Episodes

  • 115. Is Value-Based Care Real … Or Just Healthcare's Favorite Myth?

    115. Is Value-Based Care Real … Or Just Healthcare's Favorite Myth?
    Feb 20 2026
    Value-based care has been around for a while. While it is a favorite buzzword in healthcare, some are questioning its effectiveness. Is that fair? 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 value-based care. It has been around for a while. While it is a favorite buzzword in healthcare, some are questioning its effectiveness. Is that fair? Key Takeaways: A recent Health Affairs Forefront blog lit a bit of a firestorm when it argued that value-based payments — and even managed care — are not going to solve healthcare affordability. They missed the fact that healthcare is in the middle of a long, messy, transformational journey — and transformation never looks impressive in the early chapters. Value-based payments are meant to move us away from the old fee-for-service system — the transactional payment model that has dominated healthcare for decades. That has driven utilization, price, and costs. And the current system does not prioritize long-term quality or outcomes. There are various value-based-care (VBC) and payment (VBP) models that have emerged, from ACOs to episodic payments to capitation to partial and global risk funds. Regions, lines of business, provider type and the size of providers all determine how penetrated VBC or VBP are. Somewhere between 35% and 45% of healthcare payments today are tied to some form of value-based model. But true risk-bearing arrangements might only account for about 20% of transactions. Critics of VBC say many pilots haven't generated dramatic savings, value-based models may be accelerating consolidation and empowering corporate intermediaries, and spending slowdowns don't appear strongly correlated with VBC adoption. But there is plenty of evidence that mature VBC models do save and drive outcomes and we just may not be there yet throughout our healthcare system. 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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    20 mins
  • 114. 2027 Rate Advance Notice Bad News For Medicare Advantage

    114. 2027 Rate Advance Notice Bad News For Medicare Advantage
    Feb 13 2026
    The Trump administration released the 2027 Advance Notice for Medicare Advantage and Part D, and the near-zero rate hike sent a shockwave through the MA industry. 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 release of the 2027 Advance Notice for Medicare Advantage and Part D. The near-zero rate hike sent a shockwave through the MA industry. Key Takeaways: In a huge shock to the industry, the Trump administration proposed a near-zero rate hike for 2027 in Medicare Advantage (MA). While the Effective Growth Rate was almost 5%, it was nearly zeroed out by two new risk adjustment reform changes. The 2027 increase stands at just 0.09% right now. That means just $700M in additional revenue in 2027 compared with $25B in 2026. Plans got no breathing room in 2027 after the new v28 risk model was phased in from 2024 to 2026 and took out 7.62% from rates. The proposed risk adjustment changes updated the new v28 model for more recent data as well as eliminated any chart review or health risk assessment submissions with diagnoses that do not have a linked medical encounter. The unlinked chart change has major impact on the biggest plans that practice very aggressive risk coding. The industry receives as much as $7.5B annually now for unlinked charts. Last year, the effective growth rate grew by almost 3% from the Advance Notice to the Final Announcement. That could happen again and move the rate for 2027 to just below 3%. This is still far below the 5% from 2026. A Stars restructuring that will reduce ratings and quality bonuses in the future compounds the overall gloomy financial picture. The MA recovery will be complicated by the rate announcement and more benefit, product, and geographic contractions are likely in 2027. The era of free-wheeling rates and risk adjustment is over. Plans need to focus on clinical management, quality, and cost control. One silver lining: overpayments are coming down and it is tantamount that the industry ensures Congress knows this before lawmakers push through more reforms. 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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    19 mins
  • 113. Warning Signs: 2024 National Healthcare Data

    113. Warning Signs: 2024 National Healthcare Data
    Feb 6 2026
    The 2024 National Healthcare Expenditure Data are out and there are huge warning signs for the country. 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 releases of the 2024 National Healthcare Expenditure Data. There are huge warning signs for the country. Key Takeaways: The 2024 National Healthcare Expenditure Data were finally released after a delay due to the government shutdown. In 2024, healthcare spending in the United States rose to $5.279 trillion, a $353.3 billion or 7.2% increase. Healthcare expenditures as a percentage of gross domestic product went from 17.7% in 2023 to 18% in 2024. This was largely driven by heightened utilization (use and intensity) and a shift in the types of services consumed (4.7%) and less so for actual inflation (2.5%). Hospital care was 31% of expenditures, physician and clinical services 21%, and prescription drugs 9%. The insured share of the population was 91.8% in 2024— down slightly from an historic high of 92.5% in 2023. Private Health Insurance was 31% of spending and reached $1.6 trillion in 2024, an 8.8% increase. Medicare was 21% of spending and reached $1.1 trillion in 2024, a 7.8% increase. Medicaid was 18% of spending, increasing 6.6% to $931.7 billion in 2024. Out-of-pocket costs were 11% of total expenditures and increased 5.9% to $556.6 billion. The typical working family in the U.S. spent $3,960 on healthcare-related costs in 2024, including premiums and out-of-pocket expenses. The robust growth shows the challenges ahead for healthcare. It was the second consecutive year costs trended up more than 7%. The ongoing growth in NHED is clearly not sustainable. Without major reform, we are faced with a number of compounding problems – economic stagnation, more Americans will become uninsured and underinsured, and healthcare will become more and more unaffordable. 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
  • 112. Donald Trump's "Great Healthcare Plan" Falls Short

    112. Donald Trump's "Great Healthcare Plan" Falls Short
    Jan 30 2026

    Donald Trump's new healthcare plan falls short and does not truly make things affordable.

    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 Donald Trump's new healthcare plan. It falls short and does not truly make things affordable.

    Key Takeaways:

    Donald Trump announced his "Great Healthcare Plan" on TikTok recently.

    It is at best a skeletal framework and would need Congress to pass legislation.

    The two main tenets include drug price reform and expansion of Health Savings Accounts (HSAs) in lieu of some or all of the current Exchange subsidies.

    It is unclear just how far-reaching the HSA expansion would be.

    Other proposals include transparency at health plans.

    The proposal would need congressional action and Trump's views dovetail with many in Congress advocated by the GOP.

    Conservative House Republicans propose to pass a second budget reconciliation bill that includes replacing Exchange subsidies with HSAs, pharmacy benefits manager (PBM) reform, and more.

    The Senate framework for the Exchange subsidy compromise also includes HSA expansion, ICHRA expansion, and more alternative coverage expansion.

    Other Senate bills would replace Exchange subsidies in whole or part or offer options to use HSAs instead.

    The HSA expansions could undermine the Exchange market and lead to a rate death spiral as risk rises.

    In general, Trump's proposals do not get to the root cause of unaffordability – prices in the system.

    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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    17 mins
  • 111. Diving Deep On GLP-1 Coverage and Drug Price Reform Models

    111. Diving Deep On GLP-1 Coverage and Drug Price Reform Models
    Jan 23 2026
    We dive deep on GLP-1 coverage and drug price reform models. President Trump certainly deserves credit for the major accomplishments. 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 dives deep on GLP-1 coverage and drug price reform models. President Trump certainly deserves credit for the major accomplishments. Key Takeaways: We dive deep on GLP-1 coverage and drug price reform models. President Trump certainly deserves credit for the major accomplishments. The president has been proposing seismic reforms for drug pricing, including direct talks with brand drug makers. Over a dozen drug makers offered price concessions, including makers of GLP-1 weight-loss drugs. A new Medicare and Medicaid model would reduce costs for GLP-1 weight-loss drugs and expand coverage to help those with obesity alone and no other underlying disease states. Cost-sharing would be no more than $50 per month in Medicare. The models start in 2026 for Medicaid and 2027 for Medicare. As promised, Trump also proposed most-favored nation (MFN) drug pricing in Medicaid and Medicare. The Medicaid model is called GENEROUS and would set MFN pricing on all Medicaid drugs for participating drug makers. The MFN price in Medicaid would be the second-lowest price in a set of eight developed world countries. The Medicare models are called GLOBE for Part B drugs and GUARD for Part D drugs. A subset of B and D drugs would be covered, and the models are mandatory for drug makers. About 25% of beneficiaries with B or D drug costs would be in each model. The MFN price in Medicare B and D is based on 19 developed-world countries and would be either the lowest international price from commercially available data sources or the average international price as reported by drug makers. A big debate has emerged on MFN pricing and the impact on innovation. Some advocate for prospective MFN on new drugs only, while others want retrospective MFN, applying it to existing drugs as well. 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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    32 mins
  • 110. Affordability Will Dominate The Midterms

    110. Affordability Will Dominate The Midterms
    Jan 16 2026

    There is little question that affordability will dominate the 2026 midterms and that is most true on healthcare. Learn more on the issue as well as on the prospects for a possible Exchange subsidy compromise.

    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 that affordability will dominate the 2026 midterms and that is most true on healthcare. He also discusses the prospects for a possible Exchange subsidy compromise.

    Key Takeaways:

    Affordability will dominate the 2026 midterms and that is most true on healthcare.

    We have seen huge price and inflation trends in healthcare since coming out of the COVID pandemic and there is little sign that the aggressive trends will subside anytime soon.

    Family coverage now costs on average almost $27,000, with employees paying almost $7,000 of the upfront cost.

    Medicare costs are rising by 10%.

    The One Big Beautiful Bill Act (OBBBA) will cause millions to lose coverage in Medicaid and the Exchanges

    Premiums will surge in the Exchanges if the enhanced subsidies expire.

    The GOP hopes it can pin unaffordability on the ACA of 2010, but it remains a popular law. It will also try to pass other conservative healthcare reforms.

    But Democrats will point to the OBBBA as a major culprit for unaffordability and win the day.

    There is at best a 50-50 shot a compromise on enhanced Exchange subsidies passes in January, but there are barriers including opposition from conservatives.

    A possible grand bargain could include a shorter extension, some reforms of existing enhancements, and some conservative healthcare reforms.

    If lawmakers really wanted to tackle affordability, they would implement site neutral payments, set prices for medical services and drugs, tackle the primary care crisis, and more.

    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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    15 mins
  • 109. The Importance of Primary Care and Managing Disease States

    109. The Importance of Primary Care and Managing Disease States
    Jan 9 2026

    A major study shows that investing in primary care and managing disease states could reap huge savings and improve outcomes.

    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 a major study showing investments in primary care and managing disease states could reap huge savings and improve outcomes.

    Key Takeaways:

    America spends the most on healthcare but has the worst outcomes.

    One reason is the lack of focus on primary care and management of disease states.

    America has huge inpatient costs due to admissions for uncontrolled conditions.

    Forty-three percent of patients with diabetes and heart disease are not treated at all with evidence-based treatments and only 20% are treated adequately based on evidence.

    Wakey Consulting finds that annual wellness visits (AWVs) can demonstrably help control costs among Medicare beneficiaries.

    Wakley found that AWVs are considerably underutilized. About 45% of beneficiaries had just one or no such visits during the study period.

    But showing how such visits can reduce costs and improve outcomes, Medicare beneficiaries who had 4 to 6 visits during the study period had lower inpatient and emergency department spending.

    Those who received AWVs had an average $885 reduction in total costs per beneficiary per year. The $885 is almost 6% of Parts A and B spending in 2024.

    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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    12 mins
  • 108. The 2025 Healthcare Year in Review and Predictions for 2026

    108. The 2025 Healthcare Year in Review and Predictions for 2026
    Jan 2 2026

    As always at the end of the year, I recap healthcare happenings and tell you my predictions for the new year – just don't hold me to them!

    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 healthcare happenings in 2025 and makes some predictions for 2026.

    Key Takeaways:

    It was a busy year in healthcare with insurer woes, a new president, and a decidedly different healthcare policy approach.

    The One Big Beautiful Bill dominated a lot of the news in the first half of 2025. It led to a massive tax cut package that cut healthcare in Medicaid and the Exchanges by $1 trillion over ten years.

    The government shutdown for a record 43 days over whether Exchange subsidy enhancements would be extended. So far, they were not.

    President Trump laid out an aggressive drug price reform agenda and so far has gained a lot of concessions and is pressing on with most-favored-nation price reform.

    There was an insurer meltdown that led to executive changes and massive realignment and contraction in the industry, especially in Medicare Advantage (MA).

    A PwC report said that there would be huge digital investments and a move to personalized care. $1 trillion would be spent annually on the tech transformation in healthcare by the mid-2030s.

    My 2025 prediction report card was pretty good. I correctly forecast deep cuts in healthcare, a healthcare shakeup by Trump, drug price reform, and the expiration of subsidies at year's end.

    My 2026 predictions include a striking of drug tariffs by courts, another GOP healthcare bill, Congress and CMS pushing many MA reforms, and Democrats taking back the House in midterms.

    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