Shows
Value Health VoicesEp 14: Medicare's Privatization Path & The $83 Billion Question with Tricia Neuman (KFF)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 sl...2025-05-2748 minValue Health VoicesEp 13. Why Healthcare Markets Fail: MedPAC Chair Michael Chernew on Medicare's Future & Payment ReformMichael 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...2025-05-0959 minValue Health VoicesEp 12. The most powerful committee in US healthcare that you've never heard ofEven 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 epi...2025-04-2535 minValue Health VoicesEp 11. • Reimagining Home-Based Care: Insights from Dr. Vipan NikoreIn 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...2025-04-0642 minValue Health VoicesEp 10. Navigating hospital/physician direct to employer contracting, truly value-based careAs 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 benefits2025-03-1452 minValue Health VoicesEp 9. Attorney and healthcare regulatory insider Matt Wetzel joins the podcastIn 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....2025-02-2845 minValue Health VoicesEp. 8 Site neutrality, whatever happened there? 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 Pay...2025-02-1821 minValue Health VoicesEp 7. The scourge of private equity ownership of hospitals (and physician practices)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. 2025-02-0430 minValue Health VoicesEp 6. AI in healthcare: payer/provider battleground or force for good?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 a...2025-01-1032 minValue Health VoicesEp 5. Demystifying Medicare's Annual Payment Cuts: The Budget Rules That Force December DramaEvery November, Medicare proposes physician pay cuts and every December, Congress tries to walk them back. But why? Dr Anthony Paravati and Dr Amar Rewari break down the hidden budget rules forcing specialties to fight over a fixed pie, why the much-celebrated MACRA law of 2015 did nothing to fix it, and how successful health systems are adapting their strategy. This episode is short and sweet but there’s something for everyone. From basic, but often flubbed, must-know facts about the Medicare program to critical insights into payer contracting and service line decisions. Knowledge is power - especially when billions are...2024-12-1226 min
Value Health VoicesEp 4. RFK Jr.: The Good, The Bad, and the UglyIn this episode, Drs. Amar Rewari and Anthony Paravati discuss the nomination of RFK Jr. as the head of the Department of Health and Human Services. They explore his controversial views on vaccines, public health implications, agricultural policies, and the pharmaceutical industry. The conversation delves into the complexities of chronic disease management, the debate over fluoride in water, and the potential impacts of RFK Jr.'s policies on public trust in science and health. Chapters 00:00 Introduction 03:24 Early Career and Background on RFK Jr. 04:23 Vaccine Controversies and Scientific Denialism 14:36 Agricultural Policies, Raw milk a...2024-11-2739 min
Value Health VoicesEp 3. The Games Insurers Play: Utilization Management and Prior AuthorizationIn this week’s episode of the VHV podcast we’ll take a comprehensive look at utilization management (UM) and prior authorization (PA). Utilization management is the healthcare industry term for the various techniques health insurance companies employ to pay for care on their terms, according to their guidelines. Many times, their utilization management approach is in line with what physicians recommend. However, many times it is not. And when it’s not, patients suffer delays in their care and physicians and their staff end up mired in extra work to make sure their patients get the care they have de...2024-11-1045 min
Value Health VoicesElection 2024: Trump vs. Harris: How Their Healthcare Policies Could Reshape the United StatesIn this timely episode, Dr. Anthony Paravati and Dr. Amar Rewari break down the healthcare implications of a Trump or Harris presidency. From prescription drug pricing and Medicare reforms to Medicaid block grants and the Affordable Care Act, this episode provides a nonpartisan, in-depth analysis of each candidate's position on healthcare. Discover what the future could hold for U.S. healthcare policies, costs, and patient access depending on the election's outcome. This is a can't miss episode before heading to the polls.2024-11-0130 min
Value Health VoicesEp 1. Medicare (dis)Advantage. Does it suck? It depends.Drs. Anthony Paravati and Amar Rewari delve into the complexities of Medicare Advantage, exploring its appeal to seniors, the financial mechanisms behind its low premiums, and the challenges faced by providers. They discuss the demographics of Medicare Advantage enrollees, the revenue structures that sustain these plans, and the implications for healthcare providers. The conversation also highlights the pros and cons of Medicare Advantage for beneficiaries and speculates on the future sustainability of the program amidst tightening margins and regulatory pressures.takeaways Medicare Advantage offers lower premiums, appealing to budget-conscious seniors. The program is administered by commercial insurance companies...2024-10-1732 min
Value Health VoicesEp. 1: Explaining the basics of Medicare and Medicare AdvantageIn this VHH fundamentals episode, we provide a primer on the basics of Traditional Medicare (Parts A, B, and D) and Medicare Advantage (Part C) for physicians and healthcare leaders. We explore key differences in out-of-pocket costs, premiums, and coverage between the two, preparing you for a deeper dive into health policy and healthcare finance on our full podcast episode. Whether you're leading a practice or guiding patient care, understanding the fundamentals of Medicare is essential for navigating today's healthcare landscape. Don't miss this overview to better support your patients and organization! #MedicarePrimer #HealthcareLeaders #MedicareAdvantage #HealthPolicy #HealthcareFinance2024-10-1714 min