The Gist Healthcare Podcast

Cigna confirms it is not pursuing an acquisition of rival health insurer Humana. OptumHealth and Aetna agree to settle a class action lawsuit alleging that they billed health plan members for administrative fees coded as medical expenses.  And, hospital-associated infection rates are down, according to recent data from the CDC. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare Hosted on Acast. See acast.com/privacy for more information.

General Catalyst’s HATco signs a definitive agreement to purchase Akron, OH-based Summa Health. The Food and Drug Administration plans to remove a common—but ineffective—decongestant ingredient from the market. And, more young people are landing in the emergency department for consuming too much caffeine. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare Hosted on Acast. See acast.com/privacy for more information.

Share prices of Medicare Advantage health insurers jump following former-President Trump’s victory in the 2024 presidential race. Novant Health completes its acquisition of 200-provider group from a South Carolina health insurer. And, Medicaid’s gross spending on GLP-1 drugs grew by 500% over a four-year period. We’ll get that story—and more—coming up on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

Physicians are facing a Medicare pay cut again in 2025 and are calling on Congress to fix the issue. Virtual mental health provider company Cerebral has reached an agreement with the federal government to pay fines tied to allegations that it overprescribed controlled substances, like Adderall. And, a smaller proportion of healthcare workers have received the latest COVID shot. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Following the COVID-19 pandemic, UMass Memorial Health in Worcester, Massachusetts began to pilot a new hospital-at-home program: one for postpartum patients. Benjamin Hamar, MD, Director of the Maternity Center at UMass Memorial and a member of the Maternal-Fetal Medicine Division, joins the podcast to tell host J. Carlisle Larsen more about the first-in-the-nation model. Hosted on Acast. See acast.com/privacy for more information.

Medicare’s largest accountable care program saved the federal government more than $2 billion dollars last year. CVS bucks the retail-healthcare contraction trend and announces expanded primary care services for its Aetna members at its MinuteClinic locations in certain markets. And, Cigna’s CEO brushes off Humana purchase rumors in a call to investors. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

A government watchdog finds that Medicare paid health insurers billions for what it says were questionable home diagnoses. UnitedHealth and home healthcare company Amedisys are reportedly appealing to regulators in an effort to finalize their proposed multi-billion-dollar merger. And, Novo Nordisk wants to block compounding pharmacies from creating Ozempic knockoffs. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

The Medicare Advantage market has seen unprecedented growth in recent years, with a majority of Medicare eligible beneficiaries enrolling in one of these privately administered plans in 2024. But over the past couple of years, the industry has experienced some growing pains—ranging from more regulatory scrutiny to higher costs associated with members utilizing more healthcare services.   In the second half of their conversation, Joyjit Saha Choudhury, Managing Director of the Kaufman Hall’s Strategy and Business Transformation practice, joins host J. Carlisle Larsen to talk about the potential worst-case scenario for the market.   You can find the first part of their conversation here.  Hosted on Acast. See acast.com/privacy for more information.

The February cyberattack on Change Healthcare could have compromised the data of 100 million people, making it the largest healthcare data breach reported to the federal government. The Cleveland Clinic and Amazon to partner on primary care clinics in Ohio.  And, Senators want more information from Eli Lilly and Pfizer about their direct-to-consumer platforms. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Cigna and Humana have reportedly resumed merger talks after abandoning plans late last year. Walgreens is looking at a healthcare future without VillageMD as a key component. And, Blue Cross Blue Shield will pay roughly $2.8 billion to settle a class action antitrust case brought by providers. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Enrollment in Medicare Advantage plans surpassed 54 percent for the 2024 plan year, as more eligible seniors seek to take advantage of the privately administered health plans. Though MA plans have become increasingly popular, the industry has had some growing pains, ranging from increased regulatory pressures and higher consumer medical utilization.  On today’s episode of the Gist Healthcare podcast, Joyjit Saha Choudhury joins host J. Carlisle Larsen to talk about his recent piece, Preparing for Medicare Advantage’s Make-or-Break Moment.   The second part of their conversation will be available on Monday, October 28. Hosted on Acast. See acast.com/privacy for more information.

UnitedHealth Group’s stock tumbles as it reveals a jump in medical costs hurt its 2025 profit outlook. More than 1,500 physicians call on the Trump campaign to release an outline of healthcare plans after the former-president said he wants to replace the Affordable Care Act. And, the Food and Drug Administration halts the clinical application of Novavax’s combination COVID-influenza shot, following a report of a significant reaction from a trial participant. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Medicare Advantage star ratings drop for the 2025 plan year, as expected. Walgreens plans to close more stores as the company continues to right its finances. And, the largest maker of IV fluid in the United States looks to import fluid from abroad to mitigate a hurricane-related shortage. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Nearly 80 percent of registered voters in the United States say that healthcare is either an extremely or very important issue, according to a recent Gallop poll. On today’s episode of the Gist Healthcare podcast, we take a look at some of the healthcare issues that have become platforms for the presidential tickets, as well as how some down ballot races are approaching healthcare policy. Dan Diamond, national healthcare reporter for the Washington Post, joins us to talk healthcare policy and politics.   Hosted on Acast. See acast.com/privacy for more information.

The nation’s largest producer of I-V fluids is expanding allocations of its products to meet demand from hospitals in the aftermath of Hurricane Helene. UnitedHealth Group, Cigna, and CVS have asked a judge to remove FTC Chair Lina Khan and two other commissioners from the agency’s insulin price antitrust suit. And, interviews are making their return to the podcast. Stay tuned to learn about what’s on the docket. These stories—and more—coming upon today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Democratic presidential candidate Kamala Harris proposes an expansion of Medicare’s home healthcare policy. The Government Accountability Office says the Centers for Medicare and Medicaid Services should be more diligent in ensuring hospitals are compliant with price transparency rules. And, some hospitals in Florida prepare to close facilities and evacuate patients as Hurricane Milton barrels through the Gulf. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Hospitals around the country are reporting shortages of crucial IV fluid in the aftermath of Hurricane Helene.  Not-for-profit hospitals add ten times their value to communities relative to their tax breaks, according to a new report. And, the Federal Trade Commission could wade into the legal fight between startup Particle Health and the nation’s largest EHR vendor Epic. That story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

The Vice Presidential candidates squared off this week and healthcare policy took center stage. Humana’s stock drops following news that federal regulators slashed the number of the company’s enrollees in high-star Medicare Advantage plans. And, the number of reported whooping cough cases has spiked this year. We’ll get that story--and more--coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

CVS is rumored to be weighing breaking up its retail and insurance businesses amid investor pressure. Johnson & Johnson is abandoning its controversial 340B drug discount rebate plan.  And, The Biden Administration is no longer pursuing its push for greater Medicaid drug price transparency, according to a report.  We’ll get that story--and more--coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

New legislation is introduced in the United States Senate that sets standards for healthcare cybersecurity. The Centers for Medicare and Medicaid Services finalizes national Medicaid renewal compliance deadlines. And, Novo Nordisk’s CEO blames health insurers and PBMs for the high cost of its blockbuster weight loss drug Ozempic. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

New legislation introduced this week in the US Senate would make ACA expanded subsidies permanent. Employers expect an increase in per employee healthcare benefit spend in 2025, according to a new survey. And, EHR giant Epic sued over allegations of anticompetitive business practices. We’ll get that story and more coming up on today’s episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

A bill introduced in Congress would exempt some smaller drugmakers from the Medicare drug price negotiation process. The Federal Trade Commission sues the nation’s largest pharmacy benefit managers over the cost of insulin.  And, consumers will be able to self-administer a nasal flu vaccine next year. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

A move to extend pandemic-era telehealth and hospital-at-home flexibilities passes out of a key Congressional committee.  Another major health insurer plans to scale back their Medicare Advantage offerings for the upcoming plan year.  And, drug overdose deaths in the US are declining rapidly, according to data from the CDC. We’ll get that story--and more--coming up on today’s episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

The Health Resources and Services Administration threatens sanctions against Johnson & Johnson over the company’s decision to change how hospitals are provided 340B discounts on some prescription drugs.  And, a summer surge of COVID infections could be abating...We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Rural hospitals are reportedly not taking advantage of free help from technology companies. A major pharmacy benefit manager sues the Federal Trade Commission over a recent...damning report of the business.  And, a new survey indicates that the physician shortage could be getting worse. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

UnitedHealthcare unveils a new “gold card” program for providers to make the prior authorization process more efficient. The Centers for Medicare and Medicaid Services suspends two ACA platforms over concerns that foreign entities had access to consumer information. And, the FDA OKs the first over-the-counter hearing aid software for use with Apple Air Pods. We’ll get that story—and more—coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

Healthcare was a hot topic during this week’s presidential debate...especially the past and potential future of the Affordable Care Act. The data of nearly 1 million Medicare beneficiaries could have been exposed to hackers through a software vulnerability discovered last year. And, hospitals experienced a slight labor rebound in August. Those stories and more coming up on today’s episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

The Biden Administration finalizes new mental health parity rules for insurers. A large-scale study suggests that the active ingredient in the blockbuster weight loss medicine Ozempic reduced the risk of severe COVID reactions among patients with obesity. And, we’ll get some more top news in heathcare. That's coming up on today's episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

Several high-ranking executives at Walgreens are being sued by a shareholder as the retail pharmacy’s stock price continues to drop. Humana will exit 13 Medicare Advantage marketplaces ahead of the 2025 plan year.  And, we’ll get some more top healthcare news headlines. That’s coming up on today’s episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

Johnson & Johnson draws the ire of hospitals and the government over a planned change to how it will provide discounts for some of its 340B-eligible drugs. Pfizer becomes the second drug company to get into the direct-to-consumer market. Those stories and more coming up on today’s episode of the Gist Healthcare podcast. Hosted on Acast. See acast.com/privacy for more information.

Struggling Steward Health Care will sell six of its Massachusetts hospitals. Kaiser Permanente backed Risant Health plans to invest more than $1 billion dollars in Cone Health. And, pharmacy benefit manager leaders could be in hot water following testimony over their business practices on Capitol Hill. That’s coming up on today’s episode of the Gist Healthcare podcast.  Hosted on Acast. See acast.com/privacy for more information.

A new report projects the average cost of employer-sponsored health plans to rise 9 percent next year. The Centers for Medicare and Medicaid Services receives 12,000-plus complaints about No Surprises noncompliance. And, the FDA approves a chemo-free treatment for a common type of lung cancer. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

A federal judge blocks the FTC’s ban on noncompetes. And, New Jersey’s governor says about $100 million dollars in residents’ medical debt will be eliminated. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Massachusetts’ governor arranges deals to force the sale of five Steward Health Care hospitals in the state. As Medicare Advantage enrollment grows, a new report warns of the program’s impact on hospital margins. And Eili Lilly's GLP-1 weight-loss drug reduces the risk of developing type 2 diabetes. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

A Texas court overturns a HHS change to how Medicare pays hospitals that serve large numbers of low-income patients. Medical-cost fiduciary litigation is on the rise. And the FDA authorizes the first over-the-counter, at-home syphilis test. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Biden’s nursing home staffing mandate gets hit with another lawsuit. This one from the Texas attorney general. Eli Lilly takes action to halt the sales of copycats of its GLP-1 drugs. And Kentucky is the first state to decriminalize medical errors. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

CMS releases results from its first Medicare prescription drug price negotiations under a new federal program. The WHO declares mpox a global public health emergency. And Elevance Health closes a deal with a private equity firm to create a primary care company. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Steward Health Care signs a definitive agreement to sell its physician group. President Biden announces $150 million dollars in federal awards as part of his “cancer moonshot.” And with no federal AI guidelines on the books, states create their own. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

The FDA approves the first nasal spray formulation to treat anaphylaxis. A report finds that U.S. not-for-profit healthcare providers’ days cash on hand hit a 10-year low. And all eligible hospitals in North Carolina opt into the state’s new medical debt relief program. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

A medical journal retracts three papers on MDMA-assisted psychotherapy following the FDA’s rejection of the treatment. CMS outlines updates for its ACO REACH model for 2025. And the DOJ finalizes a rule to improve access to medical care for people with disabilities. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

A federal judge dismisses a lawsuit over the Medicare drug price negotiation program. Provisional data show that COVID has dropped to the 10th leading cause of death in the U.S. And a recent poll finds that fewer Americans view childhood vaccinations as “important.” That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

CMS finalizes a policy that creates a faster pathway to reimbursement for “breakthrough” medical devices. The FDA approves Purdue Pharma’s opioid overdose-reversal device. And a recent report finds that untreated vision loss and high cholesterol could be risk factors for dementia. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Providers receive a win in the latest appeals court ruling on the No Surprises Act. About 700 rural hospitals are at risk of closing, according to a new report. And a recent survey finds that less than half of Americans trust doctors. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Tenet Healthcare plans to sell its majority stake in five Alabama hospitals. The FDA now lists Eli Lilly’s blockbuster GLP-1 drugs as “available.” And a new study finds that less than half of patients challenge insurance claim denials. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

CVS is co-locating Oak Street clinics at existing pharmacies. A new Epic feature allows patients to release their medical records to apps of their choice. And a recent study finds that Gen Xers and millennials are more likely to develop certain cancers. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

CMS finalizes a 2.9 percent Medicare pay bump for inpatient hospital care in 2025. Google is not renewing its contract with Amazon’s One Medical. And more states pass legislation to limit hospitals and provider organizations’ liability following cyberattacks. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

CMS finalizes four payment rules for 2025, including for skilled nursing and inpatient rehab facilities. A cyberattack strikes a Florida blood bank that serves more than 350 hospitals. And two health system merger deals cross the finish line. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Community Health Systems plans to sell its three Pennsylvania hospitals to WoodBridge Healthcare. Walmart will open 25 new pharmacies focused on autoimmune diseases. And CMS green lights North Carolina’s medical debt relief plan. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Massachusetts commits $30 million dollars to keep Steward hospitals in the state operating. A new study finds that a double mastectomy did not improve survival for patients with unilateral breast cancer. And healthcare once again lands at top of an annual report on the cost of data breaches. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.

Guardant Health’s blood screening test for colorectal cancer receives federal approval. The FDA warns about dosing errors tied to compounded versions of GLP-1 drugs. And a new study shows that a blood test can accurately diagnose Alzheimer’s disease. That’s coming up on today’s episode of Gist Healthcare Daily.  Hosted on Acast. See acast.com/privacy for more information.