Off the Chart: A Business of Medicine Podcast

Forty-seven percent of chief information officers (CIOs) named cost as their top barrier to interoperability in a survey CliniComp conducted with the College of Healthcare Information Management Executives (CHIME) Foundation, according to Sandra Johnson, senior vice president of client services at CliniComp. She says the barrier has shifted from technology and standards to cost and vendor unwillingness.

Medical Economics Managing Editor Todd Shryock sat down with Johnson, whose company CliniComp makes electronic health record (EHR) systems for hospitals and health systems.

Johnson says data stuck in disconnected systems leaves physicians treating patients with only half the chart, which carries a clinical cost as well as a financial one. She credits vendor consolidation, policy and government incentives with connecting more systems and says the next step is making that data usable at the point of care. She argues health systems need to treat interoperability as core infrastructure instead of bolting new tools onto old systems.

She also discusses whether data blocking is still a problem, how patient identity matching fits in and why artificial intelligence (AI) running on siloed data works from partial information. Every CIO in the survey said AI running on interoperable systems was important to their organization, she says.

Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET.

Don’t miss our recent episodes on AI in hiring, practice revenue, direct primary care and unanswered patient calls.

Music Credits:
Rooftops by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:33 | Cold open. Johnson on why siloed data leaves physicians treating patients with half the chart.

0:33 – 1:50 | Introduction. Austin Littrell introduces the episode and the guest and previews the Oct. 29 Practice Academy.

1:50 – 3:03 | Cost is now the barrier. Johnson says 47% of CIOs in the CHIME survey named cost as their top barrier, making interoperability a business problem more than a technical one.

3:03 – 3:53 | Treating patients with half the chart. Siloed data carries a clinical and human cost as well as a financial one.

3:53 – 5:14 | How interoperability got this far. Vendor consolidation, policy and government incentives connected more systems, and the next step is making that data usable at the point of care.

5:14 – 6:13 | Treating interoperability as infrastructure. Johnson says bolting tools onto existing systems doesn’t build interoperability, and health systems need a core foundation that can scale.

6:13 – 7:00 | Is data blocking still a problem? Johnson calls it a market failure that every part of the industry has to help fix.

7:00 – 7:59 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

7:59 – 8:42 | Patient identity matching. Johnson says normalizing data across systems is the key to a complete view of the patient.

8:42 – 9:38 | Where AI fits. Every CIO surveyed said AI running on interoperable systems matters, but AI built on siloed data sees only part of the patient.

9:38 – 10:32 | Who’s the bottleneck? Johnson says no single stakeholder is to blame and CIOs want industry consortiums where EHR vendors and health systems share ownership of the problem.

10:32 – 11:31 | Interoperability in five years. Johnson describes a complete view of every patient at the point of care, with technology helping clinicians instead of getting in their way.

11:31 – 12:24 | What doctors should do now. Johnson urges physicians to tell their IT teams where fragmented data slows down clinical decisions.

12:24 – End | Outro. Littrell reminds listeners about the Oct. 29 Practice Academy and wraps the episode.

A single job posting can draw 1,000 applicants in a week, according to Dina Taylor, chief evangelist at HireVue. She says no hiring team has the time to read all of those resumes.

Medical Economics Managing Editor Todd Shryock sat down with Taylor, whose company HireVue makes artificial intelligence (AI) hiring software, including video interviewing and candidate assessments.

Taylor says AI has made it easy for job seekers to write resumes and cover letters and to apply to many jobs in a short time, and the strongest candidates get buried in that volume. She describes using AI to summarize and rank every applicant for a hiring manager, with a human making the final decision. She also describes using it to evaluate skills and behaviors, such as empathy, that a resume can’t show.

She also explains how the interview changes when the hiring team already knows a candidate and why she says better-matched hires stay longer. She names the mistake she sees most often in health care hiring: being afraid to start.

Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET.

Music Credits:
Healing Breeze by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:31 | Cold open. Taylor on why no hiring team can read 1,000 resumes in a week.

0:31 – 2:01 | Introduction. Austin Littrell introduces the episode and the guest and previews the Oct. 29 Practice Academy.

2:01 – 3:30 | Why staffing is so hard right now. Taylor says unfilled shifts directly affect patient care, and health care roles require specific skills even as application volume keeps growing.

3:30 – 5:03 | How AI changed job applications. AI makes it easy to write a resume and cover letter and apply to many jobs at once, and the volume buries the strongest candidates.

5:03 – 6:50 | Using AI to sort the pile. Taylor says AI should make the hiring team’s work easier, with a human checking what it finds.

6:50 – 8:15 | What the hiring manager sees. In place of a top-20 list, AI summarizes and ranks every applicant so each one still gets considered.

8:15 – 9:07 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

9:07 – 10:54 | Looking past the resume. Taylor says AI-polished resumes can look identical, so skills, behaviors and cultural fit carry more weight.

10:54 – 11:47 | How the interview changes. The interview becomes a conversation to confirm what the hiring team already knows about a candidate.

11:47 – 12:32 | Better matches, longer tenure. Taylor says well-matched hires stay longer, earn higher patient satisfaction scores and move up faster.

12:32 – 13:19 | The biggest hiring mistake. Being afraid to start because health care has always hired the same way.

13:19 – 14:22 | Hiring in five years. Taylor expects more focus on skills and behaviors than on job titles, and more people entering health care from other careers.

14:22 – 14:53 | Final advice. Lean into innovation and don’t be afraid to try.

14:53 – [END] | Outro. Littrell recaps the conversation, reminds listeners about the Oct. 29 Practice Academy and wraps the episode.

Akash Madiah has seen the Medical Group Management Association (MGMA) from both sides. He used its data to redo physician compensation plans while working in practice finance, and he now leads the association as acting CEO in its centennial year. Following MGMA’s 2026 annual conference in San Antonio, he sat down with Physicians Practice Managing Editor Keith Reynolds to talk about what practices are calling MGMA about most, what administrators should do this quarter as Medicare pay stays flat and costs keep rising, and what the association’s first member pulse survey says it still needs to fix. He closes with two things any practice leader can start on Monday.

Register for the Physicians Practice Practice Academy Series: Protecting Your Practice’s Revenue, a virtual event on Thursday, Oct. 29, from 12 to 4 p.m. ET: https://registration.physicianspractice.com/990031/

Music Credits:
Coffee Shop Sketches by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:32 | Cold open Madiah on finding the revenue a practice is already losing before chasing new revenue.

0:32 – 1:44 | Introduction Austin Littrell introduces the episode and the guest and previews the Physicians Practice Practice Academy on Oct. 29.

1:44 – 3:13 | What practices are calling MGMA about Medicare cuts and prior authorization top the list, echoing the town hall Anders Gilberg led at the conference.

3:13 – 4:11 | From data user to association leader Madiah describes using MGMA data to redo physician compensation plans and why he judges every offering by how members will use it “on Monday morning.”

4:11 – 5:54 | What he heard in the hallways Reimbursement and administrative burden dominated the conversation in San Antonio, along with members asking how to get involved and volunteer.

5:54 – 7:44 | What MGMA still needs to get right MGMA’s first member pulse survey found trust is strong, but members want easier access through digital tools, education and local engagement.

7:44 – 9:12 | What administrators should do this quarter Know your numbers, collect what you’ve already earned before adding volume, invest in retention and benchmark against peers.

9:12 – 10:08 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

10:08 – 13:23 | Preparing for MGMA’s second century Madiah outlines three priorities: evolving MGMA’s data products, engaging members from early-career staff to veterans, and building the association’s voice as an industry leader.

13:23 – 15:12 | Two things to start on Monday Pick the one metric that matters most to your organization and review it every week, then schedule one conversation with a peer outside your organization.

15:12 – 16:21 | Closing thoughts Madiah reflects on MGMA’s role in taking work off physicians’ plates so they can focus on patients.

16:31 – [END] | Outro Littrell thanks listeners and reminds them about the Oct. 29 Practice Academy.

Health care organizations often promote their top clinicians into leadership roles with little preparation for the business side of the job, according to Kate Atchley, Ph.D., professor of practice at the Haslam College of Business at the University of Tennessee, Knoxville. A brilliant cardiologist, she says, isn’t automatically ready to handle capital allocation, payer economics or change management.

Megan Manzano, senior custom content specialist at Physicians Practice, sat down with Atchley, who directs Haslam’s Executive Master of Business Administration (MBA) in Healthcare Leadership and Physician Executive MBA programs.

Atchley says the biggest change in health care leadership over the last decade is how interconnected the problems have become. That leaves leaders choosing between two legitimate priorities, such as clinician autonomy and standardization or patient access and clinician workload. She names the five skills she sees as essential for physician leaders: systems thinking, business fluency, leading through influence, change leadership and curiosity. She also explains how organizations can build leaders earlier by giving promising staff gradually harder assignments and exposure to other parts of the organization, and offers her advice for physicians who want a bigger voice in how their organizations are run: “get out of your lane.”

This special report is sponsored by the Haslam College of Business at the University of Tennessee, Knoxville.

Music Credits:
Cup of Coffee by Ionics - stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 1:19 | Introduction. Austin Littrell introduces the special report and the guest.

1:19 – 2:21 | Meet Kate Atchley, Ph.D. Megan Manzano welcomes Atchley and lays out the pressures facing health care leaders, from reimbursement to workforce shortages.

2:21 – 3:25 | What’s changed in a decade. Atchley says health care’s problems are now so interconnected that leaders can’t pull one lever without moving three or four others.

3:25 – 5:07 | Why clinical expertise isn’t enough. Expertise in one domain is necessary but not sufficient for leading across many.

5:07 – 6:58 | Choosing between two valid priorities. Clinician autonomy vs. standardization, and patient access vs. clinician workload.

6:58 – 10:23 | Five skills physician leaders need. Systems thinking, business fluency, leading through influence, change leadership and curiosity.

10:23 – 11:49 | Building a leadership pipeline. Spotting potential leaders early and giving them gradually harder assignments before they step into the role.

11:49 – 14:01 | Get out of your lane. Atchley’s advice for emerging leaders: learn enough finance, operations and strategy to understand the trade-offs.

14:01 – [END] | Closing thoughts and outro. Manzano thanks Atchley, and Austin Littrell wraps the episode.

Direct primary care physicians charge an average of about $98 a month for a membership, and those who consider their practices full care for roughly 400 to 700 patients, according to a national survey led by Kenneth Qiu, M.D. Qiu says most of the practices that responded have a single physician, and a third of those have no staff at all.

Medical Economics Senior Editor Richard Payerchin sat down with Qiu, a family physician who founded EuDoc in the Richmond, Virginia, area straight out of residency and led the Direct Primary Care Alliance’s “State of Direct Primary Care” report.

Qiu says the community’s rule of thumb is that 1% to 5% of a physician’s fee-for-service patients will follow them into a new practice. Physicians starting from scratch often moonlight while their panels grow. Qiu says that work generally requires being opted into Medicare, which means billing Medicare for any Medicare patient they see. Many choose not to see those patients, which he says slows practice growth and limits access for beneficiaries. He also discusses repealing certificate-of-need laws, letting patients apply cash prices toward their deductibles, how his model differs from concierge medicine, why many practices stop growing around five physicians and how academic medicine still looks down on primary care.

Music Credits:
Midnight Serenade by MORRIX Holyhold - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor’s note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:32 | Cold open. Qiu on how his model differs from concierge medicine.

0:32 – 1:23 | Introduction. Austin Littrell introduces the episode and the guest.

1:23 – 2:55 | Meet Kenneth Qiu, M.D. Qiu describes opening his practice straight out of residency and first learning about the model as a fourth-year medical student.

2:55 – 4:48 | Why the alliance ran the survey. Figures on pricing and panel size had circulated by word of mouth with no hard data behind them.

4:48 – 6:57 | Reaching physicians outside organized medicine. How the committee pushed the survey through every network it could find.

6:57 – 10:07 | What the survey found. Practices in 49 states, average pricing near $98, full panels of roughly 400 to 700 patients and a large share of solo practices.

10:07 – 12:02 | How many practices are out there. Qiu explains where the estimate of about 3,600 practices nationwide comes from.

12:02 – 15:46 | Will your patients follow you? Building a panel, moonlighting while a practice grows and the Medicare billing rule that slows new practices.

15:46 – 18:46 | Removing barriers. Repealing certificate-of-need laws and letting patients apply cash prices toward their deductibles.

18:46 – 19:39 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

19:39 – 22:10 | Not concierge medicine. Why Qiu says criticism aimed at concierge practices doesn’t fit his model.

22:10 – 25:12 | Wearing every hat. The business demands of a solo practice and why growth often stalls around five physicians.

25:12 – 27:57 | Primary care’s image problem. How academic medicine looks down on family medicine and how the alliance reaches students and residents.

27:57 – 30:42 | The next generation. Qiu credits the survey’s collaborators and explains why physicians starting out of residency may push the model further.

30:42 – [END] | Closing thoughts and outro. Austin Littrell thanks listeners and wraps the episode.

Amol Nirgudkar, CPA, CGMA, estimates that 25% to 30% of calls to health care offices go unanswered during business hours. He says patients who reach voicemail rarely leave a message. They call the next practice in their search results.

Medical Economics Managing Editor Todd Shryock sat down with Nirgudkar, co-founder and CEO of Patient Prism, which uses artificial intelligence (AI) to analyze patient calls to practices.

Nirgudkar explains why access has become patients' top frustration and how unanswered calls waste money practices spend on search and social media ads. He suggests using AI voice agents for overflow, weekend and after-hours calls. He puts AI receptionist services at $500 to $800 a month, sometimes $1,000, against per-visit revenue he says can run from $250 to $5,000 depending on specialty. He also advises physicians to fix one broken process at a time and says the harder problem with AI is getting staff to use it.

Music Credits:
Sky Drifter by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:25 | Cold open. Nirgudkar grades today's AI voice agents.

0:25 – 1:19 | Introduction. Austin Littrell introduces the episode and the guest.

1:19 – 3:00 | Access is the problem. Nirgudkar says patients want to be seen when they need care, and the first hurdle is whether anyone answers the phone.

3:00 – 4:43 | What missed calls cost practices. Nirgudkar estimates 25% to 30% of calls go unanswered during business hours and says some voicemails are never returned. Unanswered calls also waste a practice's ad spending.

4:43 – 5:33 | Where patients go instead. Callers move on to the next physician in their Google or chatbot search results.

5:33 – 7:55 | Why the front desk is still a bottleneck. Clinician shortages, low pay for front office roles, staff trained as order takers and rising labor costs since the COVID-19 pandemic.

7:55 – 8:48 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

8:48 – 10:26 | Where AI voice agents fit today. Online scheduling handles simple bookings. Nirgudkar says voice agents are a good first step for overflow, weekend and after-hours calls.

10:26 – 12:31 | The return on investment. Nirgudkar compares monthly service costs with per-visit revenue and explains why most callers never leave a voicemail.

12:31 – 13:30 | Supporting staff, not replacing them. AI takes on routine work so front office teams can spend more time with patients at check-in and checkout.

13:30 – 15:30 | Will patients talk to AI? Low-acuity scheduling for existing patients works well, but insurance and coverage questions can still frustrate callers.

15:30 – 17:50 | Pick one problem and fix it. Chatbots, text agents, radiology AI and revenue cycle tools. Nirgudkar says the bigger challenge is getting staff to use what a practice buys.

17:50 – [END] | Closing thoughts and outro. Austin Littrell thanks listeners and wraps the episode.

In a June survey from reputation management company rater8, 55% of adults said they had walked away from at least one physician because of something they read online. When one of those reviews is fake or false, Michael Pelagalli, J.D., says HIPAA leaves physicians with very little they can say in a public reply, and federal regulators have fined practices that said too much.

Medical Economics Associate Editor Austin Littrell sat down with Pelagalli, a partner at Minc Law, a Cleveland firm that works exclusively on internet defamation and online reputation matters.

Pelagalli explains the difference between a defamatory review and a protected opinion. He covers what a practice should document and flag the moment a false review appears and how his firm uses John Doe lawsuits and subpoenas to unmask anonymous reviewers. He also describes a case in which dozens of fake reviews traced back to a family physician in the next county over. And he discusses the RESPOND Act, an advocacy campaign to amend HIPAA so physicians could reply in proportion to what a patient has already disclosed.

Music Credits:
Groovy 90s Hip Hop Acid Jazz by Musinova - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:28 | Cold open. Pelagalli on the family physician who woke up to dozens of fake reviews overnight.

0:28 – 1:52 | Introduction. Austin Littrell introduces the episode and the guest.

1:52 – 4:09 | Meet Michael Pelagalli. Pelagalli describes Minc Law's focus on online defamation, harassment and extortion. He explains how his early career defending physicians in malpractice cases led to the health care side of his practice.

4:09 – 6:13 | Opinion vs. fact. A rude physician or a long wait is opinion. Pelagalli explains why a claim that a surgeon was intoxicated in the operating room is a statement of fact that records can disprove.

6:13 – 10:16 | When a review crosses the line. Why reviews from real patients are harder to pursue than reviews from people who never were patients. Pelagalli describes a physician who took a patient's repeated accusations, which investigators had cleared, all the way to trial and won.

10:16 – 14:19 | The first step after a false review appears. Document it, check it against patient records and flag reviews from nonpatients to the platform repeatedly. Pelagalli explains when to call a lawyer before responding at all.

14:19 – 15:12 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

15:12 – 18:21 | How much a physician can say in reply. A generic invitation to talk privately is allowed. Confirming that the reviewer was ever a patient is not, even if the patient already said so.

18:21 – 21:24 | The RESPOND Act. Pelagalli on an advocacy effort to amend HIPAA so physicians could answer in proportion to what a patient has disclosed, and why litigation shouldn't be the only option.

21:24 – 26:43 | Unmasking an anonymous reviewer. How John Doe lawsuits, platform subpoenas, basic subscriber information and IP addresses lead to a name. Pelagalli explains what the letter to the unmasked reviewer says.

26:43 – 29:33 | When the reviewer is a competitor. The family physician from the next county over, and why a competitor opens the door to unfair competition, tortious interference and Lanham Act claims.

29:33 – 31:18 | Act promptly. Pelagalli says reaching the patient privately within a couple of days or a week makes removal far more likely than letting reviews pile up.

31:18 – End | Closing thoughts and outro. Littrell thanks Pelagalli and wraps the episode.

D2 Solutions' survey, "Patient Access Barriers 2026," found that 21% of patients delayed starting a prescribed medication because of confusion or access problems, and 47% said a lack of transparency left them anxious and uncertain. Dean Erhardt says the prior authorization rejections behind many of those delays are largely administrative rather than clinical, and they often come back with no reason given.

Medical Economics Senior Editor Richard Payerchin sat down with Erhardt, president and CEO of D2 Solutions, a health care consulting and technology company that works with drug manufacturers, pharmacies and payers on market access and patient support.

Erhardt explains how errors as small as a mismatched ZIP code get submissions thrown out, why guidance from payer call centers changes from one call to the next and what patients still don't know about manufacturer copay and affordability programs. He also weighs labor against technology costs for smaller practices, makes the case for upskilling staff around artificial intelligence (AI) and describes how primary care physicians could reach patients in health care deserts by setting aside time for telehealth.

Music Credits:
Her Name by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:40 | Cold open. Erhardt on what a newly diagnosed patient hears from everyone involved in getting a medication approved.

0:40 – 1:44 | Introduction. Austin Littrell introduces the episode and the guest.

1:44 – 3:47 | Meet Dean Erhardt. Erhardt describes D2 Solutions' start in consulting in 2008 and his earlier career on the payer, distributor and pharmacy benefit manager (PBM) sides of the industry.

3:47 – 5:34 | Why prior authorizations stall. Denials often come back with no reason given. Erhardt says delays of days are an infrastructure problem, and some manufacturers see products held up for as long as three to four weeks.

5:34 – 7:38 | Catching errors before they're submitted. Payer call center guidance varies from one call to the next. Erhardt explains how matching each payer's requirements for a given product and flagging errors as small as a mismatched ZIP code prevent rejections.

7:38 – 10:16 | What patients go through. Erhardt describes patients fielding conflicting calls from the physician's office, the pharmacy and the payer, practices needing as many as nine calls to reach them and patients who never learn about copay and affordability programs.

10:16 – 12:08 | Options for smaller practices. Erhardt weighs labor against technology costs, points to staff turnover as a hidden expense and says training on a new platform should take about 15 minutes.

12:08 – 13:01 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

13:01 – 16:08 | Can technology offset the workforce shortage? Erhardt expects dramatic shortages by 2030 and says people nearing retirement now are more comfortable with technology than the generation before them. He points to digital therapeutics and wearables as part of care delivery.

16:08 – 18:03 | Upskilling staff around AI. Erhardt's horse-and-buggy case for training, and why a couple of classes a year can keep a practice's skills from falling behind the technology.

18:03 – 20:56 | What comes after AI scribes. Virtual consults that put a distant physician in a rural exam room, AI call centers and why Erhardt thinks patients are 12 to 24 months from being comfortable with AI agents.

20:56 – 22:40 | A volatile year for drug access. Erhardt points to PBM reform, revamped manufacturer contracts, growing lists of non-covered drugs and the risk of a race to the bottom on biosimilar prices.

22:40 – 24:26 | Behind the "ask your doctor" ads. Erhardt describes enrolling patients in manufacturer programs straight from TV ads and screening them before they reach a physician. He estimates about 30% of patients don't have a primary care physician.

24:26 – 25:54 | Direct-to-patient models and primary care. Erhardt says patients will drive the shift toward virtual care based on convenience, and that they'll decide how they want to receive care.

25:54 – 27:46 | Investing in primary care. Health care deserts, physicians 75 miles away and the case for setting aside telehealth time for patients who can't take hours off work.

27:46 – 28:54 | What the survey says about access. Erhardt on the patient who learns they have a disease that costs $250,000 a year to treat and doesn't know what to do next.

28:54 – End | Closing thoughts and outro. Payerchin thanks Erhardt, and Littrell wraps the episode.

Nearly two decades into the push toward value-based care, Dan D'Orazio says the industry isn't much further along than it was when the effort began. He says value-based programs are still pegged to fee-for-service, and the fee-for-service revenue hospitals collect routinely outweighs the penalties meant to move them off it.

Medical Economics Managing Editor Todd Shryock sat down with D'Orazio, CEO of Sage Growth Partners, a Baltimore-based health care strategy and marketing firm.

D'Orazio explains why remote monitoring of implantable cardiac devices stalled long after the technology was ready. He also explains why he doesn't expect artificial intelligence (AI) to fix incentives that were never a technology problem, and what capitation and Maryland's global hospital budgets can and can't do outside an integrated system. He makes the case that physician-led accountable care organizations are one of the few places value-based care is working, and explains why he expects incremental gains at best from here.

Music Credits:
Sleepy Sunday by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:12 | Cold open. D'Orazio on where value-based care is headed.

0:12 – 1:12 | Introduction. Austin Littrell introduces the episode and the guest.

1:12 – 2:41 | Where value-based care actually stands. Todd Shryock welcomes D'Orazio, who says the industry isn't much further along than it was in 2008 and 2009, and not for lack of effort. He weighs 10 to 20 years of value-based care against 80 years of fee-for-service.

2:41 – 5:45 | Why the shift stalled. Value-based programs are still pegged to fee-for-service, and the incentives to stay put outweigh the penalties. D'Orazio uses remote monitoring of implantable cardiac devices to show that the barrier was never the technology. It was the workflows, liability, staffing and alert fatigue around it.

5:45 – 9:28 | Penalties vs. revenue. D'Orazio says readmission penalties are small next to what hospitals still collect under fee-for-service, and that most of what drives a patient's health sits outside a physician's control.

9:28 – 14:23 | Why payers and the government keep pushing it. Costs keep rising and employers are bearing them. D'Orazio says even online scheduling runs into directory data, interoperability and physician templates. He adds that short commercial plan tenure undercuts the long-term incentive value-based care depends on.

14:23 – 15:17 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

15:17 – 18:32 | Can AI solve it? AI is only as strong as the data beneath it. D'Orazio sees real gains in administrative automation but says AI won't change fee-for-service, incentives or patient behavior.

18:32 – 21:41 | Capitation's comeback. Integrated systems like Kaiser Permanente and Geisinger can make it work. D'Orazio walks through the underwriting, data and care coordination capitation demands, and why several health systems have exited the health plan business.

21:41 – 23:55 | The Maryland model. Maryland pays its hospitals through global budgets, an approach D'Orazio says is returning through a CMS model. He explains how it changed hospital behavior and why commercial insurers and employers can't easily replicate it.

23:55 – 27:45 | Where health care is headed. D'Orazio expects incremental gains at best. He points to physician-led accountable care organizations outperforming hospital-led ones and calls for a rebirth of independent physician leadership. He names end-of-life spending and prior authorization as problems that won't unwind easily.

27:45 – End | Closing thoughts and outro. Shryock thanks D'Orazio, and Littrell wraps the episode.

In a Buzz Health survey of prescribers, 54% said patients often or very often fail to start therapy because of cost, but only 17% said prescription abandonment is highly visible in their workflows. Joseph Kleiman, president of Buzz Health, says the gap comes down to connectivity: prescriber, pharmacy and health plan systems that still don't share data.

Medical Economics Managing Editor Todd Shryock sat down with Kleiman to talk through the survey, which included prescribers and electronic health record (EHR) workflow leaders.

Nearly all prescribers in the survey said seeing insurance and discount prices side by side in the EHR would be extremely or very valuable, and when cash or discount pricing was available at the point of prescribing, it was chosen most often. Kleiman explains why that doesn't necessarily make insurance the worse deal, what it costs patients and practices when price comparisons happen after the visit, and what he would tell the primary care physician who has stopped trying and tells patients to search for a coupon. He also weighs in on the role artificial intelligence (AI) could play and whether federal attention on price transparency is moving things in the right direction.

Music Credits:
Ocean Calm by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using artificial intelligence (AI) tools.

0:00 – 0:15 | Cold open. Kleiman on cash prices and surprises at the pharmacy counter.

0:15 – 1:14 | Introduction. Austin Littrell introduces the episode and the guest.

1:14 – 2:23 | Why patients don't start therapy. Todd Shryock welcomes Kleiman, whose company's survey found 54% of prescribers say patients often or very often fail to start therapy because of cost. Kleiman says the problem persists because prescriber, health plan and pharmacy systems still don't share data.

2:23 – 3:15 | Closing the feedback loop. Only 17% of prescribers said prescription abandonment is highly visible in their workflows. Kleiman says fixing that takes systems that deliver results in one centralized location, and that it hasn't been a priority rather than something anyone opposes.

3:15 – 4:04 | Pricing inside the EHR. Nearly all prescribers said side-by-side insurance and discount pricing in the EHR would be valuable. Kleiman says nothing is standing in the way, and the technology can already deliver real-time pricing at the point of prescribing.

4:04 – 5:12 | Cash price vs. insurance. When cash or discount pricing is shown at the point of prescribing, it gets picked most often. Kleiman says insurance isn't necessarily the worse option, but prior authorization and deductibles create friction that surfaces at the pharmacy.

5:12 – 6:10 | The cost of sorting out prices after the visit. When price comparisons fall to staff or patients after the appointment, Kleiman says the uncertainty leads to abandoned prescriptions.

6:10 – 7:04 | Primary care's role in affordability. Kleiman says primary care physicians want an active role, and connecting pharmacy, prescriber and health plan will let them play a bigger part in the prescription journey.

7:04 – 7:56 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

7:56 – 8:46 | A message for health systems and administrators. Kleiman says the technology is there and isn't difficult to implement, and that better adherence helps costs for practices and health plans.

8:46 – 9:40 | For the physician who's given up. Kleiman on patients quoted one price who find another at the pharmacy, and his message that solutions now exist through the EHR and health plans.

9:40 – 10:33 | Where AI fits. Kleiman says AI can play a big part, but data sharing must be permitted and the work done carefully in a heavily regulated industry.

10:33 – 11:21 | Are things getting better? Kleiman points to CMS and legislative action on price transparency and says the remaining work is tying systems to a single source of truth.

11:21 – 12:00 | Final thoughts. Kleiman urges pharmacies, prescribers and health plans not to push pricing transparency aside.

12:00 – End | Outro. Littrell wraps the episode and points listeners to Medical Economics and Physicians Practice coverage of the MGMA Annual Conference in San Antonio, Sept. 27-30.