Inside Healthcare from Fulcrum Strategies

What will healthcare look like in 2026—and how will it impact physicians and patients? This episode reveals the strategies insurance giants and policymakers are deploying, and what it means for your practice and community.Ron Howrigon and Matthew Handley discuss Affordable Care Act (ACA) subsidies, changes to the Medicare Physician Fee Schedule, and why the payers are going to push on provider groups to take pay cuts. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

In this episode of Inside Healthcare, Matthew Handley and Ron Howrigon delve into the complexities of healthcare costs and insurance denials. They discuss the financial incentives that drive insurance companies to deny claims and Ron's recent appearance on ‪CBS Sunday Morning‬ .Listen: Matthew and Ron talk to Dr. Dan Hurley about his cancer diagnosis and subsequent insurance denialsWatch: Why do insurance companies deny prior authorizations? Ron Howrigon explains on CBS Sunday Morning This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On this episode of Inside Healthcare, Ron Howrigon and Matthew Handley discuss the Affordable Care Act subsidies that were at the heart of the record long government shutdown. What do they do? Who are they for? And is it really “free” healthcare? All questions Ron and Matthew answer. Plus they take a look at a reform plan from Oscar Health CEO Mark Bertolini.LIVE stock prices:Oscar Health - $OSCR Listen wherever you get your podcast or watch us on Substack and YouTube. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Join Ron Howrigon and Matthew Handley as they break down the latest in healthcare costs during the ongoing government shutdown. In this episode, they explore four GOP-backed compromise solutions and what they mean for consumers, while analyzing why fully insured plan premiums are projected to rise by 11%. Stay informed on healthcare trends, policy updates, and practical insights for navigating rising insurance costs.Articles mentioned in this program:US Health Insurers Face Rising Uncertainty from ACA Subsidy Expiration - Fitch Ratings4 GOP ideas for an Obamacare subsidies compromise - POLITICOHow much and why premiums are going up for small businesses in 2026 - Peterson-KFF Health System TrackerListen wherever you get your podcast or watch us on Substack and YouTube. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

The US Senate could not agree on a budget and as a result, the government has entered a partial shutdown. We’ll talk about what healthcare spending will continue and what problems may arise at the Centers for Medicare and Medicaid Services. Plus: What are those Affordable Care Act subsidies that Democrats are so concerned about?Listen wherever you get your podcast or watch us on Substack and YouTube. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Fulcrum Strategies President and CEO Ron Howrigon breaks down the problems with the "Make America Healthy Again" (or MAHA) movement. It's not that the goals and sentiment aren't good; it's that the process is extremely flawed.Listen wherever you get your podcast or watch us on Substack and YouTube.Learn more about what Fulcrum Strategies can do for your practice at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Ron Howrigon and Matthew Handley are back with healthcare analysis and discussion on Inside Healthcare from Fulcrum Strategies.In this episode, Ron and Matthew discuss claims by current Health and Human Services Secretary Robert F. Kennedy, Jr. that there are no impending cuts to Medicaid and what physicians are really facing as a result of the Big Beautiful Bill. They also discuss the sudden change to Medicaid reimbursement in North Carolina.Listen wherever you get your podcast or watch us on Substack and YouTube.LIVE STOCK PRICES:UnitedHealth Group: $UNH Elevance: $ELV CVS: $CVS Cigna: $CI Humana: $HUM Molina: $MOH Learn more about what Fulcrum Strategies can do for your practice at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon discuss the life of the late Dr. Dan Hurley with his wife Dr. Traci Hurley, his sister Christine, and his brother Tom. They shared memories of his life and why he fought so hard for transparency in our healthcare system.Matthew and Ron spoke to Dr. Hurley last year on the FLATLINING Podcast after he was diagnosed with dedifferentiated chondrosarcoma and his insurance company had denied payment for radiology scans that would have aided his treatment.--Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.--Dan Hurley, M.D. Endowment Fund - CS FoundationThe Story of Dr. Dan Hurley - Ron Howrigon at FLATLINING.netCLICK HERE to listen to our original conversation with Dr. Hurley--Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On the FLATLINING Podcast from Fulcrum Strategies this week, Ron Howrigon and Matthew Handley a recent PBS News report on the shortage of pediatric physicians.  Is the mainstream media finally seeing what patients have been experiencing for years?  How do we ensure that we will have enough doctors to take care of us in the future?---Articles mentioned in this program:The causes and consequences of a decline in doctors going into pediatric care - PBS News---Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.Follow Matthew on X and LinkedIn.  Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On the FLATLINING Podcast from Fulcrum Strategies this week, Ron Howrigon and Matthew Handley discuss what sort of healthcare platforms Vice President Kamala Harris could advocate as the new Democratic nominee.  They also discuss a recent interview Ron gave with New York Magazine on automatic insurance denials. --Further reading:Where Kamala Harris Stands on Key Healthcare Issues - Medpage TodayIn Denial - New York Magazine--Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and CEO Ron Howrigon discuss how the Supreme Court overturning Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. could affect healthcare down the road.  There is a possiblity that it could dictate how the Centers for Medicare and Medicaid Services detirmine Medicare reimbursement, whether or not the Food and Drug Administration can approve over the counter medications, and more.  Matthew and Ron also discuss how this ruling could affect the No Surprises Act.--Further reading:What Does the Overturning of Chevron Mean for Healthcare? - Holland and KnightHow the Supreme Court has roiled U.S. health-care agencies - The Washington PostWe break down the overturning of the Chevron doctrine - NPR--Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and CEO Ron Howrigon have a conversation with universal healthcare advocate Wendell Potter.  They discuss Wendell's decision to get out of the insurance business and become an advocate for affordable healthcare for all Americans.Wendell Potter was a VP level executive at Cigna before he left in 2008.  He now advocates for universal healthcare and is the leader of two reform advocacy nonprofits: the Center for Health and Democracy and Business Leaders for Health Care Transformation.  He is also a New York Times best-selling author and his most recent book is For Want of a Dentist: The Rise of the Dental Therapy Movement in Tribal Nations and the US.  You can follow his work on his Substack: Health Care Un-covered. ---Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have ubscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.Follow Matthew on X and LinkedIn.  Follow Ron on LinkedIn.---Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Next week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon talk to former Cigna executive Wendell Potter about the feasibility of universal healthcare in the United States.---Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and CEO Ron Howrigon have a conversation with Gus Geraci, MD about the challenges of reforming healthcare.Dr. Gaspere Geraci has more than thirty-five years of clinical, process, and quality improvement experience.  He has worked as a physician, recruiting physicians and working with insurance companies.  You can find more about him on his website, drgeraci.com, Rate Your Healthcare Employer, and and follow him on X and LinkedIn.--Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and CEO Ron Howrigon discuss several healthcare-related news items and how they affect patients and providers. They discuss for-profit HMO’s being banned from participating in Minnesota Medicaid products.  They also discuss the economic impact and future of insurance coverage for GLP-1 weight loss drugs such as Wegovy and Zepbound.  Also on the program: UnitedHealthcare has announced they will increase their usage of artificial intelligence.  Plus: a former AstraZeneca executive is charged with cyber stalking after he sent threatening messages to leadership at CVS Health and Aetna.--Articles mentioned in this program:For-profit HMOs will, again, be blocked from Minnesota's Medicaid program - Minneapolis Star Tribune Weight loss drug coverage gets more complicated - Becker's Payer IssuesReal-World Trends in GLP-1 Treatment Persistence and Prescribing for Weight Management - BlueCross BlueShieldUnitedHealth testing 500 AI use cases - Becker's Hospital ReviewPatient’s Dark Fantasy About Aetna Lands Him in Jail - The Daily Beast--Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley sit down with Lou Tharp to discuss patient-centered healthcare and patient advocacy.  Lou Tharp is the co-founder and executive director of the Global Healthy Living Foundation, a non-profit organization that focuses on improving the quality of life for those living with chronic diseases such as arthritis, psoriasis, IBS, cardiovascular disease, and more.  Lou is also the co-founder of Creaky Joints®, an international, digital community of arthritis patients and caregivers.  You learn more about the Global Healthy Living Foundation at GHLF.org and Creaky Joints® at CreakyJoints.org.  You can also follow Lou on X (@LouisTharp).Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley take a look back at the last 20 years of Fulcrum Strategies.  They discuss why Ron left his employment with the payers and began working with physicians and what has changed in the last twenty years.  They also take a look at what might change in the future.Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley break down testimony from the Congressional hearings about the Change Healthcare cyber attack.  On May 1, UnitedHealth Group CEO Andrew Witty was in the hot seat as senators and representatives grilled him on the impact to patients and providers.  Ron and Matthew break it down in a way that is easy to understand and help you know how it impacts you.Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On today’s episode of the FLATLINING Podcast from Fulcrum Strategies, President and CEO Ron Howrigon and Matthew Handley talk to John Scagnelli, MD, about multiple sclerosis.  This disease has no known cause and no known cure, but there have been some incredible advancements in treatment over the past few decades.Dr. Scagnelli specializes in Multiple Sclerosis and Adult Neurology at Raleigh Neurology’s Durham and Raleigh offices. Dr. Scagnelli received his BS in Human Development from Cornell University in 2002. He earned his MD from the University of Miami, Miller School of Medicine in 2006. He then completed his Neurology Residency at the University of Rochester, Strong Memorial Hospital. Following this he was awarded a National Multiple Sclerosis Society Fellowship to study the clinical care and research of patients with multiple sclerosis and related disorders at the University of Virginia.  Dr. Scagnelli is a member of the National MS Society and the American Academy of Neurology. ---Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.---Follow Matthew on X and LinkedIn.Follow Ron on LinkedIn.---Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Next week on the FLATLINING Podcast from Fulcrum Strategies, President and CEO Ron Howrigon and Matthew Handley are joined by John Scagnelli, MD of Raleigh Neurology.  They will be discussing multiple sclerosis, a devastating disease with no known cause and no known cure.  But there is hope.  Recent research has created new advancements in treatment.  You won’t want to miss this episode of the FLATLINING Podcast.  Subscribe now wherever you listen to podcasts.----Follow Ron Howrigon on LinkedIn. Follow Matthew Handley on X and LinkedIn.----Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On today’s episode of the FLATLINING Podcast from Fulcrum Strategies, President and CEO Ron Howrigon and Matthew Handley discuss some of the most pressing topics affecting physicians and their patients.  In this episode, they discuss:•    UnitedHealth Group admits they paid the ransom for the Change Healthcare cyber attack•    The Justice Department sets up an online portal for people to report anti-competitive healthcare practices•    Emergency Medicine physicians in Detroit strike against their private equity backed employerTune in to hear more about how these topics affect patients and physicians alike.Articles mentioned in this program:UnitedHealth CEO to testify before House subcommittee May 1 - Becker's Payer IssuesFeds launch portal for reporting anticompetitive healthcare deals - Becker's Payer IssuesContracted doctors, physician assistants at Ascension St. John go on strike - The Detroit News----Follow Ron Howrigon on LinkedIn.Follow Matthew Handley on X and LinkedIn.Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.----Fulcrum Strategies is a healthcare consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Our firm has helped over 5,000 physicians in groups of all sizes and specialties across the country to significantly improve their contract language and reimbursement rates, strategically plan for the future, and achieve business success.  Learn more at FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss the news that UnitedHealth Group posted a $1.4 billion loss in quarter 1 of 2024 following the Change Healthcare cyber attack.  They talk about whether or not providers should care about news such as this.Then, they discuss a new law going into effect in California that ups the minimum wage for healthcare workers to $25 an hour.  There could be some very dramatic setbacks to healthcare quality, access, and affordability. Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Articles mentioned in this program:UnitedHealth posts $1.4B loss in Q1 following Change cyberattack - Becker's Payer IssuesCalifornia health workers may face rude awakening with $25 minimum wage law - KFF Health NewsFollow Matthew on X and LinkedIn.Follow Ron on LinkedIn.Fulcrum Strategies is a health care consulting firm specializing in payer contract negotiation and strategic planning for physician practices.  Learn more about what we can do for your practice at fsdoc.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Today on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley take a look at some of the latest healthcare news.  First, they discuss changes to the Medicare Advantage rates published by the Centers for Medicare and Medicaid Services; they explain why insurers are saying out of pocket expenses will go up for seniors.  Ron and Matthew also discuss Home Depot’s decision to appeal a settlement with BlueCross BlueShield to the Supreme Court; why wasn’t $2.67 billion enough for Home Depot?  Finally, they talk about why a bill to reduce prior authorizations in Kentucky falls flat.Listen to the FLATLINING Podcast from Fulcrum Strategies wherever you listen to podcasts and have every episode delivered to your email by subscribing at www.FLATLINING.net.Articles mentioned in this program:CMS finalizing 2025 Medicare Advantage rates – Becker’s Payer IssuesHealth insurance shares tumble on CMS news – Bloomberg 🔒Home Depot asks SCOTUS to rule on BCBS anti-trust lawsuit – Becker’s Payer IssuesKentucky gold card prior authorization bill dies – Becker’s Payer Issues This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Today on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon have a conversation with Matthew Stephens, MD, a board certified radiologists at Radiology of Indiana. Dr. Stevens, Matthew, and Ron discuss the exciting topic of artificial intelligence in healthcare, particularly AI's influence in radiology.  They discuss what some of the pitfalls are of using the new technology and what might be coming next. -- Dr. Matthew Stephens is a board-certified Body Imager with a cardiothoracic radiology specialty who joined Radiology of Indiana in 2023. He received his B.S. in Chemistry from Indiana University, Bloomington, IN. He also received his M.S. in Computer Science from Purdue University, Indianapolis, IN, along with another M.S. in Physiology from Indiana University, Indianapolis, IN.  His medical degree is from Indiana University School of Medicine. He also finished a fellowship in Medical Informatics from the Regenstrief Institute, Indianapolis, IN. -- Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

In this episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss Congress’ late fix to eliminate part of the cut to Medicare physician fee schedule.  They also discuss a recent report about a whistleblower case that alleges major accountable care organization Aledade engaged in serious Medicare fraud. -- Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. -- Articles mentioned in this episode: Congress nixes part of the Medicare cut - Matthew Handley at FLATLINING.netAledade accused of Medicare fraud in whistleblower lawsuit - Modern HealthcareAledade’s statement on whistleblower lawsuit — A previous version of this episode had an inaccurate title and an inaccurate description of a former executive at Aledade.  Those errors have been corrected.  This episode has also been updated to include a statement from Aledade. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Medicare Advantage continues to be one of the most profitable sectors of the health insurance industry, yet a lobby group backed by the nation's largest payers has claimed the federal government isn't paying them enough.  Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss this. Plus, Elevance-owned Anthem BlueCross BlueShield in New Hampshire has royally screwed up their mail-order pharmacy benefits for NH's retired employees. Matthew and Ron also discuss why UnitedHealthcare and UNC Health are possibly going to go non-par on April 1. Subscribe wherever you get your podcasts or at www.FLATLINING.net.Follow Matthew on X: @radioHandley --- Articles mentioned in this program: Payers urge 'stability' from CMS on Medicare Advantage - Becker's Payer IssuesAnthem under fire for 'massively screwed-up' Medicare Advantage contract implementation  - Becker's Payer Issues UnitedHealthcare, UNC Health near split date - Becker's Payer Issues This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a proposal in Washington to remove the site of service differential.  Removing that change would pay doctors the same regardless if a procedure is performed at a hospital or an office. Ron and Matthew also discuss if the Medicare fee schedule is going to change, a PhRMA's lawsuit against the Biden administration over drug price negotiations, and a Florida health plan that now owes the Federal Trade Commission $195 million. Listen wherever you get your podcasts or subscribe at FLATLINING.net. --- Articles mentioned in this program: In Fight Over Medicare Payments, the Hospital Lobby Shows Its Strength - KFF Health NewsJudge tosses PhRMA lawsuit over Medicare power to negotiate drug prices - STATFTC obtains $195M judgment against Florida payer, imposes healthcare ban over 'bogus' product  - Becker's Payer Issues This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

On today's episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a current US Supreme Court case that is looking at COVID-19 misinformation and free speech.  Namely, the justices are evaluating if misinformation is protected speech.  Matthew and Ron discuss what this could mean for physicians who think they are giving their medical opinion to patients or to the public on social media. Plus, Ron and Matthew discuss a new list from JUST Capital that lists Cigna and Elevance as two of the nation's most "just" companies.  What does that even mean? Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. Articles mentioned in this episode: Supreme Court to weigh whether Covid misinformation is protected speech - STAT News2024 Overall Rankings - JUST Capital2 payers among the 'most just' companies - Becker's Payer Issues This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

In our continuing series on prior authorization, Ron Howirgon and Matthew Handley discuss a press release from Cigna detailing all the "good" reasons big insurers like it use prior authorizations.  They claim it is to save patients money but ultimately, it saves patients' lives.  But a new law in New Jersey seems to fly in the face of that saying in its introduction that prior authorizations can be detrimental to patient health in the name of saving money.  Matthew and Ron explain. Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net. Articles mentioned in this episode: Prior authorizations help keep patients safe, improve health, and make care more affordable - Cigna HealthcareNew Jersey signs prior authorization reform bill into law - Becker's Payer IssuesBill Text: NJ A1255- Legiscan.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, Matthew and Ron talk about a new Centers for Medicare and Medicaid Services rule that requires insurance companies to respond to prior authorization requests for certain products within seventy-two hours.  Those products include Medicare, Medicaid, CHIP, and Obamacare plans.  Unfortunately, commercially insured patients are left out in the cold.  Ron shares his concerns with the rule but acknowledges it's a step in the right direction. Plus: An update on the 2024 Medicare fee schedule - Is the cut still happening? Listen wherever you get your podcasts or subscribe so it is delivered to your email weekly at www.FLATLINING.net. Articles mentioned in this episode: Biden administration cracks down on prior authorization - The HillCMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process - CMS.gov This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcas from Fulcrum Strategies, Matthew and Ron discuss the current situation with the Medicare fee schedule.  Unfortunately, a cut was not removed by Congress and doctors are now being paid (on average) 3% less to see Medicare patients.  Ron shares his insights into what he thinks will change in the next few weeks. Then, Matthew and Ron discuss a story that was previously shared on Matthew's Friday Pulse Check newsletter (subscribe at FLATLINING.net).  The Pennsylvania Department of Insurance has launched a new website that allows patients to submit claims they believe were improperly denied by their insurance company.  Matthew and Ron share who is eligible for this service and whether or not this is a step in the right direction to combat massive claim denials. Read the original story here: PA launches website for patients to dispute denials - Matthew Handley  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howirgon discuss the failed Cigna / Humana merger and why Wall Street analysts thought it was a bad idea from the start.  They also talk about the potential buyer for Cigna's Medicare Advantage business and why it doesn't really matter in the grand scheme of Medicare Advantage plans. Matthew also asks Ron what he's looking at in 2024. The FLATLINING Podcast is a production of Fulcrum Strategies, a provider-focused healthcare consulting company that specializes in making sure providers are being paid fairly by the insurance companies.  Learn more at FSDOC.com. Articles mentioned in this episode: Cigna abandons pursuit of Humana, plans $10 billion share buyback - ReutersCigna pulls out of blockbuster deal to create insurance giant with Humana - The Financial TimesCigna Nears Deal to Offload Medicare Business - The Wall Street JournalCigna, HCSC near deal on Medicare Advantage business: WSJ - Healthcare Dive This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Our most listened to episode of 2023: In 2023, the nation’s largest health insurers saw several lawsuits brought against them for refusing to cover care under the guise that it was not medically necessary or that physicians did not comply with prior authorizations. This happened to otolayrngologist Dan Hurley and Matthew had the opportunity to interview him for the FLATLINING Podcast from Fulcrum Strategies before he died in August. A medical director at his insurance company denied PET scan for being “not medically necessary” as Dr. Hurley and his physician were fighting to figure out how to best treat his cancer. Tragically, that decision may have cost him his life. Appropriately, as we continue to work to better our healthcare system in his memory, our most listened to episode of 2023 was Matthew's interview with Dr. Dan Hurley. New episode next week! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

We are continuing the Best of 2023 series on FLATLINING Podcast from Fulcrum Strategies. Weight loss drugs got a lot of hype this year as more were approved by the FDA with very promising results. But, as has been noted by several lawmakers and activists, insurance companies are still refusing to cover the drugs. Ron and Matthew discussed the new drug from Novo Nordisk called Wegovy and how it could change America’s public health. Next week: the most popular episode of 2023. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast, we start our best of 2023 countdown with our third most popular program of the year.   Ron and Matthew discussed a bill that was proposed in the Indiana state legislature that attempted to regulate how hospitals can do business in the state.  That bill was later signed into law by Indiana Governor Jonathan Jennings.  Ron and Matthew also discussed statistics that showed just how many physicians died during the COVID-19 pandemic and what that means for our healthcare system going forward. Next week, Matthew shares the second most popular episode of the year. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, economist and CEO Ron Howrigon and Matthew Handley discuss the recent news that health insurance giants Cigna and Humana may merge.  They discuss why Cigna's stock price has failed to rebound since the news and why Ron thinks this deal will be approved by the FTC. They also discuss, briefly, former President Donald Trump's statements that he is “seriously looking at alternatives” to the Affordable Care Act.     Follow Ron on LinkedIn. Follow Matthew on X and LinkedIn.   Articles mentioned in this program: Reports of Cigna and Humana merger - Matthew Handley at FLATLINING.netThe 543-word editorial that may have just upended the presidential campaign - POLITICO This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

We are continuing our series on the FLATLINING Podcast which takes a look at the healthcare policies of the presidential candidates.  One of the Republicans who has some concrete ideas is former United Nations Ambassador and former South Carolina Governor Nikki Haley.   Haley has proposed: Raising the Medicare and Social Security ageExpanding access to Medicare Advantage plansEliminating Certificate of Need laws Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss Haley's proposals, their viability, and how they might affect American healthcare. Follow Matthew on X.Follow Ron on LinkedIn. --- Pulse Check on Robert F. Kennedy, Jr.Pulse Check on Perry Johnson --- Articles mentioned in this program: Nikki Haley is coming for your retirement - Paul Krugman in the New York TimesNikki Haley's Medicare Advantage - The Editorial Board of the Wall Street JournalNikki Haley Calls For Eliminating 'Certificate of Need' Bills [sic] to Lower Medical Costs - Timcast This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss recent reporting that the American Medical Association may lobby to ban corporate medicine.  Corporate medicine is the practice of entities owning physicians, such as an insurance company or a large hospital system.  They also discuss the potential cuts to the Medicare fee schedule in 2024. Articles mentioned in this episode: The AMA Debates a Federal Ban on Corporate Medicine - The American Prospect --- Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. Subscribe and find more at FLATLINING.net. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Yesterday, Reuters reported that Cigna is in talks to sell its Medicare Advantage line of business.  Upon the release of the news, Cigna's stock price was down nearly 4% at points and ended the day down 3.85%.  As other insurers (namely Humana) aim to get out of their commercial business because Medicare Advantage was much more profitable, how is it that Cigna was unable to make their plans as profitable as they would have liked?  Matthew Handley and Fulcrum Strategies CEO Ron Howrigon (also a former Cigna executive) discuss. Reuters - Cigna explores shedding Medicare Advantage Follow Matthew on X and LinkedIn. Follow Ron on LinkedIn. Subscribe and have every episode delivered to your email inbox! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss UnitedHealthcare's new variable co-pay product called Surest.  They talk about these questions providers and patients may have about the product: What is a variable co-pay plan and how does it work?Why will some doctors cost more than other doctors?Is this a cheaper plan for employers to buy for employees?Why do providers need to be on the lookout for new plans?Follow Matthew Handley on X.Subscribe and have each episode delivered to your email inbox! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss a recent move by BlueCross BlueShield of North Carolina to purchase the NC locations of retail healthcare chain FastMed.  What does that mean for patients and nieghboring providers?  Then, they dive into a recent LinkedIn post by Ron that discussed a call he had with a managed Medicaid payer who wanted one of his clients to take on a lot of risk for Medicaid patients.  What does risk mean in the healthcare world and should providers take on risk? BCBS North Carolina to purchase more than 50 FastMed urgent care clinics - Becker's Payer IssuesFollow Matthew Handley on X.Subscribe and have each episode delivered to your email inbox! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

The Centers for Medicare and Medicaid Services issued new guidance for the No Surprises Act after the previous guidance was struck down in federal court.  In short: the Department of Health and Human Services handed a win to the insurance companies that will surely end up back in court.  Fulcrum Strategies president and CEO Ron Howrigon discusses with Matthew Handley what it means for emergency medicine doctors, radiologists, and anesthesiologists. Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible. Follow Matthew Handley on X: @radioHandleySubscribe to have every episode delivered to your email each week. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

As we enter the open enrollment period, there is little doubt that you will be seeing ads for Medicare Advantage ads on TV.  Several weeks ago on the Friday Pulse Check Newsletter, Matthew Handley broke down the top plans by tv ads in recent years.  Regardless if you are a patient or a provider, there are things you ought to know about Medicare Advantage plans.  Can they pay a provider less than Medicare rates?  Can a patient use out-of-network benefits?  What is the deal with all these promotional ties with grocery stores?  Matthew Handley and Ron Howrigon discuss. Follow Matthew Handley on X.Subscribe and get this podcast and other newsletters delivered to your email inbox! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon discuss recent actions by the Biden Administration to combat medical debt.  The White House announced last week that they would be working to bar medical debt from being reported to the major credit bureaus which would then help patient's credit scores.  But what happens to physicians and hospitals when consequences are taken away from medical debt?  Plus: you'll be suprised to hear that the Biden Administration is taking on action on an issue that most credit agencies have already dealt with. Matthew and Ron look at these questions: Why do people go into medical debt?Aren't there already safety nets to protect patients from medical debt?What happens if debt doesn't matter?Who is to blame for medical debt?Do doctors just charge too much?Don't the credit agencies already ignore medical debt? Like, comment, and share.  Let us know what you think by emailing us: [email protected] Follow and message Matthew Handley on Twitter: @radioHandley Read more healthcare news and subscribe to our newsletters at www.FLATLINING.net. Find out what Fulcrum Strategies can do for your practice at www.FSDOC.com. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, CEO Ron Howrigon and Matthew Handley discuss political holdups to Medicaid expansion in North Carolina.  The House wants to separate the Medicaid from the state budget and pass it with a casino bill but the state Senate is refusing to agree.  So who gets hurt?  Is the state ready to handle more patients on Medicaid?  Why should you care?  Matthew and Ron break it down on the FLATLINING Podcast from Fulcrum Strategies.   Articles mentioned in this program: House to vote on budget and separate casinos-Medicaid bill this week, top appropriator says - The News and ObserverThe fate of North Carolina's Medicaid expansion could be tied to casinos - Becker's Payer IssuesFollow Matthew Handley on X. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron break down several healthcare news items that are relevant to the business administration of provider practices.  They take a look at these stories: Cigna, UnitedHealthcare, and BlueCross BlueShield of Michigan claim they have cut prior-authorizations by 20% - Becker's Payer IssuesAffordable Care Act (ACA) compliant plan enrollment reaches record high - Kaiser Family FoundationPrisma Health and UHC get into a nasty contract negotiation - Becker's Payer Issues Matthew and Ron discuss whether or not the prior authorization cuts will help patients and their physicians.  They also talk about ACA Marketplace plan reimbursement and how the record enrollments will affect provider revenue.  And they share some tips on what to do in nasty negotiations. Follow Matthew and Ron on X.  Matthew is @RadioHandley and Ron is @RonHowrigon. Subscribe, like, and share! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Matthew and Ron dive into the debate on whether Medicare should cover every FDA-approved drug, focusing on the case of Aduhelm and Leqembi, two Alzheimer's drugs.  Aduhelm was is not covered by Medicare due to limited effectiveness and high cost.  The Centers for Medicare and Medicaid Services announced Leqemebi would be in certain circumstances. Key highlights FDA approval does not guarantee that a drug should be used by everyone, it only indicates clinical effectiveness and acceptable side effects.Medicare's decision to deny coverage for certain drugs is based on cost-benefit analysis and clinical effectiveness.The case of Aduhelm, an Alzheimer's drug, highlights the importance of considering both the clinical value and cost of a drug.   Registries can help ensure that drugs are given to the right patients and monitor potential side effects.   The fragmented system of drug coverage and the need for a more unified approach.The importance of checks and balances in the healthcare system, including the role of the courts.The necessity of administrative levels and bureaucracy in healthcare organizations.The ongoing debate about the size and efficiency of the federal government. Follow Matthew and Ron on X: Matthew Handley on XRon Howrigon on X Subscribe to the FLATLINING Podcast from Fulcrum Strategies to stay informed about healthcare and policy topics. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Matthew Handley and Fulcrum Strategies president and CEO Ron Howrigon discuss the recent rulings in the third Texas Medical Association case against the Centers for Medicare and Medicaid Services (CMS), commonly known as TMA 3.  Judge Jeremy Kernodle ruled that CMS violated the No Surprises Act by publishing guidelines on the Qualified Payment Amount that contradicted the law in several ways.  However, Judge Kernodle ruled against the plaintiffs by deciding that the QPA does not have to be transparent.  Matthew and Ron discuss what this means for physicians, hospitals, and the general public. Follow Matthew and Ron on X. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

Matthew Handley and Ron Howrigon discuss the ongoing relevance of COVID, the cost of weight loss drugs in the US, and public opinion on prescription weight loss drugs. Key highlights COVID still matters, especially for those at riskThe cost of weight loss drugs in the US compared to other countriesThe need for a free market economy in healthcarePublic opinion on prescription weight loss drugsThe potential impact of covering weight loss drugs under insurance Resources mentioned Health System Tracker - How do prices of drugs for weight loss in the U.S. compare to peer nations’ prices?Kaiser Family Foundation - KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs Facts COVID can still be severe for at-risk populationsVaccines can help prevent severe symptomsThe US pays more for weight loss drugs compared to other countriesThe prevalence of obesity is high in the USThe cost of covering weight loss drugs for all Americans would be significant Action steps Stay informed about the ongoing impact of COVIDConsider the cost of weight loss drugs and explore alternative optionsShare your opinion on prescription weight loss drugsAdvocate for healthcare policies that promote a free market economy   Listener challenge: Reflect on your own opinion about prescription weight loss drugs and consider the potential impact of covering them under insurance.   Matthew Handley on XRon Howrigon on X Subscribe to the Flatlining Podcast to never miss an episode and join the conversation about important healthcare topics. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net

We received the news last week that Dr. Dan Hurley, who Matthew interviewed on the FLATLINING Podcast several months ago, had lost his battle with cancer.  This week, Fulcrum Strategies president and CEO Ron Howrigon shares how Dr. Hurley's story affected him and continues to motivate him to fight for physicians. You can listen to our entire interview with Dr. Dan Hurley by clicking here. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.flatlining.net