Health Affairs This Week

Health Affairs' Jeff Byers welcomes Gabriel Perna, Deputy Editor of Digital Health Business & Technology at Modern Healthcare, to the pod to discuss Epic Systems, how they became one of the leading American health care EHR companies, a recent antitrust lawsuit filed by Texas Attorney General Ken Paxton against Epic Systems, and even touch on ChatGPT's entrance into health care.Related Articles:Texas files antitrust suit against Epic over health data (Modern Healthcare)Texas hits Epic with an antitrust suit: Here’s what to know (Modern Healthcare)

Stacie Dusetzina, a health policy researcher at Vanderbilt specializing in drug pricing and insurance policy. She dissects the Trump administration's Great Healthcare Plan as vision-board rhetoric with few details. She explains most-favored-nation pricing, limits of transparency, OTC drug shifts, insurer finance disclosures, and HSA affordability risks in short, clear takes.

Michael Chernew, a Harvard health policy professor and health economist, dives into the striking 7.2% growth in 2024 health spending, revealing why this figure is troubling against inflation. He discusses the sacrifices families face, like higher taxes and out-of-pocket costs, due to rising healthcare expenses. Chernew also explores the dual role of AI in healthcare, hinting at its potential to cut costs but also risk further spending. Finally, he advocates for payment reforms to tackle low-value care as a solution to curb excessive expenditures.

Jamila Michener, a political scientist at Cornell University and author of 'Fragmented Democracy', dives into the complexities of Medicaid and political power. She discusses how the design of Medicaid limits beneficiaries' influence and emphasizes the importance of framing power in policy discussions. Michener also explores how organized interests shape Medicaid's growth and advocates for empowering beneficiaries in decision-making. Lastly, she highlights obstacles to change but notes a positive momentum towards shifting power.

Mark Fendrick, Director of the University of Michigan's Center for Value-Based Insurance Design, dives into the significance of value-based insurance design (VBID) and the recent end of the Medicare Advantage VBID model. He explains how the model uniquely targeted cost-sharing reductions and discusses the reasons behind its termination, including rising Medicare costs. Fendrick also shares insights on VBID's effectiveness in lowering barriers to high-value care and offers recommendations for improving future designs, ensuring patients receive better access and outcomes.

Health Affairs' Jeff Byers welcomes Senior Editor Leslie Erdelack back to the pod to discuss the proposed rule change to the Medicare Physician Fee Schedule for 2026, which includes payment conversion factors for doctors, alternative payment models, add-on codes for Advanced Primary Care Management services, a new mandatory value-based payment model, and more.Order the August 2025 issue of Health Affairs.Join us for a live taping of A Health Podyssey on Tuesday August 12 where Rob Lott will discuss recent findings about changes in clinician's participation across Medicare value-based payment models with Kenton Johnston.Upcoming Events include:8/20: 340B w/ Sayeh Nikpay (INSIDER EXCLUSIVE)8/26: Provider Prices in the Commercial Sector: Independent Dispute Resolution (FREE TO ALL)9/23: Prior Authorization: Current State and Potential Reform (INSIDER EXCLUSIVE)View all Upcoming Events.Become an Insider today to get access to exclusive events like the ones highlighted above.Related Articles:PRESS RELEASE: Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (CMS-1832-P)CMS proposes rule aligning Medicare physician payment with ‘Big Beautiful Bill,’ MACRA (Healthcare Dive)CMS proposes 3.6% pay bump for docs, takes aim at chronic conditions in physician fee schedule (Fierce Healthcare)Physicians will see Medicare payments rise in 2026 (AMA)Medicare proposes ‘efficiency’ pay cuts that would hit highly paid specialists the most (STAT News)

Health Affairs' Jeff Byers is joined by Michael Chernew from Harvard Medical School to discuss the recently released National Health Expenditures Projections for 2024–33 from the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS).Related Articles:National Health Expenditure Projections, 2024–33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDPCMS National Health Expenditure Data

Health Affairs' Jeff Byers welcomes Katie Keith of Georgetown Law and Deputy Editor Chris Fleming to the pod to discuss Trump administration's One Big Beautiful Bill and how this will affect Medicaid, Medicare, health savings accounts, rural hospitals, and more. Become an Insider today to get access to our trend reports, events, and exclusive newsletters.Related Links:The 'One Big Beautiful Bill,' Now Law, Does Not Protect Rural Hospitals (Health Affairs Forefront)Rural Health Transformation Program Won’t Shield Hospitals And Other Rural Providers From OBBBA’s Fallout (Health Affairs Forefront)With Budget Reconciliation Bill Enacted, Health Care Changes Loom (Health Affairs Forefront)Congress Should Remove The Rare Disease Carve-Out From Medicare Drug Price Negotiation, Not Expand It (Health Affairs Forefront)Recent Experience Shows National Medicaid Work Requirements Would Create Enormous Administrative Inefficiencies (Health Affairs Forefront)

Health Affairs' Jeff Byers welcomes Rachel Bonesteel of Duke-Margolis Center for Health Policy to the pod to discuss her recent Forefront article focused on how ACO REACH enabled ACOs to participate in an advanced, global-risk, population-based payment model.Related Articles:ACO REACH 2023 Performance Results Indicate A Pathway To Sustainable Accountable Care (Health Affairs Forefront)Opportunities To Enhance Design And Implementation Of ACO REACH’s Core Payment Model Design Elements (Health Affairs Forefront)Enhancing Design And Implementation Of ACO REACH’s Equity-Focused And Beneficiary Engagement Design Elements (Health Affairs Forefront)Future Of Accountable Care: Lessons Learned And Potential Paths Forward During A Time Of Transition (Health Affairs Forefront)Medicare Accountable Care Organizations In 2023: Large Savings With Increasing Value-Based Programmatic Competition (Health Affairs Forefront)Medicare ACOs In 2024: Increased Participation And Evolving Policy Impacts (Health Affairs Forefront)

Health Affairs' Jeff Byers welcomes Nathan Hostert of The Center for Advancing Health Policy Through Research at Brown University to the pod to discuss a recent Forefront article on how states are utilizing hospital price caps to save money.Become an Insider today to get access to our third trend report focusing on the influence of private equity in health care.Related Articles:How States Are Using Hospital Price Caps To Save Money (Health Affairs Forefront)Hospital Payment Cap Simulator (Brown University)Hospital Facility Prices Declined As A Result Of Oregon’s Hospital Payment Cap (Health Affairs)Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy (Health Affairs)How Massachusetts’s New Health Care Reform Takes Aim at Private Equity (Health Affairs Forefront)