Podnosis

It’s been a buzzy few years for prescription digital therapeutics, marked by bankruptcies, reimbursement policy changes and AI advancements.  At their best, DTx solutions can offer a more personalized, convenient and cost-effective care experience. But barriers to adoption remain. What are they, and what’s being done about them? Senior Writer Anastassia Gliadkovskaya explores these questions with Joseph Perekupka, CEO of Freespira, and Andy Molnar, SVP of industry affairs for the American Telemedicine Association.  To learn more about the topics in this episode:  Access to Prescription Digital Therapeutics Act reintroduced in Congress How companies use scientifically informed music to impact health outcomes CMS puts forward meager offering for digital health in final Medicare physician fee schedule rule American Telemedicine Association's lobbying division acquires Digital Therapeutics Alliance See omnystudio.com/listener for privacy information.

Conduent is leaning into artificial intelligence to help clients navigate budget constraints, improve service quality and streamline operations, according to Mandy Huckaby, vice president and general manager of customer experience management. Speaking on Fierce Healthcare’s Podnosis podcast, Huckaby said the company is focused on helping clients “do more with less” by integrating AI across customer-facing and back-office functions. She emphasized that AI is not new to Conduent, which has used the technology for more than a decade. “AI is literally just having technology augment an interaction,” Huckaby said. “We’ve been doing technology augmentation with chat, digital landscaping and other services for a long time.” Conduent’s AI strategy targets three areas: pre-engagement automation to help customers self-serve, agent support tools to improve response speed and quality, and back-office enhancements such as document processing and legal text analysis. In healthcare, Huckaby said AI is being used to support nurses and HR representatives, among others. The company also partners with vendors like Microsoft to deliver sentiment analysis and quality audits. Huckaby said clients are increasingly looking for creative problem-solving and authentic customer advocacy. “It can’t just be reading off a script,” she said. “Our customers are looking for empathy and understanding.” As industries face rapid technological change, Huckaby said Conduent encourages its teams to remain agile and forward-thinking. “Change is inevitable,” she said. “It’s our ability to be flexible and agile through that change.”See omnystudio.com/listener for privacy information.

With the longest government shutdown in U.S. history as a backdrop, for-profit providers and payers detailed the continued regulatory uncertainty and pressures on their businesses in the third quarter.  In this episode of "Podnosis," Editor Dave Muoio and Senior Writer Paige Minemyer break down the key trends for the third quarter, including how insurers shed light on strategic priorities, the impact of the ACA subsidy conversation and why providers saw a surprise revenue windfall.  To learn more about the topics in this episode:  Insurers slammed by medical costs, regulatory pressures yet again in Q3 Tax credit turmoil, cost pressures set stage for tumultuous ACA open enrollment Amid shutdown, health IT vendors say hospitals are cutting back on spending See omnystudio.com/listener for privacy information.

In a recent episode of Podnosis, Dr. Jerilyn Morrissey, chief medical officer at CorroHealth, called for a strategic overhaul in how hospitals approach clinical documentation and payer denials. “Documentation has become the battlefield where clinical, financial and payer priorities collide,” Morrissey said. Tracing the evolution of medical records from ancient Egypt to modern electronic systems, she emphasized that while technology has enabled better data sharing, it has also introduced administrative overload and clinician disengagement. Morrissey challenged the common belief that denials stem from provider error. “Denials are a payer strategy,” she said. “They distract and delay, and they’re designed to do just that.” She urged healthcare leaders to shift from reactive to proactive strategies, focusing on clear expectations around reimbursement. Hospitals spend nearly $20 billion annually fighting denials, often by adding more staff or vendors. Morrissey cautioned against this approach, noting that more resources rarely yield better outcomes. She also questioned the effectiveness of AI-generated appeal letters, citing a low success rate and rapidly changing payer policies. Instead, Morrissey advocated for integrating technology earlier in the care process. “Denials don’t start when we submit a claim,” she said. “They start at the point of documentation and decision-making.” Looking ahead, Morrissey sees promise in AI for clinical support, pattern recognition and denial prediction. But she warned that trust in technology must be earned. “AI works most of the time, but not all of the time,” she said. “We’re not yet at a point where we can remove the human from the loop.” Her advice to healthcare executives: embrace innovation with creativity and collaboration, and aim to be “constructively destructive” in reshaping the system.See omnystudio.com/listener for privacy information.

Florida is among the fastest-growing states in the U.S. Demand for healthcare is also growing. Predicting community needs can help organizations be better prepared to serve patients.   To understand what health systems in Florida are thinking about when it comes to architecture and design, Senior Writer Anastassia Gliadkovskaya talks to Michael Compton, director of healthcare, Florida, at Barge Design Solutions.   Compton shares the projects he takes on as a board-certified healthcare architect and predicts what the next few design trends might be in the state.   To learn more about the topics in this episode:  'We can't do this alone': Hospitals share lessons from Hurricane Helene to prepare for extreme weather events Kaiser Permanente launches renewable energy microgrid at California hospital Florida health system tackles expansion challenges to meet growing demand See omnystudio.com/listener for privacy information.

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.