Georgetown Professor Linda Blumberg Discusses Commercial Health Insurance "Middlemen"
Over roughly the past year Prof. Blumberg and her Georgetown Center for Health Insurance Reform (CHIR) colleagues have been researching healthcare providers and payers increasing use of third-party entities they collectively termed “middlemen” with whom providers and payers contract to provide various supportive administrative or financial services. For example, payers frequently use of Third Party Administrators/TPAs and providers of Revenue Cycle Managers/RCMs. The use of middlemen is a problem because these entities are “rent seeking,” meaning they profit without creating new or additional value, thereby reducing economic efficiency and competition and driving prices up. In CHIR’s October report titled, The Complex Web of HC Fin Interests & Their Implication for Even Higher Spending,” Prof. Blumberg and her colleagues concluded relationships with middlemen have “resulted in a complex web of cost increasing incentives, money flows, and conflicts of interest. The complexity is so tremendous that it is virtually impossible to capture the entire picture of the existing financial relationships.” (Listeners may recall interviewed Leigh’s Prof. Katz-Olson in March 2022 regarding her related work, “Ethically Challenged, PE Storms US Health Care.” CHIR writings discussed during this interview include:https://chir.georgetown.edu/events/why-health-care-costs-are-rising-the-role-of-corporatization-and-bipartisan-solutions-to-increase-affordability/https://chir.georgetown.edu/events/why-health-care-costs-are-rising-the-role-of-corporatization-and-bipartisan-solutions-to-increase-affordability/https://chir.georgetown.edu/evidence-on-private-equity-suggests-that-containing-costs-and-improving-outcomes-may-go-hand-in-hand/https://chir.georgetown.edu/third-party-administrators-the-middlemen-of-self-funded-health-insurance/https://chir.georgetown.edu/independent-dispute-resolution-process-2024-data-high-volume-more-provider-wins/CHIR’s publication page is at: https://chir.georgetown.edu/search/?filter=publications This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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Prof. Troy Brennan Discusses His Just-Published, "Wonderful and Broken, The Complex Reality of Primary Care in the US"
Even though PC is the only component of healthcare shown to increase life expectancy and is crucial to achieving healthcare equity, outcomes, quality and value PC remains on life support. For example, an August National Academy of Medicine report concluded, “despite PC’s essential value for the health of the nation, more than 100 million people across rural and urban communities in the US are experiencing a calamitous lack of access to primary care.” Among numerous problems: PC accounts for less than 5% of total healthcare spending; there are too few primary care clinicians and too many, at 7,501, HRSA PC shortage areas; PC clinicians are inadequately reimbursed and maldistributed. Consequently, PC struggles to adequately address prevention, the social determinants of health, integrate care particularly behavioral health services and ultimately achieve optimal value. In “Wonderful and Broken,” Prof. Brennan discusses how PC care can be improved and organizations that are at least on the path toward stable and effective PC delivery. (Listeners may recall I interviewed Prof. Brennan in October 2024 regarding his just published previous work, “The Transformation of American Health Insurance” & that this is at least my 5th PC discussion dating back to 2013.)Information on Prof Brennan’s book is found at: https://www.press.jhu.edu/books/title/54051/wonderful-and-broken?srsltid=AfmBOor4SJMCBvCYWck_6Aobdxk-ZUJgusnceOxxT-eghoU8CkPc3kMl. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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Dr. Sachin Jain Discusses Ethical Erosion in Healthcare
Because healthcare today can be increasingly defined as commodified, expedient, financialized, myopic, reductionist and failing to transcend politics, the question of healthcare’s ethics or the roll ethics plays should play is increasingly begged. For example, last October Health Affairs launched an “Ethics and Health Systems Change” series that to date has simply complained about private equity and corporate medicine, federal immigration and gender care policies and de-professionalization. What fidelity does healthcare have to normative ethics when, for example, 27 million Americans and counting are uninsured, over 100 million lack a primary care provider and over 90 million cannot afford care if they needed today. Dr. Jain, President and CEO of the SCAN Group and SCAN Health Plan, discusses the causes of healthcare’s ethical erosion and how begged ethical issues or questions can be addressed. The two Forbes articles authored by Dr Jain and discussed during this interview are at: https://www.forbes.com/sites/sachinjain/2025/09/22/ethical-erosion-how-good-people-lose-their-way-in-healthcare/ and https://www.forbes.com/sites/sachinjain/2025/01/21/who-me-ethical-erosion-and-the-deafening-silence-of-americas-healthcare-leaders/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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Drs. Michael Liu and Rishi Wadhera Discuss CMS's WISeR Medicare Demonstration
This past summer CMS, more specifically CMMI, announced a six-year Medicare Part A demonstration that would require hospitals in six states to submit claims for prior authorization (PA) approval by non-medical, CMS-contracted, 3rd party entities using enhanced technologies, i.e., AI, for 17 medical items and services. Private/commercial Medicare or Part C Medicare Advantage plans have for years extensively used PAs though data suggests Medicare Advantage PA use has been excessive, e.g., a very high percentage of PA denials are reversed upon appeal) and widely viewed as a tool to enhance profit taking. CMMI-contracted tech/AI companies will be compensated based on a share the money saved from PAs contractors’ deny though subject to meeting quality criteria. The WISeR demo has attached a fair amount of criticism, e.g., 12 Senate Democrats and 17 House Democrats each wrote letters to HHS/CMMI noting their concerns that include the demo will present patient roadblocks, cause some patients to abandon care, risk denying necessary care, inflict substantial administrative burden on clinicians, perversely incent AI contractors and they argued Americans do not want AI involved in their healthcare decisions. The July 1 Federal Register WISeR notice is at: https://www.govinfo.gov/content/pkg/FR-2025-07-01/pdf/2025-12195.pdf.The CMS/CMMI WISeR website is at: https://www.cms.gov/priorities/innovation/innovation-models/wiser.Liu and Wadhera’s NEJM Perspective essay re: the WISeR demo is at: https://www.nejm.org/doi/abs/10.1056/NEJMp2510451. Don Berwick and Andrea Ducas’s STAT opinion essay re: the WISeR demo is at: https://www.statnews.com/2025/07/25/medicare-advantage-prior-authorization-cms-innovation-center-wiser-project/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
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37:48
Mr. Michael Millenson Discusses the (Tragic) State of Patient Safety
The World Health Organization (WHO) defines patient safety as “a framework of organized activities to reduce risks, lower the occurrence of avoidable harm, make errors less likely, and minimize their impact when they occur.” Over this past summer the HHS Office of the Inspector General (OIG) published three patient-safety reports. (Since 2008 the OIG has published at least 24 related studies.) One published in July found hospitals failed to capture half of harm events that occurred among hospitalized Medicare patients, few were investigated and even fewer led to hospitals making PS improvements. These findings were sadly unsurprising since the OIG previously found in 2008 that 27% of Medicare patients experienced harm during hospital stays, a decade later, or in 2018, still 25% experienced harm. In an July 24 OIG letter to CMS Administrator, Dr. Mehmet Oz, the OIG noted in part that while CMS and states require hospitals to publicly report just 15 of 94 harm events, hospitals reported only 5 of 15, or 5% of all 94 harm events. HHS has yet to publicly respond to the OIG’s recent reports much less recognize them. Dedicated podcast listeners may recall I’ve previously discussed patient safety in 2015, 2017 and in 2020.A summary of the HHS OIG’s adverse events/patient safety work with a list of its publications can be found at: https://oig.hhs.gov/reports/featured/adverse-events/. Information regarding Mr. Millenson is at: https://millenson.com/.Mr. Millenson’s recent medical errors essay in Forbes is at: https://www.forbes.com/sites/michaelmillenson/2025/09/12/lessons-from-the-medical-error-that-orphaned-a-cabinet-secretary/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
About The Healthcare Policy Podcast ® Produced by David Introcaso
Podcast interviews with health policy experts on timely subjects.
The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics.
An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void.
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