The world is changing quickly, and health systems need to keep up with AI, clinical innovation, therapeutic discoveries, an aging population, the shift toward outpatient care and more. But transformation is expensive and requires capital to modernize facilities, invest in new equipment and technology, and build the services communities will need next.

Healthcare finance can feel opaque outside the C-suite, but it’s central to the future of care. For not-for-profit hospitals especially, access to capital markets and the credit ratings that shape borrowing costs can determine whether a long-term vision becomes reality.

In this episode of Healthcare is Hard, Keith Figlioli spoke with Lisa Goldstein, managing director of treasury and capital markets at Kaufman Hall. After decades at Moody’s evaluating the financial strength of hospitals and health systems, Lisa brings a rare perspective on how investors, rating agencies and health-system leaders weigh risk, cash flow and strategy. Lisa and Keith discussed topics including: 

• The mechanics of a credit rating. With common misconceptions about what a credit rating is – or isn’t – Lisa gave a quick history lesson about how the system works. Rather than a pass-fail grade or seal of approval, a rating is a way for investors to assess an organization’s likelihood of repaying its debt and the risks they take on by investing. While this system has existed for more than a century, Lisa explains why ratings have come to carry such outsized meaning for health systems, and why leaders need to manage their financial performance proactively.
• The difference between for-profit and not-for-profit. As Lisa points out, “Not-for-profit” does not mean “pro-deficit.” Even though nonprofit hospitals do not have shareholders, they still need durable margins and cash reserves to sustain operations and invest in their communities. And because they cannot raise equity by issuing stock, the tax-exempt bond market is a critical way they finance major projects. This is an advantage not available to their for-profit peers, which instead rely on taxable corporate debt and equity markets.
• The heroic work of health system CFOs. With responsibility for ensuring an organization has the financial strength to carry out its mission, hospital finance leaders must balance strategy, governance, operations and clinical care. Lisa describes that work as heroic. Navigating difficult negotiations with commercial payers, while being unable to negotiate reimbursement rates with government payers that account for a growing share of the payer mix, is just one challenging element of their role. Ultimately, they have to protect cash flow and preserve the capital needed to invest in the organization’s future.
• Why healthcare will continue to be capital intensive. There’s an ongoing debate about whether advancements like AI, virtual care and therapeutic breakthroughs will make healthcare less capital intensive. But Lisa doesn’t see that happening anytime soon. With an aging population, rapidly evolving treatments and equipment, ambitious ambulatory plans, and aging hospital infrastructure, she believes capital needs will remain high. The question is not whether health systems will need to invest, but how they will prioritize, finance and manage that investment.

To hear Lisa and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

CVS Health operates one of healthcare’s largest consumer platforms, with businesses spanning health insurance, pharmacy benefits, retail pharmacy, care delivery and digital channels. This creates a rare opportunity to understand the full journey people navigate as they seek care, fill prescriptions, manage coverage and work to stay healthy. 

The company’s overarching goal is not simply to improve each touchpoint. It is to remove the fragmentation that forces patients to piece care together on their own across multiple channels and organizations.

In this episode of Healthcare is Hard, Keith Figlioli talked to CVS Health’s head of enterprise customer experience, insights and innovation, Sri Narasimhan, to learn how the company uses customer signals, AI, and agentic twins to make healthcare more proactive and consumer-centered.

Sri brings an unusually broad background to this challenge. He worked in Bangladesh and India on tuberculosis control, HIV initiatives and public health during college, but then decided to branch out so he could ultimately bring a more diverse skillset back to the healthcare industry. He started an economic consulting firm before going to business school. Then he joined GE, where he learned about commercial functions and consumer value. After GE, he worked at the tech company Medallia, where he sharpened skills around speed of innovation, and then moved to Wells Fargo where he worked as head of customer experience for branch banking, learning how to operate in a highly regulated environment.

In 2021, Sri joined CVS Health where his work now sits at the intersection of consumer strategy and AI. During this interview, Sri shared his vast knowledge and experience to discuss topics including:

• Navigating bureaucracy. Sri points out that patients do not benchmark healthcare against other health plans, pharmacies or health systems. They compare it with the simple experiences they have everywhere else. He says most people want answers to four questions: Is it covered? What will it cost? When can I get it? And can I trust the answer? Healthcare’s tendency to bury those questions in process and bureaucracy is a major source of frustration that Sri is focused on addressing.
• AI versus primary care. Trust grows when people get something valuable, and Sri expects consumers to increasingly turn to AI for quick answers about symptoms, diagnoses and side effects as those tools become more useful and accurate. But for serious health issues, he believes the provider relationship will remain essential. AI may change the questions patients bring to clinicians – and which interactions require a clinician at all – but people will still want a trusted human when the stakes are high.
• Agentic twins revolutionizing consumer research. Sri calls this technology one of the most transformational capabilities he has seen because it allows CVS Health to simulate the reactions of roughly 150,000 individual consumers in minutes. Through consented interviews, behavioral data and other context, CVS Health built digital twins of actual consumers that simulate how they think and act. Instead of recruiting a new panel, running a focus group or launching a small pilot every time the company wants to test an idea, CVS can assemble the relevant population from its bank of agentic twins and pressure-test messages, choices and scenarios before going live. As Sri puts it, “I have 150,000 patients in the room with us."

To hear Sri and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

J.D. Whitlock’s path to becoming a health system CIO began in the U.S. Air Force, where he served in a variety of healthcare management roles, including a deployment to Afghanistan as Commander of the Patient Administration Division at Bagram Airfield in support of Operation Enduring Freedom in 2007. After retiring from the military, he spent three years at a federal healthcare systems integrator before becoming VP, Enterprise Intelligence at Bon Secours Mercy Health. For the past eight years, he has served as chief information officer at Dayton Children’s Hospital.

J.D.’s role at Dayton Children’s gives him a view into two corners of healthcare that are often underrepresented in digital health conversations: children’s health and smaller health systems. Dayton Children’s is an independent pediatric system with about $900 million in revenue and 4,900 employees. It runs the same core platforms and must meet many of the same expectations as far larger organizations, but without the same resources. As J.D. puts it, there is no office of transformation; it’s everybody’s job.

In this episode of Healthcare is Hard, J.D. joined Keith Figlioli to discuss the unique technology needs of children’s hospitals, and how smaller systems can participate in healthcare’s AI transformation. Some of the topics they discussed include:

• Why pediatric technology requires a different lens. Children’s hospitals have unique demands because their patients are not just smaller adults. Digital tools must account for parents and guardians, adolescent privacy, state-specific confidentiality laws, and a patient population whose families increasingly expect digital-first communication. Yet pediatric use cases often remain an afterthought for vendors and investors. He argues that vendors and health tech leaders need to think about pediatrics earlier, because the children’s hospitals that serve 25% of the population can’t just bolt on adult solutions.
• Innovating without “science experiment” money. Dayton Children’s cannot simply pilot technology because it’s interesting. J.D. describes a more disciplined approach in which pilots are treated as phase-one implementations, with the expectation that the organization has already studied the evidence and believes a solution can work. That also means learning from larger pediatric academic medical centers, participating in collaborative networks, and focusing internal resources on ideas that have demonstrated value elsewhere. 
• A platform-first approach to AI. Despite the flood of new AI companies entering healthcare, J.D. believes much of the near-term value will come from the core systems health organizations already use. Point solutions can still earn a place, but they need mature integrations and evidence of ROI. As agents increase AI consumption and introduce more variable costs, health systems will also need to scrutinize whether each new capability is being used enough to justify its expense.
• Matching ROI to the use case. Not every technology investment has the same kind of return. Some need to show hard savings, while others are about improving the clinician experience, supporting retention, or making care delivery work better. J.D. discusses how the key is being clear about which kind of value you expect.

To hear J.D. and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Growing up on a farm in rural Missouri, and even through college, a career in healthcare was never in the forefront of Laura Wilt’s mind. She studied finance at Tulane and thought she might go into banking, but a decision to take a job at Epic changed everything. What began as an unexpected first step into healthcare IT quickly became a career, as Laura found she could use technology to make a real difference for physicians, nurses and patients at scale.

That path eventually took her to Ochsner Health, where she rose to become system vice president and chief information officer. When Ochsner CEO Warner Thomas left to become Sutter Health’s president and CEO, Laura followed soon after, joining Sacramento-based Sutter in 2023 as executive vice president and chief digital officer. Today, she is helping lead a broad transformation at Sutter built around expanding access, adding ambulatory and advanced-care capacity, and advancing a more unified, people-centered digital strategy.

In this episode of Healthcare is Hard, Laura joined Keith Figlioli to discuss what it takes to lead digital change at a time when technology is moving exponentially faster than health systems can adopt it. In a conversation that steered clear of hype and more towards the hard work underneath real transformation, some of the topics Laura and Keith discussed include:

• Designing pilots for scale. Laura makes the case that a pilot should never exist just to prove something can go live. Its real purpose is to teach an organization what it will take to scale. That means bringing in the people closest to the workflow, building with the broader enterprise in mind, and accepting more upfront work if that is what it takes to make a solution usable for everyone in the long run.
• Principle-based decision making. Looking back, Laura says one of the most important lessons she carried forward from Epic was the value of guiding principles. In a moment when no organization can write rules for every scenario, she argues that leaders need a clearer framework for decision-making – one that asks whether a tool makes work easier, improves care, and serves people first. At Sutter, that mindset has also meant balancing foundational system work with innovation as equally important efforts.
• The AI-informed consumer. With patients already turning to ChatGPT and other AI tools for medical guidance, Laura discussed how health systems need to embrace this shift and make it part of the workflow. Over time, she says the goal should be to create a connected digital experience where patients increasingly turn to Sutter first for guidance, not just to an outside AI tool. She also shared early metrics about a new AI assistant Sutter is in the process of launching.
• Leading with humility. For Laura, one of the most important traits for digital leaders today is humility. As organizations look to IT leaders for answers in a fast-changing environment, leaders need the confidence to admit when those answers do not yet exist. That makes transparency, curiosity, and strong human communication more important than ever.

To hear Laura and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Cedars-Sinai has evolved from a community hospital to a major academic health system with an international reputation for quality care, community service, research and education. Much of that evolution and expansion took place under the leadership of Tom Priselac, who served as President and CEO for 30 years, until his retirement in 2024.

After joining Cedars-Sinai in 1979, Priselac spent nearly half a century at the organization, rising through a series of leadership roles as the institution expanded its academic mission, built an integrated medical network and adapted to major shifts in healthcare delivery. That long tenure gave him a rare vantage point on how health systems change over time, and what it takes to lead through multiple eras of disruption.

In this episode of Healthcare is Hard, Priselac reflects on why the leadership job in healthcare feels more challenging now than ever. The pace of change is faster, and today’s leaders are navigating a far more complicated environment shaped by financial pressures, regulatory demands, rapid technological advancement and major scientific breakthroughs. But even with all that complexity, Priselac argues that the fundamentals of leadership remain the same. He advocates for creating a culture of excellence, helping people understand why change is necessary, and making sure an organization can absorb change in a thoughtful way. 

Some of the topics Tom and Keith discussed include:

• Culture at the heart of healthcare. Priselac returns repeatedly to the importance of values, emotional intelligence and culture in healthcare leadership. In his view, an organization’s culture reflects the decisions, behaviors and priorities of its leaders, and that matters even more in complex environments like academic medical centers. Whether the challenge is aligning faculty, community physicians, researchers or administrators, success depends on keeping patient care at the center and building a shared sense of mission.
• Pushing change too fast. One of Priselac’s clearest leadership lessons is that organizations and people can absorb only so much change at once. While today’s leaders face real pressure to move more quickly, he warns that some of the biggest mistakes happen when executives short-circuit the change management process. Looking back on his own career, he says some of his most important learning came from moments when he pushed for too much change too quickly.
• Why cost and access still keep him up at night. Even with all the promise of genomics, proteomics, cell and gene therapy, and AI, Priselac remains deeply concerned that healthcare’s affordability and access problems are worsening faster than policymakers are addressing them. He points to clear signs of strain already in the system – communities losing access to care, hospitals in urban areas operating beyond capacity, and patients spending hours waiting for admission. For all the excitement around innovation, he sees cost and access as the country’s most urgent unresolved healthcare challenges.

To hear Keith and Tom discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Bob Wachter describes his career as the result of “what happens when a political science major becomes an academic physician.” Rather than focus on one specialty or scientific domain, he became fascinated by the healthcare system itself and has spent more than 40 years examining how care is organized, where it breaks down, and how technology can help make it better.

The author of more than 300 articles and six books, Dr. Wachter famously coined the term “hospitalist” in 1996, helping give rise to one of the fastest-growing specialties in medicine. Among other roles, he has served as president of the Society of Hospital Medicine and chair of the American Board of Internal Medicine. He also founded and directed the Division of Hospital Medicine at the University of California, San Francisco (UCSF), where he is currently Professor and Chair of the Department of Medicine.

For the past 15 years, Dr. Wachter has focused much of his attention on the impact of technology on healthcare, a topic that shaped his two most recent books. In The Digital Doctor, he explored why electronic health records created as much frustration as progress. But he has since come to see that EHRs were never the full answer, only the foundation healthcare needed before better tools could emerge. On the day ChatGPT was publicly released in 2022, Dr. Wachter recognized the major shift ahead, paving the way for his newest book, A Giant Leap.

In this episode of Healthcare is Hard, Dr. Wachter joined Keith Figlioli to discuss why AI is different from previous waves of health IT, how quickly it may change care delivery, and the opportunity for AI to address many of healthcare’s long-standing problems. Some of the topics Dr. Wachter and Keith discussed include:

• Why “better than today” may be the right benchmark. One of Dr. Wachter’s core arguments is that AI does not need to be perfect to be valuable in healthcare. If clinicians are currently expected to review 600-page charts in minutes, keep up with a flood of new medical literature, and navigate increasingly complex administrative tasks, then tools that can summarize, suggest, and support – even imperfectly – may still represent a meaningful step forward. The real challenge will be keeping isolated failures or headline-grabbing mistakes from derailing progress that is net positive. 
• Reshaping the patient-doctor relationship. Dr. Wachter expects patients to be increasingly informed by the ability to use AI to review records, understand symptoms, and map care decisions. However, he warns that it could create tension for clinicians that are already working within tight visit windows and may need to spend more time responding to GPT-generated advice. He also discussed how it raises bigger strategic questions for health systems, as AI-guided navigation may begin to influence where patients seek care, and even which institutions they trust. 
• Elevating primary care. Dr. Wachter sees AI as a kind of specialist in a clinician’s pocket, opening the possibility for primary care physicians to do more by offloading routine work and improving their ability to support complex cases. He also discussed how patients will be more likely to shift away from health systems, and more towards new entrants in the market for primary and preventative care.   
• Underestimating the speed of change. In Dr. Wachter’s view, many leaders don’t yet realize how fast AI will change healthcare. For health systems, the risk is not just missing out on productivity gains. It is losing control of the patient relationship, the referral pathway, and ultimately an organization’s competitive position. 

To hear Keith and Dr. Wachter discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Dr. John Brownstein has been on the leading edge of digital health since medical school, where he was drawn to epidemiology because of the opportunity to use data sets for large-scale impact beyond the exam room. He’s been on a hunt for data ever since, shaping a career that has spanned public health, technology, startups, and healthcare innovation.

Dr. Brownstein helped develop Google Flu Trends, served as a healthcare advisor to Uber, and launched one of the first data analytics companies in public health, where he applied AI long before it became today’s dominant topic. In 2015, he became Chief Innovation Officer at Boston Children’s Hospital, where he has helped turn it into a proving ground for emerging technologies.

With its manageable size, nimble culture, and an administration willing to invest in innovation, Dr. Brownstein has helped turn Boston Children’s into an ideal setting for testing emerging technology. This environment, which put Boston Children’s on the front edge of healthcare IT for more than a decade, has positioned it to help lead the current AI wave.

In this episode of Healthcare is Hard, Dr. Brownstein joined Keith Figlioli to discuss AI adoption, how it’s changing health systems, and what those changes mean for the companies selling to them. They discussed topics including:

• The fast pace from pilots to production. Only half joking, Dr. Brownstein mentioned that his conversation with Keith would be outdated by the time the podcast aired. The reality is, everything related to AI is moving so quick – even in healthcare, which is bucking its reputation as a slow mover on tech adoption when it comes to AI. Health systems are no longer just dabbling in isolated pilots; they’re taking significant steps toward broad deployment, using AI for intelligent automation, workflow support, and clinical tools in ways that are beginning to produce measurable impact.
• The build versus buy equation. After launching Boston Children’s innovation program, Dr. Brownstein recognized that having a large engineering team wasn’t sustainable and began turning to startups that could innovate and deploy quickly. But that tide is shifting again, with the ability to use AI for internal development. He hasn’t closed the door on startups, but says the bar is much higher. Companies selling into providers will need to show a stronger moat – whether through proprietary data, regulatory expertise, deep workflow integration, or some other advantage that cannot be easily recreated in-house.
• Designing AI architecture. AI procurement has become much more strategic than investing in point solutions. Dr. Brownstein discussed how health systems need to think about foundation models, hyperscalers, core systems like Epic, and point solutions, and how they all fit together to benefit users including clinicians, researchers, patients and families. For startups and incumbents alike, success will depend not only on product performance, but on how well a solution fits into the broader technology stack health systems are now building around AI.
• Why culture is just as important as capability. Even with strong interest in AI across healthcare, adoption is not purely a technical issue. Dr, Brownstein notes that while demand for AI tools is high, there are also signs of fatigue and anxiety as AI becomes an unavoidable topic in boardrooms, leadership meetings, and day-to-day work. With real questions about trust and job impact, organizations will need to pair technical progress with a thoughtful approach to culture, communication, and workforce readiness.

To hear Keith Figlioli and Dr. John Brownstein discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

The daughter of a hospital administrator, Amy Gleason never considered a career in the public sector – she went straight into healthcare. As an emergency room nurse, she started to see the dangers that unfold when healthcare providers don’t have access to the information they need to treat patients. Those experiences drove her towards a tech career in the emerging electronic health records space before a very personal experience altered her professional path yet again.

Amy’s active and healthy 10-year old daughter began suffering unusual healthcare events, from rashes and headaches to broken bones. Eventually, she couldn’t walk. It took more than a year from the start of these symptoms for doctors to diagnose her with a rare autoimmune disease. Even then, it was an accidental diagnosis from a dermatologist conducting a skin biopsy.

Amy attributes the delayed diagnosis to siloed data, not unsimilar to the challenges she experienced as a nurse and was working to solve in the EHR space. It motivated her to co-found a company focused on helping patients with chronic diseases access their data to share it with the providers and family members helping to navigate complex care journeys.

In 2015, Amy’s work earned her an award from the White House for Champions of Change in Precision Medicine – her first foray into the public sector. By 2018, she entered civic service full time with a role at the United States Digital Service, which she describes as “DOGE 1.0.”

In this episode of Healthcare is Hard, Amy talked to Keith Figlioli about the work she’s doing now as Strategic Advisor to CMS and Administrator of the U.S. DOGE Service, where her main mission is modernizing technology across government agencies for the millions of people who rely on federal services every day. This ranges from modernizing FAFSA and the student loan process, to improving the Visa system ahead of the World Cup, and work on various critical healthcare systems. 

Some of the topics Amy and Keith discussed in this episode, include:

• Bold plans for a Digital Health Ecosystem. Launched in July 2025, CMS’ Health Tech Ecosystem is a public-private partnership designed as a voluntary, fast-moving alternative to slow rulemaking. Rather than years of regulation, the program uses pledges, working groups, and short development cycles to put interoperability building blocks and real patient-facing use cases in place. The goal is to get usable capabilities into the market in months – not years – let the community iterate, and have baseline use cases live by March 31, 2026 with more advanced capabilities rolling out by July.
• Carrots and sticks before regulation. Recognizing the limitations of regulation, Amy talked about a new philosophy for incentivizing the market to change behaviors on its own first. “Carrots” include the rural health transformation fund and the recently introduced ACCESS model, a 10-year pilot that, for the first time, lets tech-enabled services bill Medicare directly. “Sticks” include stricter enforcement of information-blocking rules.
• Replacing the 1970s-era Medicare claims system. Amy discussed plans to replace Medicare’s decades-old COBOL-based adjudication platform. While it’s a stable platform, it can’t support real-time processing, AI, or rapid change. To replace it, CMS is looking to commercial, off-the-shelf solutions that operate at scale so claims processing can be modernized, made real-time, and integrated with new interoperability rails. It’s a concrete example of bringing modern engineering and product thinking to government technology.

To hear Amy and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

After three decades working to deliver easy, fast and cost-effective patient experiences through technology, Ryan Howells is more optimistic about the future than he’s ever been before.

At a time when healthcare has been at the center of polarizing and partisan politics, Ryan is focused on an area foundational to digital health that he says draws consensus across party lines: data exchange and interoperability. Freely moving data can unlock innovation in technology, payment models, and regulation to make healthcare work better for everyone, and Ryan is extremely encouraged by the openness to ideas and volume of activity he’s seeing from the second Trump Administration in these areas.

As Principal at Leavitt Partners since 2015, Ryan collaborates with the private sector, the White House, Congress, HHS, and the VHA to improve health care nationwide. For the past ten years, he has also led the CARIN Alliance, a bi-partisan, multi-sector alliance uniting industry leaders to advance the adoption of consumer-directed exchange across the U.S.

In January 2023, Ryan joined Keith Figlioli on the podcast to discuss the myriad of new possibilities emerging in healthcare as a result of better access to data. In this episode, he recounts the progress and obstacles since that conversation, but more importantly, helps unpack the flurry of new activity.

Topics Ryan and Keith covered include:

• ACCESS & TEMPO. These are the latest examples of two new government programs that Ryan believes will remove barriers to innovation. ACCESS is a CMS initiative that now makes it possible for technology companies to bill Medicare directly for digital health services – and get paid only when patients achieve specific, measurable clinical outcomes. Ryan explains how ACCESS is a breakthrough for transparency and has the potential to change contracting for digital health vendors as health system may now ask to share risk. TEMPO is a program from the FDA that complements ACCESS by allowing participating companies to bypass traditional device clearance processes through “enforcement discretion,” provided they share real time data with the FDA. Ryan explains how this oversight lowers cost and complexity for startups and accelerates the path to market for new digital health solutions.
• Removing administrative roadblocks. In early 2025, Ryan’s team at Leavitt Partners published a paper titled, “Kill the Clipboard” that offered recommendations to cut administrative costs, lower the burden on consumers and providers, and modernize the health care data exchange ecosystem. Ryan discussed recommendations like the need for stronger enforcement of information blocking rules and suggestions for the government to change its certification program to focus on APIs, versus functionality of EHRs. He explained how these things would allow health systems to control their own data, build cloud-based workflows, and integrate with payers and innovative companies more easily.
• Linchpins for data liquidity. Ryan believes that achieving true data liquidity in healthcare requires three foundational elements: a cloud-based data store, an API endpoint, and robust digital identity credentials. With these in place, he says organizations can exchange data securely and efficiently, supporting everything from public health to quality measurement and pharmacy exchange. He says these are the linchpins to finally achieve the data liquidity needed for innovation, interoperability, and improved patient outcomes.

To hear Ryan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for

Sitting at the intersection of healthcare policy, hospital finance, and patient access, the 340B drug discount program is a hot button issues in the pharmacy space. The program is critically important to providers that serve high volumes of low income and vulnerable patient populations, but it’s drawing increasing scrutiny.

340B was established in 1992 as part of the Public Health Services Act to help providers stretch scarce resources, expand services, and improve access to care for those most in need. It does this by requiring pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at significant discounts to safety net hospitals and other covered entities – including federally qualified health centers (FQHCs), HIV clinics, homeless clinics and more. Covered entities are reimbursed for the full cost of the medication and use that margin to offset losses from caring for low‑income, uninsured, and underinsured patients. It’s become a critical component to their operating budgets.

The program has grown substantially since its inception, with increasing numbers of hospitals and entities participating. This expansion has led to questions about whether the program is being used as intended or stretched beyond its original purpose.

Ted Slafsky – one of the nation’s leading experts on 340B – joined Keith Figlioli for this episode of Healthcare is Hard to unpack this complex and critical program. For 22 years, Ted served as president and CEO of 340B Health, a Washington D.C.-based association of over 1400 hospitals nationwide participating in the 340B program. In 2020, he started 340B Report, the only news outlet in the country focused exclusively on the 340B program.

Some of the topics Ted and Keith discussed include:

• Balancing oversight and operational efficiency. The 340B program faces growing calls for transparency and accountability, with proposals for more detailed reporting on how hospitals and clinics use the savings. While oversight is important to ensure compliance and integrity, Ted warns that excessive administrative requirements could overwhelm providers and divert resources away from patient care. The challenge is finding a balance that promotes trust without creating an operational burden.
• Dispelling Myths. One common misconception about 340B is that it’s a direct patient discount program. Ted addressed this myth, explaining how the discount is intended for providers to give them more resources to reach and serve more patients. The other myth Ted addressed is how the program is described – mostly by the pharmaceutical industry – as a “markup scheme.” He doesn’t think that’s a fair depiction and explained that revenue from commercially insured patients is essential for offsetting the cost of treating uninsured and underinsured patients, making the program a lifeline for safety-net providers.
• An uncertain future. The 340B program faces significant uncertainty as policymakers consider major changes. Recent efforts to replace upfront drug discounts with a rebate model could strain the financial stability of small and rural providers, while federal proposals to cut Medicare Part B reimbursement add further pressure. At the same time, state legislatures are enacting a patchwork of laws to protect providers and restore contract pharmacy discounts, creating complexity across the country. Ted advises providers to not simply hope for the best. He urges hospitals and health centers to engage directly with lawmakers and their staff by inviting them to visit facilities where they can see the program’s impact and its role in supporting vulnerable populations.

To hear Ted and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.