Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has selected one of our most impactful and widely listened-to conversations from the archives to revisit. He introduces this timely discussion with Chris Van Gorder, which explores how cost shifting, regulatory mandates, and Medicare Advantage risk transfer are pushing healthcare toward structural unaffordability.

Summary:

Leading a major health system today means juggling patient-first ethics with a financing model that keeps tightening the screws.

In this episode, Chris Van Gorder, President and Chief Executive Officer of Scripps Health, explains why health care is becoming structurally unaffordable amid soaring premiums, uncompensated emergency care, and rising input costs. He describes how hospitals have become the default safety net as county systems disappear, while underpayment by Medicare and Medicaid forces cost shifting onto employers and commercially insured patients. Van Gorder also highlights California’s seismic rebuilding mandates, which create massive capital pressure without matching reimbursement. He critiques managed care, value-based care, and Medicare Advantage for pushing risk onto providers through prior authorization and denials, recounting Scripps’ difficult decision to exit several Medicare Advantage contracts after heavy losses and the downstream impact on patients.

Tune in and learn how payment design, intermediaries, and regulation shape what hospitals can sustain and what patients can access.

About Chris Van Gorder:

Chris Van Gorder, MPA, FACHE, is the President and Chief Executive Officer of Scripps Health in San Diego, where he has led the organization since 2000 after serving as its Chief of Healthcare Operations and COO. A veteran healthcare executive with decades of experience across California hospital systems, he previously held CEO and senior leadership roles at Long Beach Memorial Medical Center, Anaheim Memorial Medical Center, and Little Company of Mary Hospital. Beyond health system leadership, he has served on multiple boards, including Prolacta Bioscience and previously Abiomed and Z-Medica, and he has been active in national and civic service as a commissioner for the U.S. National Commission for UNESCO. He also brings an uncommon public-safety background, including reserve service with the San Diego Sheriff’s Department and long-running involvement with California’s Emergency Medical Services Authority, earning a Distinguished Service Medal. An educator and author, he teaches at USC and wrote The Front-Line Leader (2014).

Things You’ll Learn:

Resources:

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Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, is revisiting some of the most impactful conversations from the archives. For this episode, he selected a standout discussion with Dr. Michelle Schreiber and Brenna Rabel, exploring how quality measures are developed, adopted, and implemented across Medicare and Medicaid programs.

Summary:

How do we decide what “good care” looks like, and who gets to choose the scorecard?

In this episode of Turn on the Lights, Kedar Mate speaks with Dr. Michelle Schreiber of the Centers for Medicare & Medicaid Services and Brenna Rabel of Battelle about how quality measures are developed, adopted, and applied across Medicare and Medicaid programs. They explore why measurement is essential for accountability, patient choice, and improvement, while also acknowledging its vulnerability to politics, feasibility constraints, and “teaching to the test.” Using diabetes and sepsis as examples, they explain how performance cutoffs are established, why “all-or-none” measures often face resistance, and what makes complex measures difficult to report and score. The conversation also addresses efforts to reduce reporting burden, including CMS’s shift from broader MIPS reporting toward MIPS Value Pathways and the expansion of digital quality measurement through FHIR-enabled eCQMs. They conclude with a forward-looking discussion on how artificial intelligence could reduce manual chart abstraction and advance quality measurement, particularly as patient-reported outcomes play a larger role in shaping the future of value-based care.

Tune in to hear how measures shape what health systems prioritize, what gets improved, and what “value” could look like in the future.

Resources:

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Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has hand-selected one of our most-listened-to and impactful conversations from the archives to highlight once again. Dr. Philip brings back to attention this conversation with Dr. Ben Sommers on how Medicaid work requirements and reduced ACA subsidies are driving coverage losses through administrative barriers, with far-reaching consequences for patient health and the stability of safety-net hospitals and communities.

Summary:

Millions of Americans could lose health coverage in the coming years, and the consequences may be more profound than most people realize.

In this episode, Dr. Ben Sommers, the Huntley Quelch Professor of Health Care Economics at the Harvard T.H. Chan School of Public Health, and professor of medicine at Harvard Medical School and Brigham & Women’s Hospital, talks about how new federal policies, including Medicaid work requirements and the rollback of Affordable Care Act subsidies, are reshaping access to health insurance in the U.S. Drawing on extensive research, he explains why these changes are expected to increase uninsured rates without meaningfully boosting employment. Dr. Sommers also shares evidence from prior state experiments showing that administrative red tape, not a lack of willingness to work, drives coverage loss. He outlines the ripple effects on patient health, safety-net providers, and hospitals, especially in rural and underserved communities.

Tune in to understand what these policy shifts mean for patients, providers, and the future of the U.S. health care system.

Things You’ll Learn:

Resources:

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Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has hand-selected one of our most-listened-to and impactful conversations from the archives to highlight once again. Dr. Philip introduces this essential dialogue with Professor Charles Vincent, reflecting on why its core message, moving past basic compliance toward true, real-time healthcare improvement, is so vital to where the podcast is headed next.

Summary:

Blame rarely makes care safer, but understanding the system usually does.

In this episode, Professor Charles Vincent, a clinical psychologist and leading patient safety researcher, explains how harm often emerges from a chain of small breakdowns, not from a single “bad” decision, and why the better question is “what in the system allowed this to happen?” He unpacks how the fixation on individual error can miss deeper contributors, such as fatigue, poor supervision, weak monitoring, clunky equipment design, noise, distraction, and communication that is not truly heard. You will hear why disrespectful behavior and hierarchy are safety risks, how simple routines like surgical safety checklists can change whether people speak up, and why healthcare struggles to name the trade-off between pushing volume and protecting safety.

Tune in and learn how a systems lens, respectful teamwork, and real trade-offs can make care safer.

About Prof. Charles Vincent:

Charles Vincent is a Professor of Psychology at the University of Oxford and a longtime researcher focused on patient safety across a wide range of healthcare settings. He studies how and why errors and patient harm happen, what actually works to improve safety, and how safety events affect patients, families, and healthcare staff. More recently, his work has zeroed in on how risk is managed when teams are under pressure, where small breakdowns can quickly compound in complex systems. Before Oxford, he spent over a decade at Imperial College London as Professor of Clinical Safety Research and later served as Emeritus Professor. His academic background spans psychology and clinical psychology, including a PhD in Psychology, which shapes his practical, systems-based approach to safety and risk management.

Things You’ll Learn:

Most serious harm in healthcare results from interconnected system conditions, such as missed monitoring, delays, and weak supervision, rather than a single individual error.

A focus on blame fosters defensiveness and inhibits organizational learning, whereas a systems perspective examines factors such as fatigue, workflow, tools, environment, and teamwork that shape human performance.

Disrespect and rigid hierarchy pose safety hazards by suppressing speaking up, whereas high-performing teams normalize open communication across roles.

Safety routines, including surgical checklists, create social permission to voice concerns, but when senior clinicians dismiss them, psychological safety deteriorates.

The tension between productivity and safety is often unacknowledged in healthcare, even though increasing volume and evolving care complexity, such as expanded home-based care, can heighten systemic risk.

Resources:

Connect with and follow Prof. Charles Vincent on LinkedIn.

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Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has hand-selected one of our most-listened-to and impactful conversations from the archives to highlight once again. Dr. Philip introduces this essential dialogue with Dr. Vivek Garg, reflecting on why its core message, moving past basic compliance toward true, real-time healthcare improvement, is so vital to where the podcast is headed next.

Summary:

Quality measurement matters only if it helps patients and clinicians deliver better care in real time, not just prove compliance after the fact.

In this episode, Vivek Garg, President and CEO of NCQA, reflects on how growing up with an immigrant physician father, living with his mother’s undiagnosed bipolar disorder, and training in internal medicine shaped his commitment to patient-centered improvement. He explains why he pursued “edge-case” primary care roles at innovative organizations and how those experiences led him to focus on quality, value-based care, and complex populations. Vivek also clarifies NCQA’s role in convening standards, accrediting health plans and practices, and validating performance through audits and support. He critiques today’s bloated measurement ecosystem and argues for digital, interoperable, clinically meaningful metrics that reduce burden and truly improve care delivery.

Tune in and learn how quality standards can evolve from checklists into a continuous improvement engine that patients can actually feel!

Resources:

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Healthcare improvement is never just about systems, measures, policies, or processes; it is fundamentally about people. In this special transition episode, Dr. Philip McAdoo introduces himself as the new host of Turn on the Lights, a podcast by the Institute for Healthcare Improvement (IHI). He honors the foundational work of previous hosts Don and Kadar while laying out an expansive vision for the podcast’s next chapter.

To bridge where the show has been with where it is going, Philip announces a summer series re-broadcasting the five most popular episodes from the past year. These episodes cover critical subjects like patient-centered quality, the systemic roots of patient safety, Medicaid access, inclusivity in healthcare measurement, and the financial complexities behind rising premiums. Looking ahead, Philip shares his commitment to widening the podcast's frame by treating stories as evidence, balancing data with human dignity, and bringing frontline workers, patients, and marginalized communities directly to the table.

About Philip McAdoo

Dr. Philip Dorian McAdoo is an organizational strategist, educator, author, advocate, and storyteller. He serves as Director of Internal Equity & Workplace Well-Being at the Institute for Healthcare Improvement, where he helps strengthen the cultures, practices, and conditions that allow people and systems to improve. As host of Turn on the Lights, Philip brings a human-centered lens to conversations about trust, dignity, leadership, and building better healthcare systems.

Resources:

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What happens after 150 conversations about the future of health care?

In this episode, co-hosts Dr. Don Berwick, Former Administrator and CMS President Emeritus at IHI, and Dr. Kedar Mate, Founder & CMO of Qualified Health-genAI for Healthcare and Former CEO of IHI, look back on more than 150 conversations exploring health care reform, patient advocacy, medical debt, AI, and global health systems. They discuss how the podcast evolved into a platform for making complex health care topics more understandable through candid conversations and personal storytelling. The hosts also announce a transition as the podcast continues under the Institute for Healthcare Improvement, with new leadership, while they prepare their next collaborative project. Looking ahead, they share their excitement about diving deeper into subjects like artificial intelligence, international health care comparisons, and investigative-style series shaped by listener feedback.

Tune in to hear Don Berwick and Kedar Mate reflect on what they learned, what surprised them most, and where the conversation about health care innovation, AI, and reform goes next!

Resources:

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Health care should not be designed around fragments of a person’s life. It should be built around the whole person, with data, intelligence, and ownership working together.

In this episode, Nasim Afsar, author of Intelligent Health and former Chief Health Officer at Oracle Health, joins Don Berwick and Kedar Mate to discuss how technology can transform healthcare from reactive and fragmented to personalized and proactive. Drawing on her experience as a hospitalist, quality leader, health system COO, and health tech executive, Dr. Afsar explains why healthcare systems often fail when they prioritize institutional needs over patient realities. She shares the story of Elena, a patient labeled “noncompliant” whose challenges were actually tied to homelessness, insurance loss, and a care plan disconnected from her daily life. Dr. Afsar also outlines the three pillars of Intelligent Health: integrating clinical and social data, applying intelligence to generate foresight and insights, and creating systems driven by consumers themselves.

Tune in and learn how intelligent health can give people more agency, more personalized support, and a better chance at living healthier lives.

Resources:

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Health insurance policy is complicated, but the consequences are deeply human.

In this episode of Turn on the Lights, Professor Jonathan Gruber, Ford Professor of Economics and Chair of the Economics Department at MIT, joins Don Berwick and Kedar Mate to explore the history, structure, and future of health reform in the United States. Drawing on his work shaping Massachusetts health reform and the Affordable Care Act, Gruber explains the three-legged stool of reform: ending insurance discrimination, requiring broad participation, and making coverage affordable through subsidies. He also reflects on the political battles behind the ACA, the importance of Medicaid expansion, and the growing risks to health care coverage today. The conversation concludes with cautious optimism about biomedical innovation alongside serious concerns about affordability, rising costs, and the need for a more seamless health care system.

Tune in to hear why health reform is not just about policy design, but about whether people can get care when they need it.

Resources

Follow MIT on LinkedIn and explore the website. 

Learn more about Professor Jonathan Gruber:https://economics.mit.edu/people/faculty/jonathan-gruber

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AI may be the breakthrough that finally helps a deeply strained health care system do what clinicians and patients have needed all along.

In this episode, Dr. Bob Wachter, Professor and Chair of the Department of Medicine at UCSF, examines why artificial intelligence marks a pivotal shift in health care and what it means for clinicians, patients, and care delivery. He draws on past transformations, like hospital medicine and electronic records, to explain why AI stands apart as a fundamentally different force. The conversation highlights where AI is already adding value, including medical scribes, chart summarization, and clinical decision support. Dr. Wachter also explores key risks, including trust, bias, deskilling, security, and conflicts of interest, while considering how AI may redefine the physician’s role, medical education, and the doctor-patient relationship.

Tune in to hear why AI may be one of health care’s greatest opportunities and one of its most important tests.

Resources:

Connect with and follow Dr. Bob Wachter on LinkedIn.

Get a copy of A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future here.

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