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Health Affairs Publishing's Jeff Byers welcomes Senior Editor Kathleen Haddad back to the pod to discuss the evolving prior authorization landscape, including CMS efforts to streamline approvals, insurer responses, and emerging questions around AI-driven decision-making.

A Health Affairs journal subscription directly connects you to the research shaping the future of health policy and health care. Until 10/14, purchase a two-year digital subscription to Health Affairs journal and receive a third year free with code ONEFREEYEAR.

Sign up for Insider to get exclusive access to our trend report focusing on the current prior authorization landscape.

Related Links:

• Medicare’s AI prior authorization pilot was rushed and full of problems, new documents reveal (Stat News)
• Prior authorization denials vary widely among insurers, first-of-its-kind data shows (Healthcare Dive)
• UnitedHealthcare cuts prior authorization from 1,700 codes (Healthcare Dive)
• TREND REPORT: The Current Prior Authorization Landscape (Health Affairs Insider)
• PR STUNT: UnitedHealth’s Big Prior Authorization Cut (Health Care Un-covered)

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This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs Publishing's Jeff Byers welcomes Allison Rizer, chief growth and innovation officer at ATI Advisory, about her recent Forefront article. They discuss upcoming 2027 Medicare-Medicaid integration requirements, how to measure if integration is valuable, and why decades of policy experimentation have produced mixed evidence.

Related Links:

• We’ve Spent Decades Testing Medicare-Medicaid Integration. Why Don’t We Know If It Works? (Health Affairs Forefront)

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs Publishing's Jeff Byers welcomes Jack Hoadley of Georgetown University to the pod to discuss the rapid growth of the No Surprises Act’s independent dispute resolution process and its estimated $22.4 billion cost over four years. They explore what’s driving the increase, why providers are winning most arbitration cases, and how the trend could affect health care affordability in the years ahead.

Join Health Affairs Publishing on September 16 for an Insider exclusive event featuring a discussion on on AI, health care, and where the two are heading with Halle Tecco, Jonathan Ketcham, and Paige Nong.

Related Links:

• Spending On IDR Process Pushes No Surprises Act Costs To More Than $22.4 Billion Over Just Four Years (Health Affairs Forefront)

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs Publishing's Jeff Byers welcomes Dan Arnold of Brown University to discuss the rapid growth of Medicaid spending on autism treatment and the expanding role of private equity-backed providers in the applied behavior analysis (ABA) therapy market.

He explores the drivers behind rising costs, emerging concerns about care quality and fraud, and the challenge of balancing oversight with continued access to services for families.

Related Links:

• The Business Of Autism Treatment: Private Equity Implications For State Medicaid Programs (Health Affairs Forefront)

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs Publishing's Jeff Byers welcomes Erica Socker of Georgetown University to the pod to discuss her recent Forefront article that explores how the Medicare Advantage quality bonus program is working in the wake of a Clover Health-CMS lawsuit over star ratings. They discuss the court’s ruling, CMS’s policy response, and why the case could become a catalyst for broader reforms to a program that now distributes billions of dollars annually.

Related Links:

• Medicare Advantage Quality Bonus Program: Court Decisions Spotlight Flaws (Health Affairs Forefront)

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This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

In this episode of Health Affairs This Week, David Betts, founder and board chair at StoryFlight Labs, shares how his ALS diagnosis inspired him to launch StoryFlight Labs and develop Talk To Me Goose, an AI-powered tool that helps people with speech-limiting conditions retain their voice and communicate with loved ones.

He discusses how AI can empower patients, the need for faster healthcare innovation, and policy changes that could improve access to ALS treatments and support.

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

On this episode, Health Affairs Publishing's Jeff Byers gets meta and invites Kent Anderson and Joy Moore, authors of the new book How The Internet Disrupted Science, onto the podcast to discuss how media trends have affected academic authors' research and get their work noticed and distributed in The Attention Economy.

Both Kent and Joy are currently consultants. Kent was the co-founder of The Scholarly Kitchen and current author at The Geyser. Joy has worked at Silverchair and The American Medical Association.

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Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs This Week is on vacation in July. We will return with new episodes in August 2026.

This episode originally aired on October 25, 2025.

Health Affairs This Week will return with new episodes next week.

Health Affairs' Jeff Byers welcomes Troyen A. Brennan of Harvard T.H. Chan School of Public Health and former CMO at CVS Health to the pod to discuss his new book, Wonderful and Broken: The Complex Reality of Primary Care in the United States. The conversation touches on themes within the book, including the current state of primary care, the diffusion of ideas in the health care space, the paradox of value-based care driven by Medicare Advantage, innovation in the Medicaid space, and what opportunities there could be to improve health care outcomes.

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This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

We interrupt the summer break for this special "emergency pod" episode.

Health Affairs Publishing's Jeff Byers welcomes Dr. Aaron Carroll, President and CEO of AcademyHealth, back to the pod to examine the sudden discontinuation of over $100 million in ongoing Agency for Healthcare Research and Quality (AHRQ) grant funding, raising questions about transparency, federal priorities, and the future of health services research.

Related Links:

• AcademyHealth's Situation Report (Substack)
• HHS research agency ends funding for dozens of health studies (Roll Call)
• AHRQ Is Being Dismantled and the Consequences Will Reach Every Part of American Health Care (Academy Health Situation Report)
• U.S. judge rejects Trump’s justification for terminating thousands of grants (Science)

Sign up for Health Affairs' free newsletter to catch up on our new articles, podcasts, and events.

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Health Affairs This Week is on vacation in July. We will return with new episodes in August 2026.

This episode originally aired on January 21, 2026.

On an emergency pod episode, Health Affairs' Jeff Byers welcomes Stacie Dusetzina of Vanderbilt University Medical Center to breakdown the recently unveiled The Great Healthcare Plan from the Trump administration.

Related Articles:

• The Great Healthcare Plan (White House)

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