Podnosis

Since the Trump administration took office in January, healthcare policy has been moving quickly, with changes touching Medicaid funding, ACA subsidies, hospital finances and the federal government’s approach to health technology. This week on "Podnosis," we’re bringing you a recording from a live roundtable at the Fierce Health Payer Summit on Dec. 4, where members of the Fierce Healthcare editorial team unpacked the policy and funding shifts already underway. The discussion covers Medicaid cuts and coverage losses, how hospitals are preparing for reduced government funding, CMS’ new health tech ecosystem and where PBM reform stands after years of scrutiny. To learn more about the topics in this episode:  Crapo, Cassidy introduce ACA subsidy plan that leans on HSAs AHIP presses for ACA subsidy extension, further program integrity measures Medicaid work rules exempt the 'medically frail.' Deciding who qualifies is tricky When the hospital leaves town Many urban safety-net hospitals threatened by OBBBA's Medicaid cuts: analysis Industry Voices—3 major changes to Medicare Part B payment policies coming for 2026 'Come fight with me'—Oz courts physicians skeptical of Medicaid cuts, MAHA's criticisms KFF: States brace for increasing Medicaid costs even as enrollment stays flat All 50 states submit applications for $50B Rural Health Transformation Program The policies top of mind for healthcare stakeholders right now Hospital M&A continues to rebound as policy uncertainty clears See omnystudio.com/listener for privacy information.

Each year, Fierce Healthcare’s Women of Influence special report asks a simple question: Who is actually reshaping healthcare from the inside? This year brought a record number of nominations and a list that reflects how broad that influence has become, across health systems, payers, tech, policy and advocacy. In this episode, Fierce Healthcare's Heather Landi and Paige Minemyer talk about why this recognition still matters, even as women make up nearly half of managerial and executive roles but remain scarce in CEO positions. They get into what the nomination surge tells us about where change is happening, how roles and titles are evolving and why so many of the most interesting ideas in healthcare are being led by women who are still fighting for a true share of power. To learn more about the topics in this episode:  Fierce Healthcare's Women of Influence 2025See omnystudio.com/listener for privacy information.

Joseph Perekupka, CEO of Freespira, and Andy Molnar, Senior VP of Industry Affairs for the American Telemedicine Association, dive into the evolving world of prescription digital therapeutics. They discuss the challenges of reimbursement policies and the barriers to adoption these innovative solutions face. The duo also tackles the implications of AI in mental health care, clinician adoption strategies, and the importance of demonstrating ROI and clinical outcomes. Their insights illuminate the future of digital health in a rapidly changing landscape.

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.