Healthcare is Hard: A Podcast for Insiders

Kody Kinsley, former North Carolina Secretary of Health and Human Services and current Milken Institute advisor, brings hands-on Medicaid and behavioral health experience. He walks through how state mega-agencies operate. He explains federal-state financing, managed care mechanics, expansion dynamics, budget scenarios, provider taxes, and real-world pilots linking social care to savings.

Dr. Ali Khan has spent his career at the intersection of medicine, public policy, and value-based care. He’s also been at the forefront of some of the country's most innovative care delivery models—from Iora Health and CareMore to Oak Street Health and now Aetna, where he serves as Chief Medical Officer of Medicare at Aetna, a CVS Health company. In this episode, Keith Figlioli sits down with Dr. Khan for a conversation about Medicare’s future—and what it will take to make the promise of better, more affordable healthcare a reality. A general internist by training, Dr. Khan’s path into healthcare began with a deep curiosity about the broader systems shaping people’s health. That curiosity took him from Harvard Kennedy School to the exam room to health plans and startups focused on reimagining the primary care experience for complex, underserved populations. Throughout his career, he’s gravitated toward organizations trying to solve public-sector problems with private-sector solutions—building care models that prioritize trust, access, and long-term outcomes. Now at the helm of a Medicare Advantage program serving 4.2 million members, Dr. Khan brings a unique vantage point. In this conversation, he shares hard-earned lessons on care model design, what payers and providers need from each other, and why Medicare is at an inflection point. He makes a compelling case for a renewed focus on the fundamentals—not just risk adjustment or benefit design, but operational follow-through, last-mile care coordination, and culturally grounded team-based models that scale. Dr. Khan and Keith discuss: Building care models that hold up under pressure. From Iora to Oak Street, Dr. Khan has seen firsthand that delivering better outcomes at scale requires more than mission—it takes structural rigor. He unpacks four key dimensions—cultural, clinical, operational, and technological—and explains why lasting impact depends on aligning all of them. Whether it's equipping care teams to deliver in complex communities or building systems that can flex and scale, success hinges on getting the foundation right. Why affordability isn’t enough—and where Medicare Advantage must go next. With over half of Medicare beneficiaries now enrolled in MA plans, Dr. Khan argues it’s time to move beyond the value prop of supplemental benefits and zero-dollar premiums. The next chapter is about proving clinical excellence at scale. That means prioritizing follow-through over features—removing last-mile barriers, improving care coordination, and designing experiences people actually trust.  From transactional to transformative: the evolving role of health plans. Plans have long relied on contractual structures to drive change, but Dr. Khan believes that era is fading. To deliver on the promise of value-based care, plans must shift from passive administrators to proactive partners—investing in infrastructure, surfacing actionable insights, and enabling providers to succeed across Medicare, Medicaid, and commercial populations alike. Where AI meets care delivery. Dr. Khan reflects on the potential of AI to reduce clinical variation, improve medication management, and drive better follow-up for patients—especially those with chronic conditions. But he cautions that technology alone won’t move the needle. To truly unlock AI’s value in Medicare, plans and providers must embed it within human-centered systems, coordinate care in real time, and ensure new tools support—not replace—the relationships that matter most. As Dr. Khan notes, we’re entering a “put up or shut up” era for Medicare Advantage, where scrutiny is high and proof points matter. Yet within that pressure lies opportunity—particularly for those willing to do the unglamorous work of identifying barriers, building connective tissue, and supporting clinical teams in the trenches.

The first two episodes in this Healthcare is Hard podcast series on “Opportunities in Oncology” explored the relationship between academic medical centers and community care, with guests Dr. Stephen Schleicher from Tennessee Oncology, and Dr. Harlan Levine from City of Hope. For the third and final episode in the series, Dr. Daphne Haas-Kogan joined Keith Figlioli for a conversation that dives more deeply into patient care, innovations in care delivery and the opportunities for entrepreneurs.Dr. Haas-Kogan is Chair of the Department of Radiation Oncology at Mass General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. She is also the Willem and Corrie Hees Family Professor of Radiation Oncology at Harvard Medical School.Dr. Haas-Kogan received her undergraduate degree in biochemistry and molecular biology from Harvard University and her medical degree at UCSF. She completed her residency in radiation oncology at UCSF in 1997 and became vice-chair for research at UCSF in 2003, and educational program director in 2008. Dr. Haas-Kogan’s laboratory research focuses on molecular underpinnings of brain tumors and pediatric cancers. She leads large multi-institutional initiatives funded by NIH/NCI, philanthropic organizations, and industry collaborators.For this episode of Healthcare is Hard, some of the topics Dr. Haas-Kogan discussed with Keith include:The collaborative approach to care. Dr. Haas-Kogan talked about how most people with cancer struggle with many other medical issues – some predating cancer diagnosis, some precipitated by the treatment itself – and how several care teams are required to treat the patient wholistically. She also discussed how important it is for academic medical centers and community hospitals to work together, the responsibilities each holds to the patient, and the goal of making sure patients receive the same exact care regardless of location.The precision of radiation oncology. There are generally three pillars of cancer treatment. The first is surgery to remove tumors, the second is medication to kill cancer cells with drugs, and the third is radiation therapy to destroy cancer cells. Dr. Haas-Kogan described how radiation oncology is, in many ways, a combination of surgical oncology and medical oncology. It requires the precision of surgery – especially when treating a tumor close to critical structures like the brain stem or spinal cord – but can also be applied in a single day or over the course of weeks, similar to medication. She discussed how this allows for unique collaboration between academic researchers and community physicians, along with opportunities for creative workforce solutions.AI in oncology. The impact artificial intelligence has already had on oncology would have been unimaginable five or 10 years ago, and Dr. Haas-Kogan says the opportunities for entrepreneurs in the space are huge. As an example of the impact AI has already made, she talked about how radiation oncologists traditionally spend hours defining exactly what they want treated and the dose of radiation required. But now, AI is doing most of that, saving physicians precious time. She talked about how medicine is an art and how treatment like this is very nuanced, so she very often makes changes after reviewing AI-generated recommendations. But she says advancements are coming quickly.To hear Dr. Haas-Kogan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Harlan Levine began his career practicing internal medicine but soon moved into business leadership roles at national healthcare organizations to help improve the dysfunction with payer-provider relationships that he experienced firsthand as a physician.At United Health Group, Dr. Levine joined as clinical lead of the team that launched Optum, where he subsequently served as chief medical officer for more than six years. He also led the health management practice at Towers Watson and served as executive vice president of comprehensive health solutions at WellPoint, among other roles.In 2013, Dr. Levine joined City of Hope, one of the country’s largest and most advanced cancer research and treatment organizations. City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas.In addition to currently serving as president of health innovation and policy at City of Hope, Dr. Levine is also chair of the board of AccessHope. A spinout from City of Hope, AccessHope partners with the nation’s most prestigious cancer research centers to help make leading-edge cancer care available to all, regardless of geographical location.Dr. Levine joined Keith Figlioli for the second episode of a Healthcare is Hard series exploring opportunities in oncology. Some of the topics they discussed include:Community practice vs. academic medical centers. Delivering personalized care and giving patients access to cutting-edge treatment is equally important, yet historically difficult to balance. In the first episode of this series, Dr. Stephen Schleicher from Tennessee Oncology shared how one of the nation’s most successful community oncology practices is tackling the challenge. In this episode, Dr. Levine discussed City of Hope’s model of putting academic research at the center and connecting it with community practices. He described how City of Hope is changing the direction of cancer care – not just delivering it – by giving patients faster access to emerging science.Defining value in oncology. Dr. Levine calls himself an outlier when it comes to value-based care in oncology because he thinks the industry missed a critical first step – defining what the term means. In most circumstances, discussions around value are centered around reducing cost. But Dr. Levine points out that a cancer patient defines value very differently. They define it as survival. They think about whether or not they returned to normal functionality in normal life, and what their experience was through the entire treatment process. He says the industry needs to recognize and customize models for these unique aspects of cancer care before the term VBC should be used in oncology.AI in oncology. Dr. Levine shared his outlook for the many ways artificial intelligence will change oncology – from drug discovery to care delivery. He believes AI will completely disrupt the approach to cancer care and that the revolution will happen quickly – not in seven to 10 years, but in three to five. He talked about the ways he sees AI changing how doctors deliver care, and why he’s even more optimistic about its ability to accelerate research.To hear Dr. Levine and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Stephen Schleicher, a medical oncologist with an MBA from Harvard, delves into the complexities of oncology, exploring the intersection of clinical care, business, and policy. He highlights the urgent need for healthcare professionals to understand the business dynamics that influence cancer treatment. The conversation reveals insights into value-based care, the evolving landscape of cancer treatment, and the challenges in securing equitable access to innovative therapies. Dr. Schleicher emphasizes the importance of collaboration to improve patient outcomes in a changing healthcare environment.

Elements of the new Trump administration are coming into focus as announcements of key healthcare appointments and nominations provide indications for what the market can expect starting in January. To dissect the impact these changes might have, Wall Street Analyst Jeff Garro joined Keith Figlioli to wrap up a four-part series of episodes on election implications. Previous episodes featured conversations with JP Morgan’s Lisa Gill, Canaccord Genuity’s Richard Close, and Maverick Health Policy’s Julie Barnes.Jeff Garro is Managing Director and an equity research analyst covering Healthcare IT for Stephens, a family of privately held, independent financial services firms founded in 1933 that’s focused on building value for companies, state and local governments, institutions and high-net-worth investors. Prior to joining Stephens in September 2022 Jeff held research analyst roles at Piper Sandler and William Blair.During this conversation, Jeff discussed the policy changes and broader market signals he’s watching to advise clients on investments in the healthcare IT market. Some of the topics he discussed with Keith include:Balance in management teams. When discussing elements he looks for in a good investment, Jeff talked about the lessons he’s learned evaluating management teams. He says companies need leaders that are great storytellers who can convey their vision and bring more investors under the tent. But cautions to stay vigilant for executives who might believe in their own narrative a little too much and in turn, don’t implement the right sets of checks and balances within their organization.Predictions by payer type. One way Jeff is assessing the market in light of pending regulatory and policy changes is by breaking it down by payer type. For example, he expects minimal change in employer-sponsored coverage and a more favorable environment for Medicare Advantage, when comparing the first Trump term to the last few years of the Biden administration. He says Medicaid markets will be harder to predict because potential for decreased federal funding could create market pressures, but could also create opportunities where technology can help. Lastly, he’s considering the individual market and the potential for ACA subsidies to not be renewed.Public vs. private markets. While Jeff’s primary role is analyzing public markets, he talked about how essential it is to understand innovation and activity occurring in private markets so he can ask the right questions and avoid being blindsided as new companies and technologies evolve. He also discussed the different mentalities of public versus private investors, and how those in private markets generally have the ability to be more patient – an advantage as we’re waiting for the new administration’s nominees to be appointed and confirmed.The post-COVID reset. There are a lot of problems to solve in healthcare – as there always have been – but Jeff also believes there are a lot of good companies, both public and private, positioned to solve them. He sees a favorable backdrop for healthcare investors following the challenging environment from the global pandemic, and is hopeful that the market has hit a reset from a performance perspective. He sees a shift from “growth at all costs” to a more reasonable approach to sustainable growth and healthy profit margins.To hear Jeff and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A

Healthcare was not a major focus during the 2024 election where other key issues drove most of the discussion. This left a vacuum around specific healthcare policies and what to expect from a second Trump Administration. With few details available and political capital to spend from the ‘red sweep’ this election, healthcare stakeholders are pondering how much of the incoming administration’s preference for disrupting the status quo will extend to the healthcare industry.For the third episode in a four part series on election implications – and the first one since votes were counted and winners declared – JP Morgan analyst Lisa Gill joined Keith Figlioli on the Healthcare is Hard podcast to analyze the outcome.Lisa has more than three decades of healthcare industry experience and has spent most of her career at JP Morgan where she has been covering the healthcare services industry for the last 27 years. In this episode, Keith talked to Lisa about the lessons she’s learned covering healthcare for several decades, and asked her to share her outlook for what to expect in the months and years ahead. A few of the topics they discussed include:Cycles of innovation. Thinking about how the industry has evolved over time and how healthcare organizations have had to continuously reinvent themselves, one of the main observation Lisa makes is that common themes and trendlines often repeat themselves. She cites the pharmaceutical industry as an example, comparing the cycle of pharmacy innovation when she started as an analyst in the late 1990s to the current wave of innovation that’s occurring now.Consolidation and diversification. With a philosophy that leans towards deregulation and loosening oversight, one expectation of the incoming administration is that it will create more opportunity for M&A. Lisa talks about the trends driving consolidation in the industry and how it’s not just about diversifying earnings and revenue. She says it’s about broadening the touchpoints organizations have with patients in order to reach the goal of finally being able to deliver truly integrated care.Optimism for managed care. If early returns in public markets after the election are an indication of what’s to come, managed care organizations are in a good position to thrive under the second Trump administration. Lisa points to the fact that managed care companies outperformed the day following the election, rising 5.8% while hospitals fell more than 4%. With a friendlier environment for reimbursement rates and STAR ratings, and a lower bar for M&A, she expects this trend to continue.Previewing the 43rd Annual JP Morgan Healthcare Conference. This venerable event sets the stage on what to expect in healthcare for the year to come. And while it takes place before the presidential inauguration, signals from the Trump transition team, including announcements about appointments to cabinet positions and healthcare agencies, will drive the conversation. However, Lisa believes the industry won’t have a clear view into the new administration’s focus and priorities for healthcare until well into the first quarter of 2025.To hear Lisa and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

With the White House and Congress up for grabs this election, anticipation in the healthcare industry is high. Shifts in healthcare policy will influence how care is paid for and delivered, which will of course influence the flow of investment dollars in both public and private markets.During the first episode of a four-part series on election implications, beltway insider Julie Barnes laid out potential scenarios for the direction healthcare policy might take depending on election outcomes. With that background, Part 2 of the series zooms in on healthcare investing. For more than 20 years – and now six presidential election cycles – Richard Close has covered the healthcare space as a Wall Street analyst. He was one of the first analysts covering healthcare technology and as Managing Director, Digital and Tech-Enabled Health Equity Research at Canaccord Genuity, he focuses on introducing the investment community to disruptive and innovative companies that are leading the digital transformation in healthcare. In this episode of Healthcare is Hard, Richard talked to Keith Figlioli about the election and how it could impact investments in the healthcare sector. A few of the topics they discussed include:Predictions on priorities. Healthcare has not been a major focus this election cycle and Richard doesn’t believe either candidate has shared many specifics about their plans for health policy. But he discussed general expectations like an increase in Medicare drug price negotiations under a Harris Administration, or giving states more control of Medicaid under a Trump Administration. Regardless of who takes the White House, he sees an increasing focus on addressing employer health costs, driven by forecasts for an 8% increase next year – the highest jump in more than a decade.Contrasts in public vs. private markets. Richard says healthcare investors in public markets tend to “paint with a broad brush” and are focused on the short-term. Because of this, he says struggles at large-cap managed care companies in recent years have influenced overall investor sentiment. Once these companies get beyond current challenges and start hitting their numbers, he believes it will open the market and drive improved valuation for smaller and mid-cap companies. On the other hand, Richard says investors in private markets look more deeply into sub-sectors and are placing bets for the long run. Optimism for health tech. With healthcare accounting for 20% of the economy and continuing to grow, Richard sees technology as a primary lever to help bend the cost curve. He’s optimistic about the future opportunity for investors in both public and private markets, and sees an opportunity for the IPO window to potentially open up after the election. He says there are a handful of companies that are profitable and have been growing revenue that may be ready to test the IPO market in 2025.To hear Richard and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Julie Barnes has made a career helping health plans, tech vendors, investors and others in the healthcare space decipher health policy. She’s a former Hill staffer who earned her law degree and spent a decade in corporate law serving healthcare clients before moving to policy think tanks, business consulting, and founding Maverick Health Policy. At Maverick, she provides strategic advice on federal health policy to private companies and industry coalitions, with particular focus on health data and value-based care.With the U.S. presidential election less than two months away, Julie is kicking off a series of Healthcare is Hard episodes that will explore the implications of the shifting power structure in Washington. Next year, there will be a new administration and a new makeup of the U.S. Congress – that much is certain. How these changes will impact health policy and healthcare investing in public and private markets is a much bigger question. During the next few episodes, both before and after votes are cast in November, Keith Figlioli will shed light on these topics with an expert panel of guests.A few of the topics Keith and Julie discussed during the first episode of this series include:The alphabet soup of healthcare policy. One of the things that surprises Julie’s clients the most is the myriad of federal agencies that play a role overseeing healthcare – from HHS and CMS, to the FDA, CDC, NIH, FTC, NIST and many others beyond the big, well known organizations. With Healthcare accounting for nearly one quarter of the federal budget, there is a massive public sector infrastructure behind it, which is a big reason why healthcare policy takes so much effort to navigate. Julie offers advice for organizations looking to better understand healthcare policy, and for the people driving it. For example, she says the wonks, lawyers and lobbyists all talk funny. She admits to being part of this group, and says they need to reduce the lingo for the sake of those not so intimately involved.AI changing everything. When discussing the modernization of the healthcare system, Julie talks about artificial intelligence (AI) being the main focus right now. She believes it has the potential to dramatically change everything because of the far-reaching impact it could have on areas ranging from workforce shortages to clinical decision support, user experiences for providers and patients, and more. She says healthcare AI policy can’t be written fast enough because of the speed with which the technology is developing, but there are many problems to navigate. One is that the public sector lacks experts who fundamentally understand this new technology, which will create challenges with ensuring that regulations are thoughtful enough to create a level of trust around AI without grinding innovation to a halt.White House hysteria. While the country is fixated and divided on an historical race for the Presidency and the impacts of the outcome, Julie is quick to point out that changes in healthcare policy will not be fast, and will not be sweeping. There are broad brush policy changes you can expect based on party philosophies, like Democrats being more skeptical about the influence of private money than Republicans. But major legislative changes require bipartisan effort, no matter who controls the White House, Senate, and/or House. But one major area where Julie thinks many people are underestimating the potential for change is the impact of the Supreme Court’s recent decision on the Chevron Doctrine. She talks about how this will open the floodgates on a wave of litigation.To hear Julie and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

OSF HealthCare stands as a model health system for those who want to do innovation right. One of the defining characteristics of the Peoria, Illinois-based system is how it aligns innovation with operations for everyone – all 24,000 employees across 159 locations, including 16 hospitals.Becky Buchen is responsible for driving innovation at OSF HealthCare. As SVP of Innovation Operations she works to engage and educate people on the innovation process, leveraging the eco-system for innovation built at OSF, including simulation, analytics, OSF Ventures, Innovation Studio, Digital Innovation Development and Performance Improvement.Becky’s background in performance improvement has been a major influence in OSF HealthCare’s approach to innovation. Prior to her role leading innovation, she served as VP of Performance Improvement where she focused on implementing methodologies to monitor, assess and improve patient experience, patient outcomes, and overall operations.In this episode of Healthcare is Hard, Becky talked to Keith Figlioli about how OSF HealthCare formalized its vision for innovation more than a decade ago and the thoughtful approach to ensuring that it would be fully integrated – not simply a “bolt on.” The goal was to truly make an impact and transform how care was delivered across the organization, and to do so, OSF HealthCare recognized that it had to apply the same level of rigor for exploring, testing and measuring innovation initiatives as it historically had to performance improvement.In her conversation with Keith, Becky discussed specifics about OSF HealthCare’s approach to innovation that both digital health entrepreneurs and other health systems can learn from. Some of the topics they discussed include:Integrating innovation into culture. Perhaps the most visible example of OSF HealthCare’s commitment to integrating innovation into every aspect of its operations is the physical footprint. At its main campus, OSF HealthCare has an entire building dedicated to innovation, including two floors built for simulation, allowing clinicians to test and understand new approaches in a safe space, two floors housing its healthcare analytics division, and much more.What health systems are getting wrong (and right). To approach innovation successfully, Becky says health systems need to first have a fundamental understanding of the problems they’re trying to solve. She warned of dedicating resources towards solutions that are looking for problems. OSF HealthCare learned to avoid this trap early, but Becky says it’s still an area of caution for some systems. She talked about how critical it is to pick problems that are big enough to make a significant impact when they’re solved in new and different ways.Retooling and reskilling due to artificial intelligence. Becky talked about the healthcare industry being “data rich and information poor,” and described efforts to centralize data and improve data quality as a critical step to driving value from innovation. While tools like those being explored with generative AI will ultimately allow healthcare organizations to operate more efficiently, data quality and proper governance are essential to establish first. And after that, healthcare organizations should be thinking about how they will need to retool and retrain frontline operators and clinicians.To hear Becky and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.