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The Healthcare Labyrinth

The Healthcare Labyrinth

Written by: Marc S. Ryan
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 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.2023 Hygiene & Healthy Living Social Sciences
Episodes
  • 115. Is Value-Based Care Real … Or Just Healthcare's Favorite Myth?

    115. Is Value-Based Care Real … Or Just Healthcare's Favorite Myth?
    Feb 20 2026
    Value-based care has been around for a while. While it is a favorite buzzword in healthcare, some are questioning its effectiveness. Is that fair? 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 the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses value-based care. It has been around for a while. While it is a favorite buzzword in healthcare, some are questioning its effectiveness. Is that fair? Key Takeaways: A recent Health Affairs Forefront blog lit a bit of a firestorm when it argued that value-based payments — and even managed care — are not going to solve healthcare affordability. They missed the fact that healthcare is in the middle of a long, messy, transformational journey — and transformation never looks impressive in the early chapters. Value-based payments are meant to move us away from the old fee-for-service system — the transactional payment model that has dominated healthcare for decades. That has driven utilization, price, and costs. And the current system does not prioritize long-term quality or outcomes. There are various value-based-care (VBC) and payment (VBP) models that have emerged, from ACOs to episodic payments to capitation to partial and global risk funds. Regions, lines of business, provider type and the size of providers all determine how penetrated VBC or VBP are. Somewhere between 35% and 45% of healthcare payments today are tied to some form of value-based model. But true risk-bearing arrangements might only account for about 20% of transactions. Critics of VBC say many pilots haven't generated dramatic savings, value-based models may be accelerating consolidation and empowering corporate intermediaries, and spending slowdowns don't appear strongly correlated with VBC adoption. But there is plenty of evidence that mature VBC models do save and drive outcomes and we just may not be there yet throughout our healthcare system. 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
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    20 mins
  • 114. 2027 Rate Advance Notice Bad News For Medicare Advantage

    114. 2027 Rate Advance Notice Bad News For Medicare Advantage
    Feb 13 2026
    The Trump administration released the 2027 Advance Notice for Medicare Advantage and Part D, and the near-zero rate hike sent a shockwave through the MA 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 the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the release of the 2027 Advance Notice for Medicare Advantage and Part D. The near-zero rate hike sent a shockwave through the MA industry. Key Takeaways: In a huge shock to the industry, the Trump administration proposed a near-zero rate hike for 2027 in Medicare Advantage (MA). While the Effective Growth Rate was almost 5%, it was nearly zeroed out by two new risk adjustment reform changes. The 2027 increase stands at just 0.09% right now. That means just $700M in additional revenue in 2027 compared with $25B in 2026. Plans got no breathing room in 2027 after the new v28 risk model was phased in from 2024 to 2026 and took out 7.62% from rates. The proposed risk adjustment changes updated the new v28 model for more recent data as well as eliminated any chart review or health risk assessment submissions with diagnoses that do not have a linked medical encounter. The unlinked chart change has major impact on the biggest plans that practice very aggressive risk coding. The industry receives as much as $7.5B annually now for unlinked charts. Last year, the effective growth rate grew by almost 3% from the Advance Notice to the Final Announcement. That could happen again and move the rate for 2027 to just below 3%. This is still far below the 5% from 2026. A Stars restructuring that will reduce ratings and quality bonuses in the future compounds the overall gloomy financial picture. The MA recovery will be complicated by the rate announcement and more benefit, product, and geographic contractions are likely in 2027. The era of free-wheeling rates and risk adjustment is over. Plans need to focus on clinical management, quality, and cost control. One silver lining: overpayments are coming down and it is tantamount that the industry ensures Congress knows this before lawmakers push through more reforms. 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
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    19 mins
  • 113. Warning Signs: 2024 National Healthcare Data

    113. Warning Signs: 2024 National Healthcare Data
    Feb 6 2026
    The 2024 National Healthcare Expenditure Data are out and there are huge warning signs for the country. 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 the space, offering analysis, insights, and predictions on the changing state of healthcare in America. About The Episode: On this episode, Marc discusses the releases of the 2024 National Healthcare Expenditure Data. There are huge warning signs for the country. Key Takeaways: The 2024 National Healthcare Expenditure Data were finally released after a delay due to the government shutdown. In 2024, healthcare spending in the United States rose to $5.279 trillion, a $353.3 billion or 7.2% increase. Healthcare expenditures as a percentage of gross domestic product went from 17.7% in 2023 to 18% in 2024. This was largely driven by heightened utilization (use and intensity) and a shift in the types of services consumed (4.7%) and less so for actual inflation (2.5%). Hospital care was 31% of expenditures, physician and clinical services 21%, and prescription drugs 9%. The insured share of the population was 91.8% in 2024— down slightly from an historic high of 92.5% in 2023. Private Health Insurance was 31% of spending and reached $1.6 trillion in 2024, an 8.8% increase. Medicare was 21% of spending and reached $1.1 trillion in 2024, a 7.8% increase. Medicaid was 18% of spending, increasing 6.6% to $931.7 billion in 2024. Out-of-pocket costs were 11% of total expenditures and increased 5.9% to $556.6 billion. The typical working family in the U.S. spent $3,960 on healthcare-related costs in 2024, including premiums and out-of-pocket expenses. The robust growth shows the challenges ahead for healthcare. It was the second consecutive year costs trended up more than 7%. The ongoing growth in NHED is clearly not sustainable. Without major reform, we are faced with a number of compounding problems – economic stagnation, more Americans will become uninsured and underinsured, and healthcare will become more and more unaffordable. 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
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    22 mins
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