Podnosis

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.

Hope, when applied with purpose and action, can be a powerful force for driving change in healthcare. That’s the philosophy of Eugene Woods, CEO of Advocate Health and a 2025 Fierce 50 honoree, who joins Ayla Ellison, Editor-in-Chief of Fierce Life Sciences & Healthcare, to share how he puts “Applied Hope” into practice. Woods explains how this approach combines optimism with action and why it’s become a guiding strategy for one of the nation’s largest nonprofit health systems. In their conversation, Woods discusses leading through massive organizational change, cultural transformation and the rapid adoption of new technologies. He offers insights on improving quality and affordability, investing in both rural communities and urban neighborhoods and preparing for a future shaped by AI and more human-centered healthcare delivery. To learn more about the topics in this episode:  Fierce 50 of 2025  Eugene A. Woods—Fierce 50 Leadership Honoree  See omnystudio.com/listener for privacy information.

Corporate venture capital is gaining traction across industries. From 2014 to 2024, it accounted for nearly half of all VC deal value. Healthcare is no exception: dozens of health systems now have venture arms or invest directly in healthcare startups. Arizona-based Banner Health is one of them, taking a strategic approach to equity deals and joint ventures. To unpack that strategy, Senior Writer Anastassia Gliadkovskaya spoke with Mark Garvin, former senior vice president of partnership and venture development at Banner Health. This episode was recorded before Garvin departed from Banner. He no longer represents the organization, but his insights remain highly relevant. To learn more about the topics in this episode:  Banner Health boosts investment in AI-powered automation tech to maximize operating rooms What’s next for digital health investing in 2025? Ardent Health execs eye outpatient expansion, see nonprofits' headwinds as growth opportunity See omnystudio.com/listener for privacy information.

Transitions of care—moving patients from one care site to another—continue to be a major challenge in healthcare. Nearly 1 in 5 Medicare patients discharged from a hospital—approximately 2.6 million seniors—are readmitted within 30 days, at a cost of more than $26 billion every year, according to the Centers for Medicare & Medicaid Services. Salman Ali, CEO and co-founder of Kouper, saw opportunities to take a tech-based approach to care transitions, using generative AI to ensure patients don’t fall through the cracks after hospital discharge. As executive-in-residence at venture capital group General Catalyst, Stephen Klasko, M.D., has a front-row seat to the latest innovations in AI. And as former CEO of Jefferson Health in Philadelphia, Klasko understands the value of using technology to tackle operational pain points at health systems. In this episode of “Podnosis,” Ali and Klasko dig into Kouper’s approach to improving care transitions and why they see AI at a true inflection point. They talk about how hospitals can deploy AI without adding to staff burden and why trust matters more than technology in winning over health system leaders. To learn more about the topics in this episode:  Kouper is tackling transitions of care armed with $10M from General Catalyst, 25Madison and CVS' venture arm Ohio attorney general approves sale of Summa Health to General Catalyst's HATCo, with some conditions Commure raises $200M in growth financing from General Catalyst See omnystudio.com/listener for privacy information.

The first half of 2025 was decidedly mixed for many publicly traded healthcare companies, and they’re facing murky waters in the back half of the year amid policy and cost upheaval.  In this episode of "Podnosis," Fierce Healthcare Associate Editor Dave Muoio and Senior Writer Paige Minemyer break down the topline takeaways from another round of corporate earnings calls, including a look at executive commentary on the “big, beautiful” policy environment.  To learn more about the topics in this episode:  Elevated Medicare Advantage, ACA marketplace costs sting insurers in mixed Q2 HCA Healthcare raises 2025 guidance on strong Q2, says Medicaid changes should be 'manageable' UnitedHealthcare to exit certain Medicare Advantage markets as costs balloon, impacting 600K enrollees Community Health Systems attributes Q2 volume stumble to low consumer confidence, immigration fears Oscar Health misses estimates in Q2, plans layoffs and inks Hy-Vee-branded ICHRA plan Aetna turnaround is a 'top priority' at CVS Health, CEO says, as Wall Street buoyed by insurance unit's rebound With buyouts looming, Humana improves outlook as revenue beats estimates in Q2 Cost pressures limit Molina Healthcare during Q2 earnings as stock dips Ardent Health has no qualms about losing exchange volumes, execs say Cigna's solid Q2 results boosted by Evernorth revenue growth, limited exposure to elevated medical costs Universal Health Services addresses behavioral volume slip by targeting outpatient, downplays Medicaid cuts Elevance Health CEO Gail Boudreaux says company taking 'concrete steps' to address cost pressures Tenet Healthcare raises 2025 outlook on Q2 overperformance; concerns linger over ACA subsidies, slowed admissions Centene slashes 2025 guidance as it navigates ACA marketplace headwinds 'Humming on all cylinders': Alignment Healthcare CEO inks profit milestone, eyes growth See omnystudio.com/listener for privacy information.

Research shows that women impacted by domestic abuse are significantly more likely to experience chronic health conditions. Survivors often live with untreated pain, anxiety and fear—and many never disclose their experiences to a healthcare provider. At Endeavor Health Swedish Hospital in Chicago, a new pilot program is rethinking how care teams engage survivors of gender-based violence. The initiative aims to improve how clinicians identify, respond to, and connect patients with trauma-informed care and critical resources. Senior Writer Anastassia Gliadkovskaya talks to Mariá Wilburn, a certified crisis counselor and manager of the Pathways Program at Endeavor Health, about the unique approach and why it’s important.  To learn more about the topics in this episode:  Some sexual assault survivors face huge hospital bills if they seek emergency care Half of women skip or delay care due to 'triple threat' of factors, report finds Unique generational mental health needs highlight demand for personalized care, survey finds See omnystudio.com/listener for privacy information.