podcast for healthcare policy analysis. Find us on YouTube, LinkedIn, and all major podcast platforms. Episode Tags: Medicare physician fee schedule, HOPPS, radiation oncology, ASTRO, ACRO, APC crosswalk, efficiency adjustment, CMS proposed rule, treatment delivery codes, comment period, healthcare policy analysis, specialty medicine, supercut

The presidents of ASTRO and ACRO join the VHV guys to provide expert analysis of CMS's newly released 2026 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) proposed rules. Dr. Sameer Keole (ASTRO President) and Dr. Brian Lally (ACRO President) join us one week after the July 2025 release to examine the implications for radiation oncology and procedural specialties. Key Topics Covered: CMS's new "efficiency adjustment"—a 2.5% reduction to work RVUs for procedural services New treatment delivery codes and potential APC "crosswalk" issues in radiation oncology Budget neutrality's role in specialty medicine reimbursement competition The shift from survey-based valuations to hospital cost data methodology Practice expense changes affecting technical component payments RUC committee dynamics and specialty representation challenges 34-year evolution of the RVU system and its impact on different specialties Critical Policy Analysis: The episode examines how CMS assigned new radiation therapy codes to ambulatory payment classifications, potentially using incorrect methodologies that may not account for IMRT services bundled into new level 2 and level 3 codes. Our expert guests explain why radiation oncology has experienced a 21% decline in relative value over two decades while primary care increased 38%. About Our Guests: Dr. Sameer Keole serves as President of the American Society for Radiation Oncology (ASTRO) and is a practicing radiation oncologist in Arizona. Dr. Brian Lally is President of the American College of Radiation Oncology (ACRO) and practices at an academic center in South Carolina. Both bring extensive experience in healthcare policy and specialty society leadership. This executive briefing provides physicians and healthcare leaders essential context for the 60-day comment period ending September 12, 2025, and explores strategies for effective advocacy during the rulemaking process. Subscribe & Connect: Follow Value Health Voices for comprehensive healthcare policy analysis. Find us on YouTube, LinkedIn, and all major podcast platforms. Episode Tags: Medicare physician fee schedule, MPFS, HOPPS, efficiency adjustment, radiation oncology, ASTRO, ACRO, CMS proposed rule, RUC committee, budget neutrality, APC methodology, conversion factor, practice expense, healthcare policy analysis, specialty medicine, procedural services

Alice Ayres, President and CEO of the Association for Healthcare Philanthropy, reveals the critical funding lifeline that most people don't know exists. As Congress slashes healthcare budgets and millions face losing Medicaid coverage, Alice exposes how healthcare philanthropy returns $4.16 for every dollar invested and why it's becoming the difference between hospitals thriving and closing their doors. This powerhouse leader, former Advisory Board Company executive who worked with 4,500+ healthcare organizations and 200,000+ leaders, breaks down the urgent shift happening in healthcare funding. With 10,000 baby boomers daily moving from private insurance to Medicare, operating margins are shrinking fast. Key Topics Covered: Why "grateful patient" programs heal faster than traditional medicine How behavioral health donations surged 500% since COVID Why 100% leadership giving is non-negotiable for foundation success How AI is revolutionizing donor identification while respecting patient privacy Mobile clinics funded by donors serving vulnerable populations Alice's game-changing advice: "No doctor should ever ask for money—but opening gratitude conversations makes patients heal faster" From her 20+ years leading healthcare transformation to guiding foundations that collectively raise $11 billion annually, Alice provides the roadmap hospitals need as federal funding disappears. About Our Guest: Alice Ayres has served as President and CEO of AHP since 2018, recognized as one of Non-Profit Times Power and Influence Top 50 in 2024. She previously led strategic marketing for The Advisory Board Company, creating strategy sessions for 150+ leading healthcare providers worldwide. She holds an MBA from Northwestern Kellogg and brings deep healthcare industry knowledge to philanthropy leadership. Subscribe & Connect: Follow Value Health Voices for insider healthcare finance strategies. Find us on YouTube, LinkedIn, and all major podcast platforms. Episode Tags: healthcare philanthropy, hospital funding, grateful patient programs, healthcare finance, Alice Ayres, AHP, medical fundraising, healthcare donations, Medicaid cuts, hospital charity care, healthcare leadership, nonprofit management

Dr. Eric Bricker returns for Part 2 of our analysis of the "One Big Beautiful Bill" and the timing couldn't be more critical. Just as the Senate moves toward a final vote, the nonpartisan Congressional Budget Office reported Sunday (6/29/25) that the Senate version would add at least $3.3 trillion to the national debt over the next decade. This internal medicine physician and founder of AHealthcareZ (400+ healthcare finance videos, 100,000+ subscribers) delivers his signature straight-talk analysis on what will be the most earth-shattering healthcare legislation in decades. Dr. Bricker exposes how this bill would strip Medicaid coverage from 11-16 million Americans while dismantling the state funding mechanisms that keep safety-net hospitals alive. Dr. Bricker and the VHV guys discuss: How "provider tax safe harbors" being cut from 6% to 3% will trigger massive prior authorization increases Why hospital systems will face a "double squeeze": less Medicaid revenue AND higher debt refinancing costs The brutal politics behind using patient care as a "political pawn" to fund tax cuts How charity care programs could become the only lifeline for millions of Americans Why even Republican senators are questioning these Medicaid cuts Dr. Bricker's urgent message to physicians: "The age of passivity is over. No one is coming to save you or your patients." He provides concrete actions healthcare professionals can take locally while this legislative earthquake unfolds in Washington. From work requirements that target caregivers to state-directed payment caps that will bankrupt safety-net hospitals, this episode breaks down thousands of legislative pages into what every healthcare leader needs to know before the Senate votes. Subscribe to Value Health Voices for critical healthcare policy analysis. Check out Dr. Bricker's AHealthcareZ YouTube channel for his complete healthcare finance education library. Chapters: 00:00 The $3.3 Trillion Healthcare Bill: An Overview 02:05 GOP Budget Reconciliation Bill: Key Healthcare Proposals 03:45 The Human Cost: Real Stories from Safety-Net Hospitals 07:23 Work Requirements: Who Really Gets Hurt 10:53 The Great Medicaid Funding Squeeze: Provider Taxes Under Attack 18:03 State-Directed Payments: The End of Hospital "Scavenger Hunts" 23:33 Political Power and Healthcare: The Real Game Being Played 29:02 The Double Squeeze: Medicaid Cuts + Rising Interest Rates 31:35 Taking Action: What Physicians Can Do Right Now 37:27 Hospital Innovation: Learning from Ochsner's Success Model 44:49 The Future of Healthcare Finance: Reasons for Optimism Keywords: #Medicaidcuts, #budgetreconcilation #Senatebill, #CongressionalBudgetOffice #Medicaid #providertaxes #statedirectedpayments #workrequirements, #safetynethospitals healthcare finance #DrEricBricker #AHealthcareZ

Dr. Eric Bricker, the powerhouse behind AHealthcareZ's 400+ healthcare finance videos with 100,000+ subscribers, joins Value Health Voices to decode the labyrinthine money flows that determine which hospitals succeed with Medicaid—and which avoid it entirely. This internal medicine physician and former co-founder of Compass Professional Health Services (which grew to 1.8M members across 2,000+ clients including T-Mobile and Southwest Airlines before being acquired) reveals the complex "scavenger hunt" that separates thriving hospital systems from struggling ones. Discover why Medicaid isn't actually one program but 50+ different state systems with wildly different funding mechanisms. Dr. Bricker exposes how provider taxes, DSH payments, and state-directed payments create a $80 billion federal funding ecosystem—and why only sophisticated hospital systems with armies of consultants can navigate it successfully. You'll learn why California gets 50% federal matching while Mississippi receives 77%, how children's hospitals depend on Medicaid for half their revenue, and why some suburban systems can ignore Medicaid entirely while urban academic centers live or die by these payments. Known for his viral whiteboard videos that deconstruct the US healthcare system, Dr. Bricker delivers essential insights every healthcare leader needs to understand the financial forces reshaping American healthcare. This eye-opening conversation explains why administrative complexity has become a competitive advantage—and what it means for patient care. Subscribe to Value Health Voices for expert healthcare policy analysis. Check out Dr. Bricker's AHealthcareZ YouTube channel for his complete healthcare finance library. Chapters: 00:00 Understanding Medicaid: A Complex Landscape 02:12 The Mechanics of Medicaid Funding 05:41 Provider Taxes and Their Impact 10:01 Disproportionate Share Hospital Payments 17:22 State-Directed Payments: Variability and Controversy 20:16 Expansion vs. Non-Expansion States 24:22 The Role of Managed Care Organizations 28:40 Challenges in Accessing Care for Medicaid Patients 32:35 Understanding the Complexities of Healthcare Funding 36:56 The Scavenger Hunt for Revenue in Healthcare 39:48 The Friction in Healthcare Administration Keywords: Medicaid, healthcare finance, health policy, state funding, provider taxes, DSH payments, state-directed payments, expansion states, healthcare access, revenue generation

RECORDED BEFORE THE HOUSE RECONCILIATION BILL PASSED - Tricia Neuman of KFF's predictions proved accurate THE REALITY: 55% of Medicare beneficiaries are now in private Medicare Advantage plans, yet Medicare pays $83 BILLION more annually for these enrollees than similar patients in traditional Medicare. That's more than what Medicare spends on ALL physician payments combined. In this prescient conversation with KFF's Tricia Neuman, we explore the hard truths about Medicare's trajectory. Takeaways: ✅ Hundreds of billions in Medicaid cuts moving through reconciliation - PASSED by House May 22nd ✅ Traditional Medicare becoming the "forgotten stepsister" ✅ Medicare's path toward privatization accelerating ✅ Critical support programs being slashed as complexity increases WHY THIS EPISODE MATTERS NOW: This isn't theoretical policy discussion. It's the unfiltered analysis from one of America's most trusted Medicare experts. Hear the roadmap that's now moving through Congress. KEY INSIGHTS: How Medicare Advantage marketing hides real trade-offs Why traditional Medicare lacks basic consumer protections (like out-of-pocket limits) The hidden costs of Medicare privatization for hospitals, physicians, and patients How Social Security office cuts will leave seniors stranded What the future holds for 68 million Medicare beneficiaries GUEST: Tricia Neuman, Senior VP at KFF & Executive Director of Medicare Policy Program. Trusted expert who has testified before Congress and provides nonpartisan analysis relied upon by policymakers nationwide. HOSTS: Drs. Anthony Paravati & Amar Rewari bring physician and healthcare executive perspectives to policy discussions that matter. RECORDED: May 7, 2025 (Days before House passage of reconciliation bill) 🎧 SUBSCRIBE for healthcare policy insights that help you understand what's really happening in American healthcare Chapters 00:00 Introduction to Medicare Concerns 02:53 The Role of KFF in Medicare Policy 07:59 Current State of Medicare and Medicare Advantage 11:19 Challenges Facing Traditional Medicare 14:54 The Impact of Social Security on Medicare 17:48 Redesigning Medicare Advantage 20:18 Consumer Protections and Future of Medicare 22:07 Drug Pricing and Medicare Part D 26:56 Medicaid Cuts and Political Dynamics 34:44 Impact of Federal Cuts on State Programs 42:54 The Future of Long-Term Care Services 46:10 Engaging Clinicians in Medicare Reform #Medicare #MedicareAdvantage #HealthPolicy #Medicaid #Healthcare #KFF #PolicyAnalysis #ValueHealthVoices

Michael Chernew is a distinguished Harvard economist, Chair of MedPAC, and leading healthcare policy expert with decades of experience in healthcare economics. In this episode, Michael provides a masterclass on why healthcare economics differs fundamentally from other markets, unpacking information asymmetry, moral hazard, and adverse selection in accessible terms. He reveals the surprising truth that Medicare Advantage plans cost the government approximately 20% more than traditional Medicare despite delivering care more efficiently, explains how these plans use this payment gap to finance enhanced benefits, and discusses the future challenges of healthcare payment reform. Michael shares breaking news about MedPAC's upcoming recommendation to partially tie physician payments to inflation after decades of declining purchasing power, explores the complexities of drug price negotiations, and offers insider insights into how Medicare policy decisions affecting billions of healthcare dollars are actually made. Chapters 00:00 Introduction to Healthcare Economics and MedPAC 02:56 The Evolution of Health Economics 06:05 Unique Challenges in Healthcare Markets 09:11 Moral Hazard and Insurance Dynamics 12:10 The Role of Technology in Rising Costs 15:10 Understanding MedPAC's Function and Influence 18:01 MedPAC Recommendations and Their Impact 22:16 The Complexity of Medicare Payment Systems 25:07 Challenges in Hospital Profitability 28:20 The Future of Payment Models in Healthcare 38:16 Geographic Variation in Medical Practice 39:15 Alternative Payment Models and Pricing Issues 46:53 The Rise of Medicare Advantage 55:20 Future of Medicare and Healthcare Reform About: Value Health Voices is a podcast redefining conversations around health policy and healthcare finance, delivering accessible and expert-driven discussions on the topics shaping the future of healthcare. Hosted by Dr. Anthony Paravati and Dr. Amar Rewari, the podcast explores how regulations, emerging technologies, and financial pressures impact patient care, provider operations, and healthcare systems. With their combined experience as radiation oncologists and healthcare leaders, they break down complex topics like Medicare reimbursement, artificial intelligence in healthcare, and prior authorization in ways that are actionable and engaging. Each episode features insights on legislative efforts, best practices for providers navigating policy changes, and trends shaping the future of value-based care, empowering listeners with knowledge they can use immediately. Connect with Value Health Voices on: Apple Podcasts: https://tinyurl.com/VHV-apple Spotify: https://tinyurl.com/VHV-Spotify Amazon music: https://tinyurl.com/VHV-amazon LinkedIn: https://tinyurl.com/VHV-Linkedin

Even seasoned healthcare leaders—those with decades of clinical, financial, or operational experience—often miss the two most powerful levers behind how care gets paid for: the CPT process and the RUC committee. These aren't just billing codes and obscure meetings. They're the gatekeepers of what and how much is paid for care in the U.S. healthcare system. To truly understand healthcare in the U.S., an understanding of CPT and RUC is fundamental. EPISODE SUMMARY: A Rare Insider's View on the Hidden Machinery of U.S. Healthcare Payment In this special episode of Value Health Voices, we flip the script—Dr Anthony Paravati interviews co-host Amar Rewari, a nationally recognized expert in the CPT development process and the RUC (Relative Value Scale Update Committee). This is your backstage pass to the invisible forces that decide how doctors are paid, which services get valued, and why the U.S. healthcare system rewards what it does. In this episode, we unpack: What the CPT process really is—far beyond billing codes How the RUC committee wields extraordinary influence over payment policy The lifecycle of a medical service's valuation—from clinical utility to reimbursement How these processes directly affect hospital strategy, service line planning, and physician compensation CONTROVERSIES EXPOSED: Where the System Breaks Down No deep dive into CPT and RUC is complete without exploring the critiques—many of which are long-standing and still unresolved: Specialty Bias: Procedural specialties often dominate the RUC, leading to higher valuations for procedures and lower ones for cognitive services like primary care. Lack of Transparency: Decision-making behind closed doors fuels frustration and distrust, especially among non-physician stakeholders. Inertia and Inequity: Efforts to revalue services often move at a glacial pace, creating systemic lag between innovation and payment. We challenge assumptions, unpack the politics, and explore what meaningful reform could look like. WHY THIS MATTERS: Essential Listening for Every Healthcare Leader Whether you're a hospital executive, a health policy analyst, a medical director, or a clinician trying to understand your paycheck, this episode gives you what textbooks and boardrooms don't: a clear, actionable understanding of the CPT and RUC systems and how they quietly influence everything from your budget to your workforce strategy. You'll walk away with: A framework to think critically about reimbursement strategy Insight into why your specialty is—or isn't—being adequately valued Clarity on how to engage with these systems to advocate for fairer healthcare Keywords: CPT process, RUC committee, physician reimbursement, healthcare payment reform, US healthcare finance, healthcare policy podcast, Medicare valuation, specialty society lobbying

In this episode of Value Health Voices, Dr. Vipan Nikore discusses his journey as an entrepreneur in the healthcare sector, focusing on the innovative concept of Home Care Hub. He shares insights on the challenges and opportunities in home-based care, the importance of metrics in measuring outcomes, and the regulatory hurdles faced in the industry. Dr. Nikore emphasizes the need for policy changes to support alternative care models and advocates for a future where smaller care homes provide dignified and personalized care for the aging population. He also offers advice for aspiring healthcare entrepreneurs, highlighting the importance of mentorship and networking.takeawaysDr. Nikore's journey from software development to healthcare entrepreneurship.The importance of home-based care in improving patient outcomes.Home Care Hub aims to create smaller, community-based care homes.Metrics such as decreased readmissions are crucial for success.Regulatory challenges vary significantly across states and provinces.Advocacy for policy changes is essential for funding alternative care models.The future of healthcare will involve more personalized and accessible care options.Data collection from home care can drive better patient outcomes.Entrepreneurship in healthcare requires resilience and adaptability.Mentorship and networking are key for aspiring healthcare entrepreneurs.Chapters00:00 Introduction to Home-Based Care Innovations 01:39 The Journey of Dr. Vipan Nikore 10:15 Exploring Home Care Hub 17:13 Metrics and Outcomes in Home Care 20:29 Navigating Regulatory Challenges 22:34 Navigating Regulatory Challenges in Healthcare Innovation 23:49 Advocating for Alternative Care Models 25:05 The Importance of Personalized Care 26:20 Addressing Loneliness and Social Isolation 27:42 Leveraging Technology in Home Care 29:39 Policy Advocacy for Healthcare Solutions 32:18 The Role of Data in Improving Outcomes 33:03 Envisioning the Future of Home Healthcare 36:12 The Entrepreneurial Journey in Healthcare 39:16 Advice for Aspiring Healthcare Entrepreneurs

As the cost of healthcare continues to rise, more employers are turning to direct employer contracting and self-insured models to take control of their healthcare costs. But how do these models compare to fully insured arrangements? And what are the key considerations for health systems, PBMs, and employers looking to engage in value-based care? In this episode of Value Health Voices, Dr. Anthony Paravati and Dr. Amar Rewari sit down with Ned Laubacher, CEO of Health Spectrum Advisors and an expert in direct-to-employer contracting, to break down: ✅ The shift toward self-insured models and employer-driven health benefits ✅ The role of quality metrics and shared savings in employer-provider contracts ✅ How data transparency is transforming healthcare finance and cost control ✅ The impact of legislation on employer health plans ✅ Common pitfalls in direct contracting and how to avoid them 💡 Key Takeaways: 🔹 Self-insured employers have more control over healthcare costs and provider networks 🔹 Direct contracts with health systems help improve cost transparency and health outcomes 🔹 Employers must take a proactive role in healthcare policy to navigate complex regulations 🔹 PBMs and cost-plus drug models are playing an increasing role in employer-led health plans 🔹 Analytics & data-driven decision-making are the future of value-based care

In this episode of Value Health Voices, hosts Anthony Paravati and Amar Rewari welcome Matt Wetzel, a trustee at the American Health Law Institute, to discuss the complex regulatory environment surrounding healthcare. The conversation covers insights from the JPMorgan Healthcare Conference, changes in NIH grant funding, Medicaid spending, and the future of FDA regulations. Wetzel emphasizes the importance of understanding the nuances of healthcare policy and encourages listeners to look beyond sensational headlines to grasp the underlying issues affecting the industry. Takeaways Matt Wetzel is a lawyer specializing in medical technology and life sciences. The JPMorgan Healthcare Conference is a key networking event in the industry. The Trump administration is focused on efficiency in healthcare regulation. NIH has implemented a cap on indirect costs for grants. There is a debate within the industry about the appropriateness of indirect cost caps. Medicaid spending is a politically sensitive issue that may face cuts. The FDA's regulatory environment is evolving, with potential for increased efficiency. Personnel changes in government can significantly impact healthcare policy. The media often sensationalizes healthcare regulatory changes. Understanding the details of regulations is crucial for stakeholders. Chapters 00:00 Introduction to the Regulatory Landscape 04:53 Insights from the JPMorgan Healthcare Conference 10:16 Changes in NIH Grant Funding 20:33 Medicaid Spending and Work Requirements 24:03 Understanding Federal Health Programs 28:24 Navigating Regulatory Challenges 32:47 The Strategic Landscape of Healthcare Policy 38:23 The Future of Leadership in Healthcare 42:59 Key Takeaways for Navigating Change

In episode 8 Dr. Anthony Paravati and Dr. Amar Rewari explore the concept of "site neutrality" in U.S. healthcare finance, discussing the disparities in reimbursement rates for the same medical services based on the location of care. They delve into the legislative efforts aimed at achieving site neutrality, the implications for healthcare providers and patients, and the unique healthcare model in Maryland. The conversation highlights the complexities of payment systems in American healthcare and the ongoing challenges in maintaining critical infrastructure. Chapters 00:00 Introduction to Site Neutrality in Healthcare 02:10 Understanding Payment Differentials 04:54 Legislative Efforts Towards Site Neutrality 07:00 Impact of Site Neutral Payments on Healthcare Providers 09:52 Patient Perspectives and Financial Implications 12:24 Regional Variations in Healthcare Payment Models 14:55 The Maryland Healthcare System: A Unique Case 17:02 Conclusion and Future Directions

In this episode, Dr. Anthony Paravati and Dr. Amar Rewari discuss the aggressive expansion of private equity (PE) in the U.S. healthcare system, highlighting its detrimental effects on quality care and patient safety. They explore how PE firms prioritize profits over patient care, leading to significant financial burdens on healthcare facilities. Through various case studies, they illustrate the negative consequences of PE ownership, including hospital closures and reduced services. The conversation also addresses the regulatory gaps that allow PE firms to operate with minimal oversight, ultimately calling for action to protect healthcare quality.

We are back after the holiday break with Episode 6 which covers the rapidly evolving landscape of AI in healthcare. Is AI just another weapon for payers and providers to bludgeon each other or will it becpme a force for immeasurable public good? In this episode, Dr Anthony Paravati and Dr Amar Rewari discuss the transformative impact of AI in healthcare, exploring its potential to improve patient care, streamline insurance claims, and the ways it is used in clash between providers and insurers over the almighty dollar. They highlight success stories in cancer detection and stroke care, while also addressing the challenges and legal implications of AI in claims processing and denials. The conversation concludes with insights into future trends and the importance of ethical considerations in AI deployment.