Healthcare is Hard: A Podcast for Insiders

Seth Hain, Senior VP of Research and Development at Epic with over two decades in the industry, discusses the transformative role of generative AI in healthcare. He describes how new tools are creating an ‘agentic’ era in which software anticipates clinician needs. Hain shares insights from Epic’s ambitious Cosmos project, a dataset aimed at integrating real-world evidence into clinical practice. He also envisions a connected health grid that minimizes delays and enhances collaboration, ultimately improving patient outcomes.

Brian D. Pieninck didn’t take a conventional path to healthcare leadership. He started his career as an 18-year-old IT contractor and spent two decades working across the industry before becoming President and CEO of CareFirst Blue Cross Blue Shield. He now also serves as Chair of the Blue Cross Blue Shield Association, bringing both local and national perspective to the role. In this episode, Keith Figlioli speaks with Pieninck about what it means to lead a not-for-profit regional payer at a time of seismic change. With 3.6 million members and coverage that spans commercial, Medicare, and Medicaid, CareFirst has become a vital part of healthcare access and infrastructure across the Mid-Atlantic. Pieninck reflects how demographic shifts, rising costs, and policy uncertainty are challenging how healthcare organizations evolve, while staying focused on long-term outcomes.  Pieninck and Keith discuss: Advancing health equity as part of the community. Pieninck sees CareFirst not just as a payer, but as part of the region’s civic infrastructure, creating economic opportunities, delivering care through primary and urgent care locations, and supporting long-term health equity initiatives across Maryland, DC, and Northern Virginia. Medicaid coverage and its downstream impact. With nearly half of children in Maryland and DC relying on Medicaid, Pieninck warns that cuts or disruptions don’t reduce the need for care; they push it into higher-cost, less coordinated settings like emergency departments. The balloon effect in healthcare financing. As costs are squeezed in one area, they inflate in another. Pieninck challenges the idea that market forces can realign care efficiently. He discusses how efforts to contain spending in one area often lead to inefficiencies elsewhere, and the system ends up paying more later because early, lower-cost interventions are underfunded or inaccessible.  Innovation that simplifies the system. Through CareFirst’s innovation arm, Healthworx, Pieninick highlights the need to design a system that works for people by reducing complexity and embedding support directly into the healthcare experience. AI and infrastructure: opportunity meets readiness. With nearly three decades of experience on the technology side of healthcare, Pieninck is bullish on AI’s potential—especially now that it's available at a price point that can scale. Real progress, he notes, will depend on thoughtful governance, better interoperability, and models built around human needs. This episode offers a look at how one regional plan is thinking through the tensions between access, affordability and innovation, and what that means for the broader system.  To hear Brian D. Pieninck and Keith discuss these challenges in depth, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Kody Kinsley has been called many things—operator, innovator, Medicaid “nerd”—but above all, he’s a fierce advocate for the health and well-being of the populations Medicaid serves. Now a senior advisor at the Milken Institute and recently North Carolina’s Secretary of Health and Human Services, Kinsley joins Keith Figlioli for a wide-ranging conversation about how Medicaid works, why it matters, and where innovation is reshaping its future. A native of North Carolina, Kinsley brings personal experience and professional depth to his perspective. Growing up uninsured, he watched his mother navigate pediatric clinics, sliding-scale providers, and supply closets offering free samples to keep her kids healthy. That formative exposure ultimately propelled him into a career spanning healthcare operations, behavioral health, public policy, and government leadership. As North Carolina’s health secretary, Kinsley led one of the country’s largest and most complex human services agencies, overseeing everything from Medicaid operations and public health to psychiatric hospitals and child welfare. He played a central role in advancing Medicaid expansion in the state—an achievement shaped by bipartisan negotiation, careful balancing of federal and state resources, and a deep understanding of the healthcare landscape. In this episode, Kinsley and Keith cover: The structural realities behind state Medicaid programs. Kinsley describes how mega-agencies like North Carolina’s bring together financing, public health, regulation, and direct care delivery—touching millions of lives daily, often invisibly. Federal-state dynamics and looming policy shifts. From federal match rates to provider taxes and budget triggers, Kinsley explains the intricacies of how money moves between federal and state governments—and what’s at stake when Congress debates Medicaid cuts or structural reforms. The human cost behind budget debates. Behind every line item is a person: whether it’s dental coverage, hospice services, or in-home care, Kinsley argues that policymakers must weigh the downstream impacts of funding decisions on real lives and long-term system costs. Bright spots and innovation. Kinsley highlights North Carolina’s “Healthy Opportunities” pilot—one of the first initiatives nationally to use Medicaid dollars for non-medical needs like food, housing, and transportation. Early results show promise, including improved outcomes and significant cost savings, suggesting a roadmap for other states. Looking forward. While political winds may shift and financial pressures mount, Kinsley remains optimistic. He points to growing public support for Medicaid and hopes the nation can move beyond divisive debates over whether healthcare is a right or privilege—focusing instead on smarter, more sustainable ways to deliver care. To hear Kody Kinsley and Keith Figlioli unpack these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Dr. Ali Khan has spent his career at the intersection of medicine, public policy, and value-based care. He’s also been at the forefront of some of the country's most innovative care delivery models—from Iora Health and CareMore to Oak Street Health and now Aetna, where he serves as Chief Medical Officer of Medicare at Aetna, a CVS Health company. In this episode, Keith Figlioli sits down with Dr. Khan for a conversation about Medicare’s future—and what it will take to make the promise of better, more affordable healthcare a reality. A general internist by training, Dr. Khan’s path into healthcare began with a deep curiosity about the broader systems shaping people’s health. That curiosity took him from Harvard Kennedy School to the exam room to health plans and startups focused on reimagining the primary care experience for complex, underserved populations. Throughout his career, he’s gravitated toward organizations trying to solve public-sector problems with private-sector solutions—building care models that prioritize trust, access, and long-term outcomes. Now at the helm of a Medicare Advantage program serving 4.2 million members, Dr. Khan brings a unique vantage point. In this conversation, he shares hard-earned lessons on care model design, what payers and providers need from each other, and why Medicare is at an inflection point. He makes a compelling case for a renewed focus on the fundamentals—not just risk adjustment or benefit design, but operational follow-through, last-mile care coordination, and culturally grounded team-based models that scale. Dr. Khan and Keith discuss: Building care models that hold up under pressure. From Iora to Oak Street, Dr. Khan has seen firsthand that delivering better outcomes at scale requires more than mission—it takes structural rigor. He unpacks four key dimensions—cultural, clinical, operational, and technological—and explains why lasting impact depends on aligning all of them. Whether it's equipping care teams to deliver in complex communities or building systems that can flex and scale, success hinges on getting the foundation right. Why affordability isn’t enough—and where Medicare Advantage must go next. With over half of Medicare beneficiaries now enrolled in MA plans, Dr. Khan argues it’s time to move beyond the value prop of supplemental benefits and zero-dollar premiums. The next chapter is about proving clinical excellence at scale. That means prioritizing follow-through over features—removing last-mile barriers, improving care coordination, and designing experiences people actually trust.  From transactional to transformative: the evolving role of health plans. Plans have long relied on contractual structures to drive change, but Dr. Khan believes that era is fading. To deliver on the promise of value-based care, plans must shift from passive administrators to proactive partners—investing in infrastructure, surfacing actionable insights, and enabling providers to succeed across Medicare, Medicaid, and commercial populations alike. Where AI meets care delivery. Dr. Khan reflects on the potential of AI to reduce clinical variation, improve medication management, and drive better follow-up for patients—especially those with chronic conditions. But he cautions that technology alone won’t move the needle. To truly unlock AI’s value in Medicare, plans and providers must embed it within human-centered systems, coordinate care in real time, and ensure new tools support—not replace—the relationships that matter most. As Dr. Khan notes, we’re entering a “put up or shut up” era for Medicare Advantage, where scrutiny is high and proof points matter. Yet within that pressure lies opportunity—particularly for those willing to do the unglamorous work of identifying barriers, building connective tissue, and supporting clinical teams in the trenches.

The first two episodes in this Healthcare is Hard podcast series on “Opportunities in Oncology” explored the relationship between academic medical centers and community care, with guests Dr. Stephen Schleicher from Tennessee Oncology, and Dr. Harlan Levine from City of Hope. For the third and final episode in the series, Dr. Daphne Haas-Kogan joined Keith Figlioli for a conversation that dives more deeply into patient care, innovations in care delivery and the opportunities for entrepreneurs.Dr. Haas-Kogan is Chair of the Department of Radiation Oncology at Mass General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. She is also the Willem and Corrie Hees Family Professor of Radiation Oncology at Harvard Medical School.Dr. Haas-Kogan received her undergraduate degree in biochemistry and molecular biology from Harvard University and her medical degree at UCSF. She completed her residency in radiation oncology at UCSF in 1997 and became vice-chair for research at UCSF in 2003, and educational program director in 2008. Dr. Haas-Kogan’s laboratory research focuses on molecular underpinnings of brain tumors and pediatric cancers. She leads large multi-institutional initiatives funded by NIH/NCI, philanthropic organizations, and industry collaborators.For this episode of Healthcare is Hard, some of the topics Dr. Haas-Kogan discussed with Keith include:The collaborative approach to care. Dr. Haas-Kogan talked about how most people with cancer struggle with many other medical issues – some predating cancer diagnosis, some precipitated by the treatment itself – and how several care teams are required to treat the patient wholistically. She also discussed how important it is for academic medical centers and community hospitals to work together, the responsibilities each holds to the patient, and the goal of making sure patients receive the same exact care regardless of location.The precision of radiation oncology. There are generally three pillars of cancer treatment. The first is surgery to remove tumors, the second is medication to kill cancer cells with drugs, and the third is radiation therapy to destroy cancer cells. Dr. Haas-Kogan described how radiation oncology is, in many ways, a combination of surgical oncology and medical oncology. It requires the precision of surgery – especially when treating a tumor close to critical structures like the brain stem or spinal cord – but can also be applied in a single day or over the course of weeks, similar to medication. She discussed how this allows for unique collaboration between academic researchers and community physicians, along with opportunities for creative workforce solutions.AI in oncology. The impact artificial intelligence has already had on oncology would have been unimaginable five or 10 years ago, and Dr. Haas-Kogan says the opportunities for entrepreneurs in the space are huge. As an example of the impact AI has already made, she talked about how radiation oncologists traditionally spend hours defining exactly what they want treated and the dose of radiation required. But now, AI is doing most of that, saving physicians precious time. She talked about how medicine is an art and how treatment like this is very nuanced, so she very often makes changes after reviewing AI-generated recommendations. But she says advancements are coming quickly.To hear Dr. Haas-Kogan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Harlan Levine began his career practicing internal medicine but soon moved into business leadership roles at national healthcare organizations to help improve the dysfunction with payer-provider relationships that he experienced firsthand as a physician.At United Health Group, Dr. Levine joined as clinical lead of the team that launched Optum, where he subsequently served as chief medical officer for more than six years. He also led the health management practice at Towers Watson and served as executive vice president of comprehensive health solutions at WellPoint, among other roles.In 2013, Dr. Levine joined City of Hope, one of the country’s largest and most advanced cancer research and treatment organizations. City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas.In addition to currently serving as president of health innovation and policy at City of Hope, Dr. Levine is also chair of the board of AccessHope. A spinout from City of Hope, AccessHope partners with the nation’s most prestigious cancer research centers to help make leading-edge cancer care available to all, regardless of geographical location.Dr. Levine joined Keith Figlioli for the second episode of a Healthcare is Hard series exploring opportunities in oncology. Some of the topics they discussed include:Community practice vs. academic medical centers. Delivering personalized care and giving patients access to cutting-edge treatment is equally important, yet historically difficult to balance. In the first episode of this series, Dr. Stephen Schleicher from Tennessee Oncology shared how one of the nation’s most successful community oncology practices is tackling the challenge. In this episode, Dr. Levine discussed City of Hope’s model of putting academic research at the center and connecting it with community practices. He described how City of Hope is changing the direction of cancer care – not just delivering it – by giving patients faster access to emerging science.Defining value in oncology. Dr. Levine calls himself an outlier when it comes to value-based care in oncology because he thinks the industry missed a critical first step – defining what the term means. In most circumstances, discussions around value are centered around reducing cost. But Dr. Levine points out that a cancer patient defines value very differently. They define it as survival. They think about whether or not they returned to normal functionality in normal life, and what their experience was through the entire treatment process. He says the industry needs to recognize and customize models for these unique aspects of cancer care before the term VBC should be used in oncology.AI in oncology. Dr. Levine shared his outlook for the many ways artificial intelligence will change oncology – from drug discovery to care delivery. He believes AI will completely disrupt the approach to cancer care and that the revolution will happen quickly – not in seven to 10 years, but in three to five. He talked about the ways he sees AI changing how doctors deliver care, and why he’s even more optimistic about its ability to accelerate research.To hear Dr. Levine and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Stephen Schleicher, a medical oncologist with an MBA from Harvard, delves into the complexities of oncology, exploring the intersection of clinical care, business, and policy. He highlights the urgent need for healthcare professionals to understand the business dynamics that influence cancer treatment. The conversation reveals insights into value-based care, the evolving landscape of cancer treatment, and the challenges in securing equitable access to innovative therapies. Dr. Schleicher emphasizes the importance of collaboration to improve patient outcomes in a changing healthcare environment.

Elements of the new Trump administration are coming into focus as announcements of key healthcare appointments and nominations provide indications for what the market can expect starting in January. To dissect the impact these changes might have, Wall Street Analyst Jeff Garro joined Keith Figlioli to wrap up a four-part series of episodes on election implications. Previous episodes featured conversations with JP Morgan’s Lisa Gill, Canaccord Genuity’s Richard Close, and Maverick Health Policy’s Julie Barnes.Jeff Garro is Managing Director and an equity research analyst covering Healthcare IT for Stephens, a family of privately held, independent financial services firms founded in 1933 that’s focused on building value for companies, state and local governments, institutions and high-net-worth investors. Prior to joining Stephens in September 2022 Jeff held research analyst roles at Piper Sandler and William Blair.During this conversation, Jeff discussed the policy changes and broader market signals he’s watching to advise clients on investments in the healthcare IT market. Some of the topics he discussed with Keith include:Balance in management teams. When discussing elements he looks for in a good investment, Jeff talked about the lessons he’s learned evaluating management teams. He says companies need leaders that are great storytellers who can convey their vision and bring more investors under the tent. But cautions to stay vigilant for executives who might believe in their own narrative a little too much and in turn, don’t implement the right sets of checks and balances within their organization.Predictions by payer type. One way Jeff is assessing the market in light of pending regulatory and policy changes is by breaking it down by payer type. For example, he expects minimal change in employer-sponsored coverage and a more favorable environment for Medicare Advantage, when comparing the first Trump term to the last few years of the Biden administration. He says Medicaid markets will be harder to predict because potential for decreased federal funding could create market pressures, but could also create opportunities where technology can help. Lastly, he’s considering the individual market and the potential for ACA subsidies to not be renewed.Public vs. private markets. While Jeff’s primary role is analyzing public markets, he talked about how essential it is to understand innovation and activity occurring in private markets so he can ask the right questions and avoid being blindsided as new companies and technologies evolve. He also discussed the different mentalities of public versus private investors, and how those in private markets generally have the ability to be more patient – an advantage as we’re waiting for the new administration’s nominees to be appointed and confirmed.The post-COVID reset. There are a lot of problems to solve in healthcare – as there always have been – but Jeff also believes there are a lot of good companies, both public and private, positioned to solve them. He sees a favorable backdrop for healthcare investors following the challenging environment from the global pandemic, and is hopeful that the market has hit a reset from a performance perspective. He sees a shift from “growth at all costs” to a more reasonable approach to sustainable growth and healthy profit margins.To hear Jeff and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A

Healthcare was not a major focus during the 2024 election where other key issues drove most of the discussion. This left a vacuum around specific healthcare policies and what to expect from a second Trump Administration. With few details available and political capital to spend from the ‘red sweep’ this election, healthcare stakeholders are pondering how much of the incoming administration’s preference for disrupting the status quo will extend to the healthcare industry.For the third episode in a four part series on election implications – and the first one since votes were counted and winners declared – JP Morgan analyst Lisa Gill joined Keith Figlioli on the Healthcare is Hard podcast to analyze the outcome.Lisa has more than three decades of healthcare industry experience and has spent most of her career at JP Morgan where she has been covering the healthcare services industry for the last 27 years. In this episode, Keith talked to Lisa about the lessons she’s learned covering healthcare for several decades, and asked her to share her outlook for what to expect in the months and years ahead. A few of the topics they discussed include:Cycles of innovation. Thinking about how the industry has evolved over time and how healthcare organizations have had to continuously reinvent themselves, one of the main observation Lisa makes is that common themes and trendlines often repeat themselves. She cites the pharmaceutical industry as an example, comparing the cycle of pharmacy innovation when she started as an analyst in the late 1990s to the current wave of innovation that’s occurring now.Consolidation and diversification. With a philosophy that leans towards deregulation and loosening oversight, one expectation of the incoming administration is that it will create more opportunity for M&A. Lisa talks about the trends driving consolidation in the industry and how it’s not just about diversifying earnings and revenue. She says it’s about broadening the touchpoints organizations have with patients in order to reach the goal of finally being able to deliver truly integrated care.Optimism for managed care. If early returns in public markets after the election are an indication of what’s to come, managed care organizations are in a good position to thrive under the second Trump administration. Lisa points to the fact that managed care companies outperformed the day following the election, rising 5.8% while hospitals fell more than 4%. With a friendlier environment for reimbursement rates and STAR ratings, and a lower bar for M&A, she expects this trend to continue.Previewing the 43rd Annual JP Morgan Healthcare Conference. This venerable event sets the stage on what to expect in healthcare for the year to come. And while it takes place before the presidential inauguration, signals from the Trump transition team, including announcements about appointments to cabinet positions and healthcare agencies, will drive the conversation. However, Lisa believes the industry won’t have a clear view into the new administration’s focus and priorities for healthcare until well into the first quarter of 2025.To hear Lisa and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

With the White House and Congress up for grabs this election, anticipation in the healthcare industry is high. Shifts in healthcare policy will influence how care is paid for and delivered, which will of course influence the flow of investment dollars in both public and private markets.During the first episode of a four-part series on election implications, beltway insider Julie Barnes laid out potential scenarios for the direction healthcare policy might take depending on election outcomes. With that background, Part 2 of the series zooms in on healthcare investing. For more than 20 years – and now six presidential election cycles – Richard Close has covered the healthcare space as a Wall Street analyst. He was one of the first analysts covering healthcare technology and as Managing Director, Digital and Tech-Enabled Health Equity Research at Canaccord Genuity, he focuses on introducing the investment community to disruptive and innovative companies that are leading the digital transformation in healthcare. In this episode of Healthcare is Hard, Richard talked to Keith Figlioli about the election and how it could impact investments in the healthcare sector. A few of the topics they discussed include:Predictions on priorities. Healthcare has not been a major focus this election cycle and Richard doesn’t believe either candidate has shared many specifics about their plans for health policy. But he discussed general expectations like an increase in Medicare drug price negotiations under a Harris Administration, or giving states more control of Medicaid under a Trump Administration. Regardless of who takes the White House, he sees an increasing focus on addressing employer health costs, driven by forecasts for an 8% increase next year – the highest jump in more than a decade.Contrasts in public vs. private markets. Richard says healthcare investors in public markets tend to “paint with a broad brush” and are focused on the short-term. Because of this, he says struggles at large-cap managed care companies in recent years have influenced overall investor sentiment. Once these companies get beyond current challenges and start hitting their numbers, he believes it will open the market and drive improved valuation for smaller and mid-cap companies. On the other hand, Richard says investors in private markets look more deeply into sub-sectors and are placing bets for the long run. Optimism for health tech. With healthcare accounting for 20% of the economy and continuing to grow, Richard sees technology as a primary lever to help bend the cost curve. He’s optimistic about the future opportunity for investors in both public and private markets, and sees an opportunity for the IPO window to potentially open up after the election. He says there are a handful of companies that are profitable and have been growing revenue that may be ready to test the IPO market in 2025.To hear Richard and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.