Turn on the Lights Podcast

If public health is the foundation for individual health, why is it still treated like a “nice to have” until a crisis hits? In this episode, Michelle Williams, an epidemiologist and public health leader, and Linda Marsa, a health care journalist, discuss what public health actually is, why it matters for human thriving, and how it differs from medical care that treats one patient at a time. They unpack how incentives often push resources toward reactive, profit-driven care instead of prevention, even though social determinants like housing and clean air drive most health outcomes. The conversation traces recurring patterns of “willful blindness,” in which commerce and ideology trump evidence, from historical outbreaks to today’s fights over air pollution. They also spotlight reasons for hope: rigorous data, public health heroes across generations, real grassroots and legal efforts protecting public health wins, and practical protocols that have cut maternal deaths. Tune in and learn how public health can move from stepchild to foundation, and what it takes to leave no population behind. Resources: Connect with and follow Michelle Williams on LinkedIn. Connect with and follow Linda Marsa on LinkedIn and visit her website! Follow Harvard T.H. Chan School of Public Health on LinkedIn and explore their website! Read The Cure for Everything: The Epic Struggle for Public Health and a Radical Vision for Human Thriving Learn more about your ad choices. Visit megaphone.fm/adchoices

Blame rarely makes care safer, but understanding the system usually does. In this episode, Professor Charles Vincent, a clinical psychologist and leading patient safety researcher, explains how harm often emerges from a chain of small breakdowns, not from a single “bad” decision, and why the better question is “what in the system allowed this to happen?” He unpacks how the fixation on individual error can miss deeper contributors, such as fatigue, poor supervision, weak monitoring, clunky equipment design, noise, distraction, and communication that is not truly heard. You will hear why disrespectful behavior and hierarchy are safety risks, how simple routines like surgical safety checklists can change whether people speak up, and why healthcare struggles to name the trade-off between pushing volume and protecting safety. Tune in and learn how a systems lens, respectful teamwork, and real trade-offs can make care safer. Resources: Connect with and follow Prof. Charles Vincent on LinkedIn. Learn more about your ad choices. Visit megaphone.fm/adchoices

Stories can help people understand why health care keeps failing both patients and clinicians.  In this episode, Shantanu Rai, a primary care physician and novelist, discusses how his medical thriller, A Dangerous Diagnosis, became a way to explore moral injury, physician burnout, concierge medicine, worsening access to specialty care, fragmented treatment, and the financial and administrative pressures reshaping modern practice. He reflects on what he sees in safety-net primary care, why more physicians are considering escape routes from traditional medicine, and how payment models can make care feel rushed and transactional. Shantanu also explains why he chose fiction over academic writing, how storytelling can build empathy among clinicians, and why public engagement may be essential to meaningful reform. Along the way, he shares his thoughts on universal coverage, physician leadership, and the bigger structural changes needed to make health care more humane.  Tune in and learn why storytelling may be one of the strongest tools for exposing what is broken in health care and inspiring people to demand something better.  Resources: Learn more about the book The Dangerous Diagnosis here. Learn more about your ad choices. Visit megaphone.fm/adchoices

How do we decide what “good care” looks like, and who gets to choose the scorecard? In this episode of Turn on the Lights, Kedar Mate speaks with Dr. Michelle Schreiber of the Centers for Medicare & Medicaid Services and Brenna Rabel of Battelle about how quality measures are developed, adopted, and applied across Medicare and Medicaid programs. They explore why measurement is essential for accountability, patient choice, and improvement, while also acknowledging its vulnerability to politics, feasibility constraints, and “teaching to the test.” Using diabetes and sepsis as examples, they explain how performance cutoffs are established, why “all-or-none” measures often face resistance, and what makes complex measures difficult to report and score. The conversation also addresses efforts to reduce reporting burden, including CMS’s shift from broader MIPS reporting toward MIPS Value Pathways and the expansion of digital quality measurement through FHIR-enabled eCQMs. They conclude with a forward-looking discussion on how artificial intelligence could reduce manual chart abstraction and advance quality measurement, particularly as patient-reported outcomes play a larger role in shaping the future of value-based care. Tune in to hear how measures shape what health systems prioritize, what gets improved, and what “value” could look like in the future. Resources: Connect with and follow Dr. Michelle Schreiber on LinkedIn. Follow CMS on LinkedIn and explore their website! Connect with and follow Brenna Rabel on LinkedIn. Follow Battelle on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices

How do health care quality measures get created, and are we measuring too much? In this episode, Jeff Geppert, Senior Research Leader at Battelle Memorial Institute, discusses the lifecycle and future of health care quality measurement in value-based care. He explains how measures move from multi-year development and evidence testing through endorsement and CMS rulemaking before being implemented in federal programs. He addresses concerns about measurement overload, noting that health care complexity has driven the growth in measures but that rising infrastructure costs, interoperability demands, and AI adoption may force greater focus and parsimony. He also shares why he’s optimistic that emerging technologies will better align quality measurement with quality improvement, helping uncover root causes of variation and drive meaningful value in care delivery. Tune in to explore where health care measurement is headed, and why the future may be more focused, fair, and impactful than ever. Resources: Connect with and follow Jeff Geppert on LinkedIn. Follow Battelle Memorial Institute on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices

What would it look like if aging in America came with a real plan instead of a quiet free fall? In this episode, Dr. Joanne Lynn, a longtime geriatric and hospice physician and elder-care policy leader, explains how longer lives have outpaced the systems people rely on when disability arrives. She highlights how ageism and invisible, unpaid caregiving strain families, often forcing them to drain savings before support becomes available. She also examines staffing shortages in nursing homes, limited geriatric training for clinicians, and gaps in long-term care infrastructure. Finally, she shares promising solutions, including community villages, the PACE model, and policy reforms like catastrophic long-term care social insurance and stronger local accountability. Tune in to learn how we can build a future where aging remains meaningful, supported, and dignified. Resources: Connect with and follow Dr. Joanne Lynn on LinkedIn. Visiting medicaring.org to learn more about community-based eldercare improvements. Learn more about your ad choices. Visit megaphone.fm/adchoices

Leading a major health system today means juggling patient-first ethics with a financing model that keeps tightening the screws. In this episode, Chris Van Gorder, President and Chief Executive Officer of Scripps Health, explains why health care is becoming structurally unaffordable amid soaring premiums, uncompensated emergency care, and rising input costs. He describes how hospitals have become the default safety net as county systems disappear, while underpayment by Medicare and Medicaid forces cost shifting onto employers and commercially insured patients. Van Gorder also highlights California’s seismic rebuilding mandates, which create massive capital pressure without matching reimbursement. He critiques managed care, value-based care, and Medicare Advantage for pushing risk onto providers through prior authorization and denials, recounting Scripps’ difficult decision to exit several Medicare Advantage contracts after heavy losses and the downstream impact on patients. Tune in and learn how payment design, intermediaries, and regulation shape what hospitals can sustain and what patients can access. Resources: Connect with and follow Chris Van Gorder on LinkedIn. Follow Scripps Health on LinkedIn and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices

What does it take to reimagine aging services in a complex health and social care system? In this episode, Marta Corvêlo, President & Chief Executive Officer at Somerville-Cambridge Elder Services, talks about her journey into health and human services and her approach to transforming community-based aging support. She shares how her upbringing in Portugal and early work with refugee families shaped her commitment to social impact and equity. Marta explains the mission of SCES and how its home-based, wraparound services help older adults, people of all abilities, and caregivers age with independence and dignity. She also discusses operating at the intersection of health care, behavioral health, and social supports to better navigate the systems serving aging populations. Tune in to hear how values-driven leadership and community-based innovation are reshaping the future of aging services! Resources: Connect with and follow Marta Corvêlo on LinkedIn. Follow Somerville-Cambridge Elder Services on LinkedIn, Instagram, and Facebook, and explore their website! Learn more about your ad choices. Visit megaphone.fm/adchoices

America’s drug crisis isn’t a science problem; it’s a pricing and policy problem that blocks patients from medicines that already exist. In this episode, Dr. Jerry Avorn, a professor of medicine and leading expert in pharmacoepidemiology and medication policy, discusses why many patients still can’t afford essential treatments even as breakthrough drugs for cancer and inflammatory disease proliferate. He shares a personal case where “nonadherence” was really unaffordability, then unpacks how US exceptionalism in drug pricing, patent “thickets,” and delayed competition keep costs unsustainably high. Dr. Avorn also contrasts access failures with overuse concerns, explores why other countries negotiate on the basis of value, and addresses objections to innovation and rationing, including a sobering example of cystic fibrosis in the UK. Finally, he explains how academic detailing spreads evidence-based prescribing and evaluates recent US attempts to let Medicare negotiate prices alongside more deal-driven approaches.  Tune in and learn how drug prices, patents, and public funding shape what patients can actually access! Resources: Connect with and follow Dr. Jerry Avorn on LinkedIn. Follow Harvard Medical School on LinkedIn and explore their website! Learn more about Brigham and Women’s Hospital on LinkedIn and visit their website. Visit Dr. Avorn’s personal website. Buy the Rethinking Meds book here and learn more about it here. Learn more about your ad choices. Visit megaphone.fm/adchoices

Mindfulness isn’t a “nice-to-have”; it’s a low-cost public health lever that changes how people handle pain, emotions, and community life. In this episode, Brother Phap Luu, a monk in the Plum Village tradition founded by Thich Nhat Hanh, discusses how mindfulness can be practiced as “everyday meditation” through breathing, walking, eating, and even cultivating awareness of dreams. He shares his personal journey from activism and disillusionment to depression, and then to healing through mindful breathing and finding community at Plum Village. Brother Phap Luu explores the roots and global reach of Plum Village, why mindfulness naturally fosters compassion, and how “watering” emotions like anger through rumination can prolong suffering. He also unpacks mindfulness as an “invitation,” the challenge of scaling it, through training, ethics, trauma sensitivity, and limited profit incentives, and its potential integration into schools of public health and policy. Tune in and learn how mindful breathing, community practice, and compassion can become practical tools for healthier lives and societies! Resources: Connect with and follow Brother Phap Luu on LinkedIn. Learn more about Plum Village on their LinkedIn and explore their website. Learn more about your ad choices. Visit megaphone.fm/adchoices