Health Affairs This Week

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 Tara Bannow of Stat News to the program to discuss Quorum Health’s proposed transition from a for-profit to nonprofit hospital system, including the operational, financial, and policy implications of the move.

The discussion explores Quorum’s history of debt and restructuring, where CHS fits into the story, the financial advantages of nonprofit status, and whether similar transitions could become a pathway for struggling investor-owned health care organizations.

Related Links:

• A private equity-owned hospital chain is becoming a nonprofit. Is it just a bailout for investors? (STAT)
• Will the Rural Health Transformation Fund Deliver? (Health Affairs This Week)

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.

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY DrFIRST.

In this sponsored episode, Dr. Colin Banas, chief medical officer at DrFirst, joins Health Affairs Publishing's Rob Lott to discuss prior authorization, why the process continues to create delays and administrative burden, and the future of prior authorization in the health care ecosystem.

Colin Banas joined DrFirst in 2019 after spending 17 years as CMIO at VCU Health System, where he also practiced as an internal medicine hospitalist. He has testified before the U.S. Senate on health IT and meaningful use and previously served as a health IT Fellow at the ONC. 

At DrFirst, Dr. Banas drives innovation in medication workflows, focusing on non-disruptive decision support that creates better experiences for providers and patients, including how AI can reduce clinical burnout and improve patient outcomes. 

This conversation explores the root causes of prior authorization challenges, from fragmented workflows and outdated technology to the competing incentives facing providers and payers. Dr. Banas and Lott also discuss how automation, interoperability, and artificial intelligence are beginning to reshape prior authorization and help organizations reduce friction while maintaining appropriate oversight of care.

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 Trilliant Health’s Allison Oakes to discuss the findings of the organization’s 2026 Trends Shaping the Health Economy report and the pressures affecting the U.S. health care system.

Together, they examine trends in affordability, insurance coverage, health care utilization, and payment policy that could shape the industry in the years ahead.

Join Health Affairs Publishing on October 21 for an Insider exclusive event exploring risk adjustment, coding incentives, spending, and outcomes with Richard Kronick and Matthew Fiedler.

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.

As Health Affairs Forefront celebrates its 20th anniversary, two of the publication's most influential contributors join Editor Chris Fleming for a conversation about the future of health policy. 

Tim Jost and Katie Keith, whose rapid-response analyses have helped readers navigate some of the most consequential health policy developments of the last two decades, reflect on what lessons from the past may shape the next 20 years.

The discussion explores the legacy of the Affordable Care Act, the policy lessons learned from reform and repeal efforts, and how recent legislative changes could reshape coverage and access in the years ahead. Jost and Keith also examine the challenges of controlling health care costs, the role of Congress in an increasingly polarized political environment, and the growing influence of courts and litigation on health policy outcomes.

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 Senior Editor Meg Winchester back to the pod to discuss the Trump administration's decision to terminate ACA marketplace coverage for more than 760,000 people as part of a broader effort to combat fraud, waste, and abuse.

They examine how the disenrollments were carried out, the potential implications for consumers and insurers, and what the move could mean for the future stability of the ACA marketplaces.

Join Health Affairs Publishing on October 21 for an Insider exclusive event exploring risk adjustment, coding incentives, spending, and outcomes with Richard Kronick and Matthew Fiedler.

Related Links:

• Administration Cancels Coverage For More Than 760,000, Blocks New Agents And Brokers (Health Affairs Forefront)
• Withholding Medicaid Dollars Won’t Stop Fraud. It Will Hurt People (Health Affairs Forefront)
• The Troubling Termination Of 760,000 ACA Marketplace Members (Health Affairs Forefront)
• Semiannual Report to Congress (HHS)
• ACA Exchange Enrollment in 2026 (ASPE)

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 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)

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 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)

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 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)

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 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)

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 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)

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

Subscribe to Semafor Healthcare for free.