Podnosis

The hype around artificial intelligence in healthcare has yet to fizzle out. The technology offers a significant opportunity for healthcare organizations to reduce complexity and inefficiencies in the system. However, there are plenty of risks to navigate, too.  In this episode of "Podnosis," Senior Writer Paige Minemyer sits down with Sandeep Dadlani, CEO of Optum Insight and former chief technology officer at UnitedHealth Group, to discuss how the industry giant is deploying AI today and the guardrails that are necessarily in place to keep patient data safe.  To learn more about the topics in this episode:  UnitedHealth taps Sandeep Dadlani to lead Optum Insight unit AI Pulse: Microsoft rolls out updated 'Copilot for health' feature; athenahealth embeds agentic AI into athenaOne platform AMA launches initiative in bid for AI policy leadership Optum unveils new AI-powered claims processing platform See omnystudio.com/listener for privacy information.

Dr. Jigar Patel, the Chief Medical and Product Officer at Claritev, shares insights on the critical issue of revenue leakage in hospitals. He discusses how inefficiencies can cost facilities 15–25 cents of every revenue dollar, particularly impacting community and rural hospitals. Dr. Patel highlights the role of specialty services and patient movement in this leakage, and he introduces Claritev’s CompleteVue, a tool that helps identify revenue loss points and improves contract negotiations. Tune in for valuable strategies to enhance financial health in healthcare.

There is a newer wave of middlemen in the self-insured market: alternative funding programs.  The for-profit vendors claim to help employers save money on expensive specialty medications by obtaining them for free or at a steep discount through alternative sources. While they may sound promising, some healthcare experts describe them as sneaky, harmful to patients and in a gray zone ethically and legally.  Last week, Fierce Healthcare published an investigation into the business model and consequences of alternative funders. In this episode, Senior Writer Anastassia Gliadkovskaya describes her reporting process and findings with Executive Editor Heather Landi. To learn more about the topics in this episode: A new wave of middlemen offers 'alternative funding' for specialty drugs. Patients bear the risks As large employers back away from self-insurance, small- and medium-sized ones embrace it: EBRI Out-of-pocket spending on prescriptions grew even after accounting for rebates: studySee omnystudio.com/listener for privacy information.

Amid a breakneck pace of regulatory changes under the Trump administration, healthcare stakeholders are scrambling to keep up. Experts are sharing learnings and doing their best to understand how the policies of today affect the sector. Senior Writer Anastassia Gliadkovskaya chats with two executives with a front-row seat to those conversations: Maria Ghazal, CEO of the Healthcare Leadership Council; and Robert Andrews, CEO of the Health Transformation Alliance. Both organizations recently had meetings with their members to debrief on policies like President Donald Trump’s One Big Beautiful Bill Act, Most Favored Nation and more. To learn more about the topics in this episode:  White House announces new prescription drug website, TrumpRx How the shutdown impacts healthcare: Reductions in force begin at HHS, with some hiccups at CDC New Medicaid federal work requirements mean less leeway for states Federal government enters shutdown, virtual care programs expire Note: Due to a recording glitch, Maria Ghazal's audio is slightly distorted early in the episode; it clears up shortly.See omnystudio.com/listener for privacy information.

Millions of Americans are affected by cancer each year. For many, hair loss is among the most distressing side effects of chemotherapy treatment, causing some to put off or refuse chemo. A revolutionary technology exists: scalp cooling, which involves wearing a cold cap during treatment to restrict blood vessels and reduce how much chemo reaches the hair follicles. Rossalynn Ripper, a breast cancer survivor, was able to use scalp cooling to prevent hair loss during her treatment. Now, she advocates for her home state of Maryland to pass a bill requiring insurers to cover the treatment. Senior Writer Anastassia Gliadkovskaya talks to Ripper and her oncologist, Young Lee, M.D., of Luminis Health, about why scalp cooling is important to treatment access and what barriers remain. To learn more about the topics in this episode:  CMS rolls out new payment model on improving cancer treatments Accelerating solutions to cancer through impact investing More patients are surviving cancer, but incident rates rising among women and younger adults: ACS report See omnystudio.com/listener for privacy information.

Payment integrity is top of mind as insurers face growing pressure to eliminate fraud, waste and abuse. Successful programs require investment in technology and expertise to analyze trends and identify abnormalities. The team at Optum Insight works closely with insurers across the healthcare system to examine this data In this episode of "Podnosis," Fierce Healthcare senior writer Paige Minemyer sits down with Steve Yurjevich, CEO of the payer market at Optum Insight, to discuss the challenges and solutions in this space. To learn more about the topics in this episode:  'Well-intentioned, poorly executed waste': How tech companies aim to reduce billions in wasteful spending New Mountain Capital merges Apixio, Varis and The Rawlings Group in $3B deal CMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial tool Industry Voices—We need to fight fraud the right way See omnystudio.com/listener for privacy information.

The Democratic Women’s Caucus, a coalition of 96 lawmakers, advocates for women’s economic prosperity, healthcare access and safety. In this week’s episode of "Podnosis," Fierce Healthcare staff writer Emma Beavins speaks with Rep. Teresa Leger Fernández of New Mexico and Rep. Kelly Morrison of Minnesota about their policy agenda, including the impact of Medicaid cuts, the fight for abortion and birth control access, and efforts to work with Republicans on healthcare reform. To learn more about the topics in this episode:  Fighting maternal and infant health inequities UnitedHealth report: Disparities persist in maternal, infant health Most states saw hospital obstetric service shutdowns from 2010-2022, with rural states hit hardest Gates Foundation invests $2.5B to spark women's health innovations The business case for investing in women’s health CMS selects states for Medicaid maternal health model Maternal mental health in the spotlight See omnystudio.com/listener for privacy information.

Lawmakers are turning up the heat on pharmacy benefit managers, with more than 1,500 bills introduced this year targeting drug costs, utilization rules and pharmacy networks. In the latest episode of Podnosis, Wes Hill, senior director at RxBenefits, said rising drug prices and pressure from constituents are driving the surge. While federal movement has been limited, states are advancing legislation at a rapid pace, creating new compliance challenges for PBMs and plan sponsors. Hill said employers—who shoulder much of the cost of pharmacy benefits—need to make their voices heard. By tracking legislation, assessing its impact and working with advisors, they can help shape reforms and protect their health plans. To hear more about the legal battles and what’s ahead for PBMs, listen to the full Podnosis episode.See omnystudio.com/listener for privacy information.

Medication nonadherence is not new, but it remains a persistent, complex problem. Adherence rates hover near 50%—roughly the same as two decades ago—as companies explore new ways to engage patients and help them stick to treatment regimens. AdhereHealth combines technology with care navigators to identify at-risk patients and help them consistently access their prescriptions. In this episode of "Podnosis," Fierce Healthcare Senior Writer Anastassia Gliadkovskaya speaks with Chandra Y. Osborn, Ph.D., M.P.H., chief experience officer at AdhereHealth, about how the company takes on risk to drive outcomes and why it keeps a human in the loop. To learn more about the topics in this episode:  Healthcare 'flying blind': Medication nonadherence and how remote therapeutic monitoring can help Out-of-pocket spending on prescriptions grew even after accounting for rebates: study PatchRx to integrate medication adherence data with virtual care platforms Scriptology acquires RxLive to build out its tech stack See omnystudio.com/listener for privacy information.

What are the main challenges hospitals face today? And how can they begin to get their arms around them while centering patients in their decision making?  In this episode of "Podnosis," Senior Writer Anastassia Gliadkovskaya speaks to Janina Beilner, SVP of healthcare at Siemens, about how the company helps hospitals use technology in a thoughtful way to improve their infrastructure, operations and ultimately the patient experience.  To learn more about the topics in this episode:  How health systems are reshaping their strategies in the face of federal policy uncertainty Human-centered design in healthcare How Nvidia-backed Artisight is taking smart hospitals to the next level with AI and computer vision Breathing better: Hospitals begin to phase out major pollutants in patient care See omnystudio.com/listener for privacy information.