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
  • 52. MA's Challenges, Its Future, And Its Value

    52. MA's Challenges, Its Future, And Its Value
    Dec 6 2024
    Medicare Advantage is struggling right now, but a new study shows how important MA is to Medicare’s future.
    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 Medicare Advantage. It is struggling right now and could see some relief from the incoming Trump administration. A new study shows how important MA is to Medicare’s future. Key Takeaways: Opponents of Medicare Advantage (MA) say plans are massively over-reimbursed, but many of their statistics are fanciful. Medicare Advantage is struggling right now due to no rate hikes, low Star scores, and a return of high costs. The incoming Trump administration could offer some rate relief for 2026. Trump will be very supportive of MA overall and could propose it as a default option for seniors and the disabled. But we should continue to expect certain reforms of MA to continue. A new study shows that MA has saved dollars in the traditional program as MA penetration grew. Provider behavior appears to have changed in the traditional program as MA grew. Providers began to focus on cost-savings and outcomes on both MA and traditional Medicare lives. This new study as well as those showing better outcomes in MA need to be part of the playbook on Capitol Hill and at CMS. 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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    26 mins
  • 51. Why Trump And The GOP Should Safeguard The ACA

    51. Why Trump And The GOP Should Safeguard The ACA
    Nov 29 2024
    There are many reasons Trump and the GOP should safeguard the Affordable Care Act, including the fact it saves and is key to overall healthcare reform. 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 Affordable Care Act and the potential for the GOP to repeal and replace it. There are many reasons Trump and the GOP should safeguard the Affordable Care Act, including the fact it saves and is key to overall healthcare reform. Key Takeaways: The Affordable Care Act (ACA) is a prudent investment. The ACA is popular among Americans and has benefited over half the U.S. population. The Exchanges are actually a red and swing state program. The uninsured rate is down considerably due to the ACA. A recent study shows how the ACA actually has already reduced costs. Affordable universal access is key to future healthcare reform. Affordable universal access is key to one GOP tenet of reform as well – personal responsibility. 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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    22 mins
  • 50. What The Election Outcome Means To Healthcare

    50. What The Election Outcome Means To Healthcare
    Nov 22 2024
    Seismic changes in healthcare may be dependent on how aggressive Trump and the GOP want to be. But expect some major budgetary impacts to healthcare.

    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 election outcome, with the GOP expected to control the House, Senate, and White House. Seismic changes in healthcare may be dependent on how aggressive Trump and the GOP want to be. But expect some major budgetary impacts to healthcare.

    Key Takeaways:

    The GOP is expected to control the House, Senate, and White House.

    Whether seismic healthcare changes occur depends on how aggressive Trump and the GOP want to be.

    Tight margins in the House and Senate could impact whether far-reaching changes to the Affordable Care Act, Exchanges, and Medicaid are passed.

    Medicare will likely not be subject to major changes, although lawmakers may push accountability changes for Medicare Advantage.

    Medicare drug price reform is popular and its repeal is questionable. America should expect a series of budget reductions that will impact the Exchanges, Medicaid, perhaps Medicare, and coverage in general. 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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    31 mins
  • 49. Big Healthcare Has Troubles And Its Future Is Unknown

    49. Big Healthcare Has Troubles And Its Future Is Unknown
    Nov 15 2024
    Some companies in Big Healthcare are having issues caused by both internal and external forces. External scrutiny will rise even as Big Healthcare attempts to right its finances. 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 Big Healthcare. Some companies in Big Healthcare are having issues caused by both internal and external forces. External scrutiny will rise even as Big Healthcare attempts to right its finances. Key Takeaways: A number of Big Healthcare companies are facing challenges. In general, stocks are lower in the seven major publicly traded Big Healthcare companies. There are pros and cons to vertically integrated Big Healthcare companies. While some of the companies continue to perform well, several have financial challenges. Regulators and Congress are closely scrutinizing Big Healthcare in various ways, including antitrust investigations, vertical integration, and more. Consolidation increases not lowers prices in healthcare. Big Healthcare trends, including acquisition and vertical integration, are likely to serve investor interests in the short term. But regulatory and congressional actions could slow further acquisitions down over time and eventually lead to changes with Big Healthcare. 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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    30 mins
  • 48. It Is Time For A Permanent Physician Rate Fix In Medicare

    48. It Is Time For A Permanent Physician Rate Fix In Medicare
    Nov 8 2024
    A physician rate fix has been put off for decades and has devastated primary care and physician practices. It is time for a permanent fix to be passed by Congress.

    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 argues that a physician rate fix has been put off for decades and has devastated primary care and physician practices. It is time for a permanent fix to be passed by Congress.

    Key Takeaways:

    A physician rate fix has been put off for far too long in Congress.

    Physicians have been on a rate roller coaster for decades.

    Physicians were subjected to huge reductions in their rates and then temporary fixes.

    Over the past decades, rates on a real basis (against inflation) have dropped by 26% from 2001 to 2023.

    The rate crisis in Medicare for doctors has led to the acquisition of 75% of all physicians by health systems, private equity, or health plans. Just 25% remain in private practice and the erosion continues.

    The erosion of independent practices has led to huge new costs in the healthcare system that dwarf what could have been put into physician rates over the years.

    A permanent doc fix could be paid in part by implementing site neutral payments in full in Medicare.

    A permanent fix is needed as well as investments in primary care.

    Other developed countries spend more than double what America does on primary care.

    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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    24 mins