Healthcare is Hard: A Podcast for Insiders

As healthcare confronts workforce shortages, rising costs and growing demand for care, the industry cannot simply hire its way out of its challenges, and using AI to make existing jobs more efficient may not be enough. Organizations will have to fundamentally rethink how work gets done, how employees develop expertise and what responsibilities should remain with humans.

Ana Kreacic has spent her career studying how markets, companies and people adapt to change. A former economist who worked across tech, telecom and healthcare, she is now Partner and Chief Knowledge Officer at Oliver Wyman and Chief Operating Officer of the Oliver Wyman Forum – the firm’s think tank. Her work focuses on integrating customer insight with business strategy and leadership effectiveness. She helps steer companies to create new business and operating models that transform them into more customer and employee-centric organizations.

In this episode of Healthcare is Hard, Ana joined Keith Figlioli to discuss how AI is changing the healthcare workforce and what leaders must do to keep pace. Ana shared her firsthand insights along with data from the recently released Oliver Wyman Forum report, “The Reality Check: Beyond the AI Hype, Hope, and Hysteria.” The research draws on more than 25,000 survey responses across 15 countries and territories and a survey of 415 CEOs conducted with the New York Stock Exchange. Among other findings, it shows how early companies are on the AI adoption curve, with only 8% of workplace AI users reporting an organization-wide standard for deciding what happens when AI saves time.

With so much to still be discovered and decided, Ana and Keith’s conversation focused on the challenges and opportunities of building an AI-enabled healthcare workforce, from developing talent to fundamentally rethinking how work gets done. Some of the topics they discussed include:

• Impact on entry-level employees. AI may not eliminate entry-level jobs, but it is raising expectations for people filling them. Employers increasingly seek judgment and expertise from recent graduates that they once expected employees to develop over years on the job. Ana argues that organizations need to rethink how they train and develop junior employees, ensuring they continue to gain the experience and judgment needed to advance their careers in an AI-enabled workplace.
• Keeping up with the speed of change. Being a fast follower made sense when technology advanced in relatively predictable, linear steps. But AI is improving exponentially, making it harder to sit on the sidelines and catch up later. Even if what employees learn today is outdated tomorrow, Ana says organizations need to keep experimenting and learning so their teams can adapt to whatever comes next.
• Finding – and keeping – AI super users. Some of the employees most skilled at using AI are also best at hiding those abilities and are worried about what employers will do with their newfound productivity. Ana argues for open conversations about how AI is changing work, learning and career development. She believes leaders need to identify and support these employees, make clear that they have a valued role in the organization's future, and encourage them to teach others rather than conceal their skills or leave.
• Thinking in extremes. To rethink work rather than just automate existing tasks, Ana challenges leaders to ask what they would do if they had to increase capacity by 20%, 30% or 40% without adding comparable staff, or serve patients in markets they cannot reach today. Imagining those constraints can reveal opportunities to redesign entire workflows. Simply adding AI to the current process, she warns, may only "move the bottleneck" somewhere else.

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

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.

From being at the center of some of the most significant shifts in U.S. healthcare policy over the past two decades, Liz Fowler can offer valuable perspective in uncertain times. In her most recent government role, Liz served as director of the Center for Medicare and Medicaid Innovation (CMMI), an organization she helped create a decade earlier.

As Chief Health Counsel at the Senate Finance Committee, Liz played a major role in the drafting and passage of the Affordable Care Act (ACA) in 2010, which established CMMI. She then served as special assistant to President Obama on health care and economic policy at the National Economic Council to implement the ACA. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA).

Liz says she’s a public servant at heart, but credits her time in the private sector at Johnson & Johnson and WellPoint (now Elevance) for making her a more effective government leader. Today, Liz provides guidance, insight, and strategy for a broad array of health care stakeholders, including payers, health systems and providers, trade associations, technology companies and more as co-founder and managing partner of Health Transformation Strategies.

Liz talked to Keith Figlioli for this episode of Healthcare is Hard to share insight and perspective as healthcare organizations navigate changing regulations, including those in the “Big Beautiful Bill.” Topics they discussed include:

• The ROI of CMMI. Liz explained the difficulties tracking the savings that CMMI generates. She believes the mechanisms for measuring CMMI are too narrowly defined, making it hard to capture the full impact of its work. She advocates for a broader definition of success, emphasizing that innovation is a process—one where failure can provide just as much impact and opportunity for learning.
• Limited bandwidth for innovation. It’s a challenging time for healthcare organizations that are scrambling to meet deadlines and ensure they’re in compliance with various regulations, including provisions of the “Big Beautiful Bill.” Liz believes this is pulling time and attention away from innovation and slowing progress toward advancing value-based care. Despite the overall constraints Liz sees with the current regulatory environment, she’s optimistic about rural health transformation funding and how that could spark some innovation.
• The revolution that’s not coming. Throughout the conversation, Liz reiterated that “healthcare is hard.” She cautioned against expecting sweeping, revolutionary change, noting that progress in healthcare is incremental. Drawing on her 25+ years in health policy, Liz encouraged listeners to celebrate small victories and keep pushing forward, as real transformation happens step by step.

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

Dr. Mark McClellan has served as a Member of the President’s Council of Economic Advisors, Administrator of the Centers for Medicare & Medicaid Services (CMS), and Commissioner of the U.S. Food and Drug Administration (FDA). But his experiences before, and accomplishments following these leadership roles at the highest levels of government health policy are equally important to his perspective on the healthcare ecosystem – especially during a time of rapid policy change.

Dr. McClellan always intended on pursuing a medical degree and entered a joint Harvard-MIT program that took him in a slightly different direction. He ended up studying economics and the rising cost of healthcare at MIT. He ultimately earned a medical degree from the Harvard-MIT Division of Health Sciences and Technology, a Ph.D. in economics from MIT, and a master’s in public administration from Harvard’s Kennedy School.

Dr. McClellan began his career at the Treasury Department in the Clinton Administration, and returned to public service under the George W. Bush Administration where he led the FDA and CMS. Today, Dr. McClellan is the Robert J. Margolis, M.D., Professor of Business, Medicine and Policy at Duke University and the founding Director of the Duke-Margolis Institute for Health Policy. His work centers on improving health care through policy and research, with a focus on payment reforms, quality, value, and biomedical innovation.

With his expertise in medicine, economics and public policy, Dr. McClellan talked to Keith Figlioli in this episode of Healthcare is Hard to share his perspective on adapting to rapid change in the current healthcare landscape. Topics they discussed include:

• Misalignment of innovation and outcomes. While advancements in digital health are coming to market faster than ever before, Dr. McClellan says there’s still a lack of technology truly centered on keeping patients healthy. He says traditional payment methods make it hard to support this type of innovation. For example, advancements in AI are helping physicians gather information for prior authorization requests, and ambient scribing saves time with note taking and administration. But these technologies essentially help providers see more fee-for-service patients or bill for more profitable services. He argues that more outcome-oriented payments are needed to advance technology-embedded care models.
• The evolution of value-based care. After Congress passed the Medicare Modernization Act in 2003 to establish Medicare Advantage, Dr. McClellan became administrator of CMS at the President’s request to lead its implementation. With unique insight from leading some of the earliest VBC programs, he shared his thoughts on the speed of adoption and why it hasn’t happened faster. He discussed how early MA models needed to be based on existing fee-for-service infrastructure, his surprise that not much has changed, and his optimism that it’s finally starting to.
• Mobilizing private capital for public health. Private investment will be essential to support the significant changes required to improve healthcare – especially with uncertainties around future levels of government funding. Dr. McClellan explained how the Duke-Margolis Capital Impact Council (CIC) was launched to guide and improve the role of private investment in healthcare. He described how members of the council are developing and sharing practices for investors and their portfolio companies to track health value return on investment alongside financial ROI.

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

Dr. Josh Mandel says his first love was software. But on a whim, while studying computer science and software engineering at MIT, he took a course that opened his eyes to the world of medicine and genetics. It changed the trajectory of his career away from software – but only temporarily. He entered medical school after earning a bachelor’s degree in computer science and began rotating through Boston-area hospitals at the same time Meaningful Use accelerated adoption of electronic health records.

With a background in computer science and training as a physician, Josh understood the promise of EHRs, how medical professionals would actually use them, and how to make them better. Based on his unique combination of expertise, Josh took it upon himself to begin making improvements to the systems at the hospital where he worked.

Nearly two decades later, Josh is now Chief Architect for Health at Microsoft Research. In this role, he focuses on developing an ecosystem for health apps with access to clinical and research data, leading standards development for data access, authorization, and app integration.

For the third and last episode in this Healthcare is Hard series, Keith Figlioli spoke to Josh about data interoperability and emerging technologies. This conversation follows previous episodes with Epic’s head of R&D, Seth Hain in Part 1, and the Interoperability Practice Lead at HTD Health, Brendan Keeler – also known as the “Health API Guy” – in Part 2.

Some of the topics Keith and Josh discussed include:

• The standards landscape. At Keith’s request to explain the evolution of health IT standards as if he were talking to a seven-year-old, Josh breaks it down in simple terms. He outlines how structured data related to things like allergies, medications, and vital signs are well standardized today, while newer data types like genomics and imaging remain fragmented. He also explains the role of HL7, FHIR, and the Argonaut Project in shaping interoperability.
• How AI flips the script on standards. Josh says generative AI changed the way he thinks about engaging with the standards community. After getting an early preview of GPT-4 a few years ago, he realized that it would dramatically reduce the value of detailed data structure standards over time. He says that as AI becomes better at interpreting unstructured data, the focus will shift from formatting to governance – who can access what, and under what conditions. He described the concept of “language first interoperability” as one initiative he’s working on where automated agents query each other in the equivalent of an email or chat thread. Instead of exposing extensive details upfront, agents that can access unstructured data and understand things like medical necessity and other guardrails can send messages to each other until they make a conclusion about a specific task. This technology will increase the value of standards for data access and privacy, while reducing the focus on interoperability.
• Advice for startups. In a fast-moving landscape, Josh urges startups to “build and explore.” He emphasizes the importance of staying close to customers, iterating quickly, and leveraging today’s best models while keeping an eye on what’s coming next. His advice: don’t get bogged down in yesterday’s limitations—focus on unlocking value now and adapting as the technology evolves.

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

Brendan Keeler’s path into healthcare interoperability has been anything but straightforward. After early stints implementing Epic in the U.S. and Europe, he helped hundreds of startups connect to provider and payer systems at Redox, Zus Health and Flexpa before taking the reins of the Interoperability Practice at HTD Health. Along the way, his Health API Guy blog turned dense policy updates into plain-language guides, earning a following among developers, executives and regulators.

In this episode, Keith Figlioli sits down with Keeler to examine the “post-Meaningful-Use” moment. They discuss how national networks like Carequality and CommonWell solved much of the provider-to-provider exchange problem, only to expose new gaps for payers, life-science firms and patients. Keeler says the real action right now is in three places where the biggest, most dramatic changes are about to happen:

• Antitrust pressure on dominant EHRs. Epic’s push into ERP, payer platforms and life-sciences services could trigger “leveraging” claims that force unbundling, similar to cases already moving through federal court.
• Information-blocking enforcement. Recent lawsuits show courts siding with smaller vendors when incumbents restrict data access, a trend Keeler believes could unwind long-standing moats around systems of record.
• A CMS-led shift from policy to execution. With ONC budgets flat, Keeler sees CMS using its purchasing power to unblock Medicare claims data at the point of care, expand Blue Button APIs, and accelerate work on a national provider directory, digital ID and trusted exchange frameworks.

Keeler’s optimism is pragmatic. AI agents may someday chip away at entrenched EHR “data gravity,” but real progress, he says, will come from steady, bipartisan layering of HIPAA, Cures Act and TEFCA foundations.

He also pushes back on venture capital’s “system-of-action” thesis. Enterprise EHRs remain sticky because switching costs—massive data migration and workflow retraining—are measured in decades, not funding cycles. AI could reduce these problems, but only slowly and only if underpinned by trusted exchange standards.

Zooming out, Keeler describes a policy arc that starts with provider-to-provider exchange, widens to payer and patient access, and ultimately points toward a nationwide digital ID that could streamline consent and credentialing. For innovators, his north star is clear: build for identity-verified, standards-based exchange; assume open APIs will become table stakes; and judge success by the friction you subtract from everyday care—not by how flashy the demo is.

To hear Brendan Keeler and Keith unpack these issues, listen to this episode of Healthcare is Hard: A Podcast for Insiders. Please note that this episode was recorded earlier this summer, before the CMS meeting, and that some developments have occurred since then.

Seth Hain has spent two decades at Epic, watching the electronic health record evolve from digital filing cabinet to care-delivery platform. Now he thinks the entire stack of software is being re-imagined, only this time it isn’t mobile or cloud driving the change, but generative AI.

In a conversation with Keith Figlioli, Hain explains how new tooling, cheaper compute and larger context windows are pushing healthcare toward an “agentic” era, where software can collect context, ask clarifying questions, and tee up next-best actions before the clinician even walks into the room. He argues that the real breakthrough isn’t documentation speed-ups, but the chance to embed a learning health system directly into daily workflows.

Central to that vision is Cosmos—a dataset of 15 billion encounters from more than 250 health systems that is already powering condition-specific growth charts and real-world evidence studies. The next step: piping those insights back to the bedside at scale.

Yet technology alone won’t deliver. Hain and Figlioli dig into:

• A real “health grid” is starting to form. Hain envisions a network that connects life-science companies, health-system clinicians and tech builders so discoveries can move from bench to bedside without today’s data hand-offs and delays. Epic’s role is to lower the technical friction, so researchers can spot patterns, then surface the insight inside everyday workflows. The long-term bet: once the pipes are in place, bespoke therapies (even gene treatments) could be developed and delivered in one coordinated loop rather than siloed phases.
• Agentic AI is rewriting the user interface, not just speeding up notes. Hain argues the shift from cloud/mobile to generative agents is “noticeably different” because large-context models can listen, remember, reason and suggest next steps in real time. That opens the door to smart exam rooms that combine ambient voice, vision and wearables, and to workflows that provide clinicians with a complete picture before they walk in the patient's room. As UI layers splinter, the possibility of deep insights from longitudinal data is becoming reality, and vendors who overlook this shift will quickly fall behind.
• AI as a Force Multiplier for a Shrinking Workforce. With demand still rising faster than the workforce can grow, Hain sees AI as a supplement, not a head-count replacement: think follow-up calls, patient triage or ambient documentation that frees staff to practice at the top of their license. But he’s clear that hype won’t bend the curve; the industry has to measure quality gains, time saved and patient outcomes before claiming ROI. Governance must evolve in parallel so speed doesn’t outrun safety or equity and incumbents that ignore this shift do so at their peril.

Throughout, Hain balances optimism with realism: the models are improving fast, but value will hinge on measurable outcomes, thoughtful deployment, and collaboration across an industry that often works in silos.

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

Brian D. Pieninck didn’t take a conventional path to healthcare leadership. He started his career as an 18-year-old IT contractor and spent two decades working across the industry before becoming President and CEO of CareFirst Blue Cross Blue Shield. He now also serves as Chair of the Blue Cross Blue Shield Association, bringing both local and national perspective to the role.

In this episode, Keith Figlioli speaks with Pieninck about what it means to lead a not-for-profit regional payer at a time of seismic change. With 3.6 million members and coverage that spans commercial, Medicare, and Medicaid, CareFirst has become a vital part of healthcare access and infrastructure across the Mid-Atlantic. Pieninck reflects how demographic shifts, rising costs, and policy uncertainty are challenging how healthcare organizations evolve, while staying focused on long-term outcomes.

Pieninck and Keith discuss:

• Advancing health equity as part of the community. Pieninck sees CareFirst not just as a payer, but as part of the region’s civic infrastructure, creating economic opportunities, delivering care through primary and urgent care locations, and supporting long-term health equity initiatives across Maryland, DC, and Northern Virginia.
• Medicaid coverage and its downstream impact. With nearly half of children in Maryland and DC relying on Medicaid, Pieninck warns that cuts or disruptions don’t reduce the need for care; they push it into higher-cost, less coordinated settings like emergency departments.
• The balloon effect in healthcare financing. As costs are squeezed in one area, they inflate in another. Pieninck challenges the idea that market forces can realign care efficiently. He discusses how efforts to contain spending in one area often lead to inefficiencies elsewhere, and the system ends up paying more later because early, lower-cost interventions are underfunded or inaccessible.
• Innovation that simplifies the system. Through CareFirst’s innovation arm, Healthworx, Pieninick highlights the need to design a system that works for people by reducing complexity and embedding support directly into the healthcare experience.
• AI and infrastructure: opportunity meets readiness. With nearly three decades of experience on the technology side of healthcare, Pieninck is bullish on AI’s potential—especially now that it's available at a price point that can scale. Real progress, he notes, will depend on thoughtful governance, better interoperability, and models built around human needs.

This episode offers a look at how one regional plan is thinking through the tensions between access, affordability and innovation, and what that means for the broader system.

To hear Brian D. Pieninck and Keith discuss these challenges in depth, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Kody Kinsley has been called many things—operator, innovator, Medicaid “nerd”—but above all, he’s a fierce advocate for the health and well-being of the populations Medicaid serves. Now a senior advisor at the Milken Institute and recently North Carolina’s Secretary of Health and Human Services, Kinsley joins Keith Figlioli for a wide-ranging conversation about how Medicaid works, why it matters, and where innovation is reshaping its future.

A native of North Carolina, Kinsley brings personal experience and professional depth to his perspective. Growing up uninsured, he watched his mother navigate pediatric clinics, sliding-scale providers, and supply closets offering free samples to keep her kids healthy. That formative exposure ultimately propelled him into a career spanning healthcare operations, behavioral health, public policy, and government leadership.

As North Carolina’s health secretary, Kinsley led one of the country’s largest and most complex human services agencies, overseeing everything from Medicaid operations and public health to psychiatric hospitals and child welfare. He played a central role in advancing Medicaid expansion in the state—an achievement shaped by bipartisan negotiation, careful balancing of federal and state resources, and a deep understanding of the healthcare landscape.

In this episode, Kinsley and Keith cover:

• The structural realities behind state Medicaid programs. Kinsley describes how mega-agencies like North Carolina’s bring together financing, public health, regulation, and direct care delivery—touching millions of lives daily, often invisibly.
• Federal-state dynamics and looming policy shifts. From federal match rates to provider taxes and budget triggers, Kinsley explains the intricacies of how money moves between federal and state governments—and what’s at stake when Congress debates Medicaid cuts or structural reforms.
• The human cost behind budget debates. Behind every line item is a person: whether it’s dental coverage, hospice services, or in-home care, Kinsley argues that policymakers must weigh the downstream impacts of funding decisions on real lives and long-term system costs.
• Bright spots and innovation. Kinsley highlights North Carolina’s “Healthy Opportunities” pilot—one of the first initiatives nationally to use Medicaid dollars for non-medical needs like food, housing, and transportation. Early results show promise, including improved outcomes and significant cost savings, suggesting a roadmap for other states.
• Looking forward. While political winds may shift and financial pressures mount, Kinsley remains optimistic. He points to growing public support for Medicaid and hopes the nation can move beyond divisive debates over whether healthcare is a right or privilege—focusing instead on smarter, more sustainable ways to deliver care.

To hear Kody Kinsley and Keith Figlioli unpack these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Dr. Ali Khan has spent his career at the intersection of medicine, public policy, and value-based care. He’s also been at the forefront of some of the country's most innovative care delivery models—from Iora Health and CareMore to Oak Street Health and now Aetna, where he serves as Chief Medical Officer of Medicare at Aetna, a CVS Health company. In this episode, Keith Figlioli sits down with Dr. Khan for a conversation about Medicare’s future—and what it will take to make the promise of better, more affordable healthcare a reality.

A general internist by training, Dr. Khan’s path into healthcare began with a deep curiosity about the broader systems shaping people’s health. That curiosity took him from Harvard Kennedy School to the exam room to health plans and startups focused on reimagining the primary care experience for complex, underserved populations. Throughout his career, he’s gravitated toward organizations trying to solve public-sector problems with private-sector solutions—building care models that prioritize trust, access, and long-term outcomes.

Now at the helm of a Medicare Advantage program serving 4.2 million members, Dr. Khan brings a unique vantage point. In this conversation, he shares hard-earned lessons on care model design, what payers and providers need from each other, and why Medicare is at an inflection point. He makes a compelling case for a renewed focus on the fundamentals—not just risk adjustment or benefit design, but operational follow-through, last-mile care coordination, and culturally grounded team-based models that scale.

Dr. Khan and Keith discuss:

• Building care models that hold up under pressure. From Iora to Oak Street, Dr. Khan has seen firsthand that delivering better outcomes at scale requires more than mission—it takes structural rigor. He unpacks four key dimensions—cultural, clinical, operational, and technological—and explains why lasting impact depends on aligning all of them. Whether it's equipping care teams to deliver in complex communities or building systems that can flex and scale, success hinges on getting the foundation right.
• Why affordability isn’t enough—and where Medicare Advantage must go next. With over half of Medicare beneficiaries now enrolled in MA plans, Dr. Khan argues it’s time to move beyond the value prop of supplemental benefits and zero-dollar premiums. The next chapter is about proving clinical excellence at scale. That means prioritizing follow-through over features—removing last-mile barriers, improving care coordination, and designing experiences people actually trust.
• From transactional to transformative: the evolving role of health plans. Plans have long relied on contractual structures to drive change, but Dr. Khan believes that era is fading. To deliver on the promise of value-based care, plans must shift from passive administrators to proactive partners—investing in infrastructure, surfacing actionable insights, and enabling providers to succeed across Medicare, Medicaid, and commercial populations alike.
• Where AI meets care delivery. Dr. Khan reflects on the potential of AI to reduce clinical variation, improve medication management, and drive better follow-up for patients—especially those with chronic conditions. But he cautions that technology alone won’t move the needle. To truly unlock AI’s value in Medicare, plans and providers must embed it within human-centered systems, coordinate care in real time, and ensure new tools support—not replace—the relationships that matter most.

As Dr. Khan notes, we’re entering a “put up or shut up” era for Medicare Advantage, where scrutiny is high and proof points matter. Yet within that pressure lies opportunity—particularly for those willing to do the unglamorous work of identifying barriers, building connective tissue, and supporting clinical teams in the trenches.

The first two episodes in this Healthcare is Hard podcast series on “Opportunities in Oncology” explored the relationship between academic medical centers and community care, with guests Dr. Stephen Schleicher from Tennessee Oncology, and Dr. Harlan Levine from City of Hope. For the third and final episode in the series, Dr. Daphne Haas-Kogan joined Keith Figlioli for a conversation that dives more deeply into patient care, innovations in care delivery and the opportunities for entrepreneurs.

Dr. Haas-Kogan is Chair of the Department of Radiation Oncology at Mass General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. She is also the Willem and Corrie Hees Family Professor of Radiation Oncology at Harvard Medical School.

Dr. Haas-Kogan received her undergraduate degree in biochemistry and molecular biology from Harvard University and her medical degree at UCSF. She completed her residency in radiation oncology at UCSF in 1997 and became vice-chair for research at UCSF in 2003, and educational program director in 2008. Dr. Haas-Kogan’s laboratory research focuses on molecular underpinnings of brain tumors and pediatric cancers. She leads large multi-institutional initiatives funded by NIH/NCI, philanthropic organizations, and industry collaborators.

For this episode of Healthcare is Hard, some of the topics Dr. Haas-Kogan discussed with Keith include:

• The collaborative approach to care. Dr. Haas-Kogan talked about how most people with cancer struggle with many other medical issues – some predating cancer diagnosis, some precipitated by the treatment itself – and how several care teams are required to treat the patient wholistically. She also discussed how important it is for academic medical centers and community hospitals to work together, the responsibilities each holds to the patient, and the goal of making sure patients receive the same exact care regardless of location.
• The precision of radiation oncology. There are generally three pillars of cancer treatment. The first is surgery to remove tumors, the second is medication to kill cancer cells with drugs, and the third is radiation therapy to destroy cancer cells. Dr. Haas-Kogan described how radiation oncology is, in many ways, a combination of surgical oncology and medical oncology. It requires the precision of surgery – especially when treating a tumor close to critical structures like the brain stem or spinal cord – but can also be applied in a single day or over the course of weeks, similar to medication. She discussed how this allows for unique collaboration between academic researchers and community physicians, along with opportunities for creative workforce solutions.
• AI in oncology. The impact artificial intelligence has already had on oncology would have been unimaginable five or 10 years ago, and Dr. Haas-Kogan says the opportunities for entrepreneurs in the space are huge. As an example of the impact AI has already made, she talked about how radiation oncologists traditionally spend hours defining exactly what they want treated and the dose of radiation required. But now, AI is doing most of that, saving physicians precious time. She talked about how medicine is an art and how treatment like this is very nuanced, so she very often makes changes after reviewing AI-generated recommendations. But she says advancements are coming quickly.

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