The Healthcare Labyrinth

Marc S. Ryan

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

  1. 1d ago

    130. Health Plans' Stocks Soar — But Is the Crisis Really Over?

    Health plan financials look up, but insurers are by no means out of the woods yet.   About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.   About The Episode: On this episode, Marc discusses Q1 financial results for insurers. Health plan financials look up, but insurers are by no means out of the woods yet.   Key Takeaways: A combination of external forces such as high utilization and policy impacts hit plan financials he past few years. As well, health plans suffered from a lack of financial discipline. The 2025 and Q1 1026 results show plans enforcing discipline and signaling conservative guidance. This has sent stocks soaring from recent lows. Plans' discipline meant retrenchment -- reducing benefits and choice as well as higher premiums and cost-sharing for consumers in all lines of business. But the recovery is not a slam dunk. Insurers will see tighter rates, further prior auth reform, and less enrollment due to Medicaid and Exchange changes. Vertically integrated insurers likely face less risks, while those with greater Medicaid and Exchange enrollment are more vulnerable. Consumers are paying more because somebody has to absorb the higher structural cost burden in healthcare. And over the next several years, we are likely to continue seeing a healthcare system defined less by expansion and more by managed retrenchment.   Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast   Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    22 min

  2. May 29

    129. The Big Bang: The Part D Instability Factor

    A combination of worrying drug trends, MA growth, and political interference has undermined the Part D program's stability.   About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.   About The Episode: On this episode, Marc discusses that a combination of worrying drug trends, MA growth, and political interference has undermined the Part D program's stability.   Key Takeaways: The Part D program was designed to be a narrow margin program with risk-sharing with the federal government. Rising drug costs and utilization as well as increased enrollment in Medicare Advantage (MA) have made the program riskier for plans along the way. Democrats then passed cost-sharing reduction to gain political points in 2022 and 2024. The combination of the two has deeply undermined the financial stability of the Part D program, increasing risk to plans and costs of the program. MA has the advantage of being able to subsidize Part D from Part C revenues, but standalone Part D (PDP) plans cannot. They are in the worst shape. All this has led to less choice, premium and cost-sharing increases for many, and narrower benefits. While the federal cost-sharing changes aimed to improve affordability, it has also introduced new forms of cost shifting—many of which are less visible, but no less real. The federal government had to introduce a premium stabilization program to stop further surges. Lawmakers and CMS will have to recalibrate and restructure the program to preserve it.   Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast   Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    17 min

  3. May 22

    128. Hospital Price Reform May Be Mounting – And It Could Be A Washington Earthquake?

    Based on a recent Capitol Hill hearing, hospital price reform could come in some way to healthcare soon.   About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.   About The Episode: On this episode, Marc discusses hospital price reform. Based on a recent Capitol Hill hearing, site neutral payments and other hospital price reform could come in some way to healthcare soon.   Key Takeaways: While other entities in healthcare have faced price reform, hospitals largely have been untouched over the years due to their powerful lobby. Hospitals are about one-third of all healthcare payments. But a recent Capitol Hill hearing signaled that price reform could be coming to hospitals too. Recent studies have shown that hospital prices are driving overall healthcare costs and that efficient hospitals can make money at Medicare rates. Consolidation in the hospital industry, too, is driving up prices. Support for site neutral payment reform is growing on Capitol Hill. For the first time, hospitals have signaled that some reform may be merited if done judiciously. Given major cuts coming to the healthcare industry impacting providers, caution is merited. But tackling price reform throughout healthcare, especially with hospitals, is important.   Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast   Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    17 min

  4. May 15

    127. The Healthcare Affordability Crisis: It is Not Just a Midterm Election Issue

    Healthcare affordability is at a crisis point. It is not just a midterm political issue. Systemic reform is needed.   About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.   About The Episode: On this episode, Marc discusses the healthcare crisis. Affordability is at a crisis point. It is not just a midterm political issue. Systemic reform is needed.   Key Takeaways: Healthcare affordability is the single biggest issue in healthcare today—and one of the biggest issues facing Americans overall. The uninsured and underinsured population is surging. Annual cost trends, and thus premiums and out-of-pocket costs, are also going up considerably. And Americans skip care due to this. That means greater costs later. America has a massive price problem. Drug price reform has begun under Trump, but it has yet to hit the commercial sector. Democrats focus on expanding coverage and benefits. The GOP focuses on stripping down the same. Neither tackles price nor the real issues. Trump's affordability czar comes too late to save them in November or make great impact. But a reform agenda is needed urgently. Focus on price, consolidation and primary care.   Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast   Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    18 min

  5. May 8

    126. Medicare Reforms Hit Potholes

    The Trump Administration is on a VBC reform model fury. It deserves credit but there are potholes ahead on its reform map. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the Trump administration's VBC reform model fury. It deserves credit but there are potholes ahead on its reform map. Key Takeaways: Medicare FFS is badly in need of reform and CMS has been introducing VBC payment models for a number of years. The Trump administration has been on a model fury, seeking to set its mark on healthcare reform. It is introducing reforms leveraging technology and expanding VBC payments. But the model fatigue of the past is setting in again with numerous new models and aggressive timeframes. The tech-enabled ACCESS model was extended to obtain more tech company participants. The ACO LEAD model may not get the volume CMS hoped for, either. The GLP-1 BALANCE model has been paused because too few plans expressed interest. BALANCE holds great promise, short-term costs in return for long-term savings and better health. But it comes at a tough time for plans, which are in the midst of a financial recovery. The Trump administration's vision is commendable but may need some tactical adjustment. Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    15 min

  6. May 1

    125. Medicare Advantage: Cutting Through the Noise

    Medicare Advantage critics pound the program with shoddy analyses. We showcase the good ones on quality, value, and savings. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc pushes back on the Medicare Advantage critics, who pound the program with shoddy analyses. He showcases the good studies showing MA's quality, value, and savings. Key Takeaways: Medicare Advantage's critics pound the program with shoddy analyses. But numerous studies show the quality, value, and savings in MA. MedPAC's studies on MA's favorable selection are easily debunked as there is great evidence MA serves some of the most vulnerable. So-called overpayments in risk adjustment have also been going away due to reforms. Studies show that MA means much lower utilization among beneficiaries through managed care and care management. Others show that enrollees in MA have much lower out-of-pocket costs. Despite attacks by critics, still more analyses show overall lower per-beneficiary costs of MA compared with FFS. MA also has a halo effect over overall Medicare spending. The greater the MA penetration, the lower cost trends in Medicare as a whole.  Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    17 min

  7. Apr 24

    124. 2027 MA Rates: Relief and Displeasure

    The final 2027 Medicare Advantage Rate Announcement provided some relief to a still displeased industry.   About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.   About The Episode: On this episode, Marc discusses the final 2027 Medicare Advantage Rate Announcement. It provided some relief to a still displeased industry.   Key Takeaways: Medicare Advantage (MA) plans got a bit of relief from CMS initial proposal of a 0.09% rate hike in 2027. The final adjustment will be 2.48%. CMS gave in a bit to the industry and pulled back on another proposed risk adjustment model change. It will follow through on some risk adjustment reform by barring unlinked charts (those not connected to an actual provider encounter) in most cases. The rate hike is far below what has been seen in terms of utilization. The hike will mean about $13 billion in new dollars to MA plans, up from under $1 billion proposed. But because most plans do not have aggressive risk adjustment practices, most plans will see an increase closer to 4%. Big plans will bear the burden of most of the unlinked chart reform. The 2027 modest hike is yet another sign that CMS will be stingier on rate dollars in the future.   Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast   Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    21 min

  8. Apr 17

    123. Final 2027 MA and Part D Rule Has Major Star Changes

    The final 2027 Medicare Advantage and Part D rule cemented some major changes in Star Ratings that will have far-reaching revenue impacts.   About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.   About The Episode: On this episode, Marc discusses the final 2027 Medicare Advantage and Part D rule. It cemented some major changes in Star Ratings that will have far-reaching revenue impacts.   Key Takeaways: The 2027 Medicare Advantage and Part D rule was finalized with major Star Ratings changes. The EHO4all health equity reward was retroactively rescinded, and the Reward Factor will be kept. Thirteen of 14 measure retirements were finalized, most of which are easy-to-hit operational measures. A new Depression Screening measure was adopted as well. The effect of the measure changes means clinical measures now are weighted almost half of overall star ratings, with CAHPS and HOS measures over a third. At least 25% of contracts are expected to lose a half Star rating, with others seeing their performance drop to put higher ratings out of reach. Other reforms adopted include repealing many health equity mandates, reining in and reforming supplemental benefits, and codifying many Part D changes.   Connect With Marc: Marc on LinkedIn Marc on Twitter THL Podcast   Resources: THL's Newsfeed THL's Blog The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

    19 min
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5
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2 Ratings

About

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

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