The Gist Healthcare Podcast

A recent Washington Post article found that seven companies allegedly submitted around $2 billion in fraudulent claims to Medicare for intermittent urinary catheters that were not ordered, wanted, or received by patients. On today’s episode of Gist Healthcare Daily, Washington Post national health reporter Dan Diamond speaks with host J. Carlisle Larsen about the story. You can read the Washington Post article here. Hosted on Acast. See acast.com/privacy for more information.

Nonprofit health insurers SCAN Health and CareOregon call off their proposed merger. Federal lawmakers are reportedly considering a slight Medicare pay increase for physicians. And, a new report outlines the states with the biggest share of adults with medical debt. 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 throws out a lawsuit challenging Medicare’s drug price negotiation process. The CDC is expected to change its isolation guidelines for COVID-19 infections. And, employer-focused primary care providers Marathon Health and Everside Health plan to merge. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The University of Minnesota strikes a deal with Fairview Health Services to buy back its flagship academic medical center, after selling it more than 25 years ago. The Biden Administration wants more oversight of healthcare accrediting organizations. And, a new study finds that popular weight loss drugs may improve some mental health conditions. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Healthcare M&A activity was up in 2023 following a decline during the COVID-19 pandemic, according to a new report from Kaufman Hall. Last Monday, Anu Singh, Managing Director and Leader of the Partnerships, Mergers & Acquisitions Practice at Kaufman Hall, spoke with host J. Carlisle Larsen about how financial distress was the main driver of many of the smaller-to-medium sized hospital deals last year. In the second half of their conversation, they discuss how more financially stable health systems are considering less traditional, strategic M&A deals and what kinds of conversations are happening right now in C-suites. You can listen to the first part of our conversation here.  Hosted on Acast. See acast.com/privacy for more information.

The leaders of three major pharmaceutical companies testified on Capitol Hill this week about the high cost of prescription drugs. The Biden Administration outlines how Medicare Advantage insurers can use AI. And, Walgreens taps a new executive to lead its healthcare business. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

A House panel passes a key PBM reform for health insurance for federal employees. Amazon will lay off hundreds of employees across its healthcare division. And, healthcare jobs grew at the fastest rate since the early 1990s. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Optum plans to purchase Oregon-based multi-specialty medical group The Corvallis Clinic. Medicaid’s net enrollment is down by about 10 million midway through the continuous enrollment unwinding process. And, Walgreens partners with pharmacy schools to address workforce shortages. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The Biden Administration finalizes telehealth flexibilities for opioid treatment programs. Novo Nordisk’s parent company will buy a US-based facility reportedly to ramp up production of its blockbuster weight loss drugs. And senior-oriented primary care provider Cano Health files for bankruptcy. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

There were 65 hospital and health system M&A deals announced last year, an increase from 53 in 2022. The rise  reflects a growing momentum following a pandemic-related slow down, according to a recent report from Kaufman Hall. Anu Singh, Managing Director and Leader of the Partnerships, Mergers & Acquisitions Practice, joins the podcast to talk more about how financial distress was a driving factor in smaller deals, as well as how other systems looked for more strategic partnerships. Upcoming webinar: Navigating Strategic Options in a Transformed Operating Environment. (February 26, 2024 at 2:00pm-CT) Register here. Hosted on Acast. See acast.com/privacy for more information.

Biogen will stop selling its Alzheimer’s drug, Aduhelm, amid controversy. The Biden Administration makes its initial offers to drug companies on the first ten drugs to be negotiated through Medicare, as courts weigh lawsuits brought by pharmaceutical companies challenging the negotiation process. And, participation in Medicare accountable care organizations is up. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Cigna officially offloads its Medicare Advantage business to Health Care Service Corporation. The Biden Administration will negotiate on behalf of states to provide a groundbreaking gene therapy for Medicaid beneficiaries with sickle cell disease. And, the Dana Farber Cancer Institute is issuing corrections and retracting some research papers amid falsification allegations. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Fitch Ratings says lower operating margins at nonprofit hospitals may be here to stay. The Biden Administration wants stakeholder input on making Medicare Advantage more transparent. And, a new study examines a small number of transmissible Alzheimer’s cases tied to a medical treatment that’s no longer used. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Federal regulators sue to block Novant Health’s purchase of two Community Health Systems hospitals in North Carolina. Insurers say that the No Surprises Act prevented 10 million surprise bills for patients in the first nine months of 2023. And, North Carolina says it will no longer pay for popular–and costly–weight loss drugs for state employees. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Congressional lawmakers established a new arbitration process when they passed the No Surprises Act in December 2020. Since April 2022, payers and providers have been able to have a third-party settle payment disputes over out-of-network claims. However, the process has been bogged down by exceedingly high caseloads and legal challenges. On today’s episode of Gist Healthcare Daily, Matthew Fiedler, Senior Fellow at the Brookings Institution, joins the podcast to talk more about how the process has fared overall since its launch.  Hosted on Acast. See acast.com/privacy for more information.

The Biden Administration releases voluntary cybersecurity goals for healthcare providers. It was a record-breaking year for health plan enrollment on the Affordable Care Act exchanges. And, a majority of rural hospitals have had to cut labor and delivery services for pregnant people. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Walgreens is reportedly exploring a sale of its specialty pharmacy business, Shields Health. Instacart expands its reach into the home care sector. And, the mortality rate among hospital-at-home patients is low, according to a recent study. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Bloomberg Philanthropies will invest $250 million to launch healthcare-focused high schools to address workforce shortages. Younger people are being diagnosed with cancer at higher rates, according to recent studies. And, funding for digital health projects is at its lowest point since 2019. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Intermountain’s Saltzer Health faces a shutdown if it can’t find a buyer. Physicians at two Allina Health hospitals get the green light to unionize. And, disproportionate share hospitals will continue to receive payments–temporarily–as Congress averts another government shutdown in the short term. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Hospitals and health insurers were more compliant with price transparency laws and regulations in 2023, according to healthcare price data company Turquoise Health. Carol Skenes, Principal Strategist at Turquoise, joins the podcast to talk more about what this data means for consumers and the healthcare industry.  Hosted on Acast. See acast.com/privacy for more information.

For the last 15 years, ZocDoc has connected physicians and other healthcare professionals to patients seeking care through its tech-enabled online marketplace. On today’s episode of Gist Healthcare Daily, Oliver Kharraz, MD, Founder and CEO of ZocDoc, joins the show to talk about how the company looks at the evolution of patient acquisition.You can check out ZocDoc’s white paper on patient acquisition here. This episode first aired on May 8, 2023 Hosted on Acast. See acast.com/privacy for more information.

Venture capital firm General Catalyst’s healthcare arm plans to purchase Akron, Ohio-based Summa Health, and turn it into a for-profit system. CMS issues a final rule that aims to streamline health insurer prior authorizations. And, the FDA approves a groundbreaking CRISPR treatment for a second blood disease. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Jarrard’s second survey in its “Beyond Burnout” series examines how nurses are feeling overall about their job satisfaction and career calling, as well as the level of trust they have in the organizations and leadership. On today’s episode of Gist Healthcare Daily, we hear the second part of JC’s conversation with David Jarrard, Executive Chair of Jarrard Inc., where they talk more about how onboarding can make or break nurse retention. You can find Jarrard's second part of the “Beyond Burnout” survey series here. You can also find the first part of JC’s conversation with David Jarrard about the nurse survey here.  Hosted on Acast. See acast.com/privacy for more information.

A recent survey published by strategic healthcare communications consulting firm Jarrard Inc. finds that job satisfaction among nurses is increasing, with roughly two-thirds saying they plan to stay in the field. Today, David Jarrard, Executive Chair of Jarrard Inc., joins the podcast to talk more about the survey. You can find the second part of Jarrard’s “Beyond Burnout” survey series here. You can also find JC’s conversation with David Jarrard about the firm’s 2023 physician survey here.  Hosted on Acast. See acast.com/privacy for more information.

Amazon and digital healthcare company Omada ink a deal focused on treating and preventing chronic conditions. The Department of Health and Human Services announces its new competition chief. And, Affordable Care Act plan enrollment reaches a record high for the 2024 plan year. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The Biden Administration replaces an expanded provider conscience rule put in place during the Trump presidency. The Federal Trade Commission has banned a data broker from selling sensitive location information, like physician office visits. And, California becomes the first state to extend Medicaid to all eligible undocumented adults. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Senate Democrats launch an investigation into the price of asthma inhalers. Walgreens will pay health insurer Humana $360 million in a drug pricing settlement. And, the American Red Cross raises the alarm over a national blood shortage. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Two midwestern health systems call off their proposed merger. The FDA–for the first time–has authorized a state to import some prescription drugs from Canada. And a new study finds that for pediatric cases ChatGPT has a higher error rate. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Burnout has been a major concern for healthcare providers for years, with clinicians pointing to administrative work being a chief contributing factor. Now, some organizations are testing new tools powered by artificial intelligence to help assist with that workload. On today’s episode of Gist Healthcare Daily, Kristine Lee, MD, Associate Executive Director of Virtual Medicine, Technology, and Innovation at The Permanente Medical Group, joins the podcast to share what the 10,000-physician group is seeing from its current pilot of an ambient AI scribe.  Hosted on Acast. See acast.com/privacy for more information.

Cigna is reportedly close to finalizing a deal to sell its Medicare Advantage business. Eli Lilly unveils a new program to sell its blockbuster weight loss drugs directly to patients. And, hospitals around the country reinstate mask mandates amid a surge of COVID and other respiratory illnesses. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

BJC and St. Luke’s finalize their merger, creating a 28-hospital system across three Midwestern states. More Americans will pay less in out-of-pocket costs for insulin this year. And, a new study finds an increase in adverse events at hospitals acquired by private equity firms. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Hospitals and health systems have long grappled with high contingent labor costs, and that issue was put into stark relief during the COVID-19 pandemic. In this encore episode, Jeff Niles, Executive Vice President of Healthcare Workforce Logistics, joins the podcast to talk more about how the company works with systems to establish private label, vendor-neutral contingent workforce solutions to bring down costs and increase fill rates. This episode originally aired on May 22, 2023 Hosted on Acast. See acast.com/privacy for more information.

Federal antitrust regulators finalize new merger guidelines that will have a significant impact on healthcare dealmaking. An independent Iowa pharmacy files a lawsuit against UnitedHealth and OptumRx alleging high back-end fees. And, we’re seeing a rise in respiratory illnesses–and a new COVID variant–ahead of the holidays. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Two Pennsylvania-based health systems announce their plan to merge in the new year. New data shows that a majority of children who have lost Medicaid coverage this year came from just nine states. And, preliminary numbers show nearly 19 million people have enrolled in coverage through the ACA exchanges for the 2024 plan year. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Elevance Health’s proposed $2.5 billion acquisition of Blue Cross and Blue Shield of Louisiana is back in play. CMS reopens the No Surprises Act dispute portal. And, a new poll shows that Americans are growing more dissatisfied with healthcare. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

On today’s episode of Gist Healthcare Daily, we hear the second part of JC’s conversation with Micky Tripathi, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, about proposed penalties for healthcare providers that engage in information blocking and how they fit into the federal government’s overall interoperability goals.  You can find the first part of our conversation here. You can read HHS’ proposed rule here.  Hosted on Acast. See acast.com/privacy for more information.

The Department of Health and Human Services released a set of three proposed monetary penalties for healthcare providers–both organizations and physicians–that engage in so-called information blocking. That practice interferes with, prevents, or discourages access, exchange, or use of electronic health information. It was banned in 2016’s 21st Century Cures Act. Today, Micky Tripathi, head of the Office of the National Coordinator for Health IT (ONC), joins the podcast to talk more about what information blocking looks like among healthcare providers and what the proposed penalties aim to do. You can read HHS’ proposed rule here. Be sure to tune in for the second part of our conversation tomorrow. Hosted on Acast. See acast.com/privacy for more information.

Healthcare spending reached $4.5 trillion in the United States in 2022. A new class action lawsuit alleges Humana used an algorithm to deny care to Medicare Advantage patients. And, WW–formerly known as Weight Watchers–unveils its new telehealth service to prescribe blockbuster weight loss drugs. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The Supreme Court agrees to review a lower federal court ruling that could curtail access to mifepristone…a key drug used in medication abortions. Massachusetts will remove stigmatizing mental health and prior drug use questions from its physician credentialing process. And, Nemours will launch a pediatric hospital-at-home program in 2024. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

The House passes a broad healthcare bill targeting site neutral payments, price transparency, and pharmacy benefit managers. A congressional inquiry finds that the nation’s largest pharmacy chains share medical data with law enforcement without a warrant. And, Moody’s downgrades Walgreens rating to ‘junk’ amid the pharmacy company's recent healthcare strategy push. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Cigna and Humana abandon their reported merger. The FDA approves two groundbreaking gene therapies to treat sickle cell disease. And, Congressional lawmakers introduce a bill that would prevent Medicare payment cuts to physicians next year. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Hospitals in states with restrictions–or even bans–on abortions are providing their physicians with little guidance on how to provide emergency abortion care. State laws are often unclear and don’t spell out exactly which exceptions are permitted and which are not. This leaves hospitals–and physicians–in a tricky situation as they navigate providing care while avoiding liability. On today’s episode, Washington Post national healthcare reporter Dan Diamond joins the podcast to talk about an article he recently co-authored that investigates how physicians and hospitals are navigating these laws. You can read Dan and Caroline Kitchener’s article here. Hosted on Acast. See acast.com/privacy for more information.

The Biden Administration will go after patents in an effort to bring down drug prices. Michigan’s governor signs two bills that increase fines for violence against healthcare workers. And, NorthShore-Edward-Elmhurst Health rebrands as Endeavor Health. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Contract negotiations between Adventist Health and Blue Shield of California break down. Residents at Northwestern Medicine announce they plan to unionize. And, a new study finds that the number of FDA drug manufacturer inspections dropped sharply after the beginning of the COVID-19 pandemic. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

CVS unveils a new ‘cost plus’ drug pricing model meant to streamline the drug reimbursement process. States that don’t fix their Medicaid redeterminations issues could face a loss of federal funding and fines under an interim final rule. And, a cyberattack on a Corewell Health vendor exposes the personal data of one million of its patients. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

North Carolina’s Medicaid expansion goes into effect. Community Health Systems finalizes its sale of three of its Florida hospitals to Tampa General. And, a House panel will investigate the Food and Drug Administration over its decision to declare certain oral, over-the-counter decongestants as ineffective. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

In March, employee healthcare navigation company Transcarent announced it would acquire AI-powered primary care startup 98point6’s virtual care platform and care business. On today’s episode of Gist Healthcare Daily, we hear the second part of JC’s conversation with Transcarent CEO Glen Tullman about that acquisition and how it fits into his Transcarent’s long-term goals. They also discuss Tullman’s thoughts on the future of employer-sponsored healthcare. You can find the first part of the conversation here. Hosted on Acast. See acast.com/privacy for more information.

The Biden Administration will invoke the Defense Production Act to manufacture more drugs in the United States amid an ongoing shortage. The FTC announces it will investigate the safety of CAR-T therapies. And, Federal lawmakers introduce a bill that would ban fees for electronic healthcare payments. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

Major health insurers Cigna and Humana are reportedly in talks to merge. The number of US physicians either employed by or affiliated with Optum  swells to nearly 90,000. And, the merger between BJC HealthCare and St. Luke’s Health System is expected to close at the beginning of the year. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.

A massive data breach last week disrupts operations at a large, multi-state health system. Optum faces a federal lawsuit from a California hospital alleging antitrust violations. And, Fairview Health plans to end its current partnership with the University of Minnesota. That’s coming up on today’s episode of Gist Healthcare Daily. Hosted on Acast. See acast.com/privacy for more information.