The Healthcare Labyrinth

By: Marc S. Ryan
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  • Summary

  • Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.
    2023
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Hygiene & Healthy Living Social Sciences
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Episodes
  • 55. Reforming The Medicare Advantage Minimum Medical Loss Ratio

    55. Reforming The Medicare Advantage Minimum Medical Loss Ratio
    Dec 27 2024
    CMS should be cautious in reforming Medicare Advantage’s minimum medical loss ratio requirements. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the recent proposal from CMS to reform the Medicare Advantage minimum medical loss ratio requirements. CMS should be cautious so as not to hurt value-based care. Key Takeaways: In its 2026 proposed rule, CMS proposes to reform the Medicare Advantage minimum medical loss ratio requirements. The minimum MLR is meant to control costs and premiums. Health plans have to spend either 80% or 85% of premium on medical expense. CMS proposes to ensure provider contracts have clinical and quality standards in the contract, gather information on plan-provider contracts, and solicit comments on vertical integration concerns. Many worry that revenue is being passed to providers and other entities and not really being spent on medical expense. The concern is big regarding plans that contract with sister entities within a larger health plan entity. These are called intraparty agreements. Placing standards in provider contracts is reasonable, but CMS should be cautious about limiting profit by providers. CMS should rein in intraparty agreements by requiring them to be arm’s length. Connect with Marc Marc on LinkedIn Marc on Twitter THL Podcast Resources THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    23 mins
  • 54. What Americans’ Experiences During Open Enrollment Tell Us About The Broken Healthcare System

    54. What Americans’ Experiences During Open Enrollment Tell Us About The Broken Healthcare System
    Dec 20 2024
    I help many people each year during open enrollment and it tells us a lot about the broken healthcare system in America. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc tells us about the people he helped during the open enrollment season. The experiences tell us a lot about the broken healthcare system in America. Key Takeaways: Each year I help many people during open enrollment. Many are having major health events and life experiences. Open enrollment causes great stress and means big financial decision. It is complex and confusing. Major plan terminations have complicated things. Premiums, deductibles, and cost-sharing are rising. Benefits are being cut back. The American healthcare system is unreasonably complex and burdensome. We have far too many lines of business, products, and plan types -- a product of an irrational system and a lack of uniform pricing and network strategies. We are fast becoming a nation of underinsured if we are not uninsured. It is easy to blame insurers for premium costs and plan benefit designs, but provider prices drive this. Costs in the system are out of control and we desperately need to tackle price. Connect with Marc Marc on LinkedIn Marc on Twitter THL Podcast Resources THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    40 mins
  • 53. The Medicare Advantage and Part D Rule For 2026 Is Out With Major Changes

    53. The Medicare Advantage and Part D Rule For 2026 Is Out With Major Changes
    Dec 13 2024
    The Medicare Advantage and Part D Rule For 2026 is out with major changes in both the Part C and Part D worlds. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the just released Medicare Advantage and Part D Rule For 2026. It proposes major changes for both the Part C and Part D worlds. Key Takeaways: The rule was not published in time for Biden to finalize it before leaving office, so Trump can make changes easily. Part D would now have to cover expensive anti-obesity drugs. Generics and biosimilars are promoted through formulary reforms. New pharmacy disclosure and network reforms Additional prior authorization and utilization management tightening. Behavioral health and supplemental benefit changes. CMS would change medical loss ratio regulations to ensure no gaming of required medical expense spending. New marketing reforms given the major controversies. New Star measures and updates. Connect with Marc Marc on LinkedIn Marc on Twitter THL Podcast Resources THL’s Newsfeed THL’s Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
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    43 mins

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