Martin Cech

Weekly Health Policy Briefing 12/04/2025

Dec 4, 2025

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12 min read

Weekly Health Policy Briefing 12/04/2025

ACA open enrollment, final rules, and the sub-optimal policy trap

A look at the Non-Emergent Medical Transport (NEMT) business with Lyft's VP of Health, Buck Poropatich

Dec 2, 2025

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4 min read

A look at the Non-Emergent Medical Transport (NEMT) business with Lyft's VP of Health, Buck Poropatich

NEMT is an obvious solution to a real problem, but it's also suffered from outsized levels of Waste, Fraud, and Abuse. Buck talks us through the balancing program integrity and convenience while opening up a new market for the ride share platform.

ACA Marketplace Pricing Strategies for ’26 with Rebecca Stob, Evensun Health

Nov 25, 2025

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2 min read

ACA Marketplace Pricing Strategies for ’26 with Rebecca Stob, Evensun Health

How payers are navigating pricing, growth, profitability, risk adjustment, and geography in the ACA marketplaces.

Rural primary care and the RHTP with Hopscotch Primary Care's Tim Gronniger and Dr. Aditi Mallick

Nov 21, 2025

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3 min read

Rural primary care and the RHTP with Hopscotch Primary Care's Tim Gronniger and Dr. Aditi Mallick

Value-based care, tech-enabled clinics, and some thoughts for states on how to make the most of their Rural Health Transformation Program budgets.

Discussing WISeR and the Merits of Prior Auths with Jeremy Friese

Nov 20, 2025

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4 min read

Discussing WISeR and the Merits of Prior Auths with Jeremy Friese

Prioritizing high value care, getting to yes, and when gold carding makes sense.

On the new Ambulatory Specialty Model from CMMI with Luis Argueso, partner at InHealth Advisors

Nov 20, 2025

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3 min read

On the new Ambulatory Specialty Model from CMMI with Luis Argueso, partner at InHealth Advisors

The new model has everything: it's mandatory, has upside and downside risk, and is focused on heart failure and low back pain. But is the juice worth the squeeze?

Weekly Health Policy Briefing 11/20/2025

Nov 20, 2025

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15 min read

Weekly Health Policy Briefing 11/20/2025

the ACA extension party lines, what enacted and imposted means, and a new strategy for CMS' innovation center

Nov 17, 2025

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3 min read

Q3 2025 Earnings Wrap-Up

Payers think they're priced correctly for 2026 medical trend, most companies retrenching while Privia and Alignment Health get asked about growth, and personalization and AI are still the buzz words with interesting examples from Hims, Oscar, and UnitedHealth Group.

Nov 14, 2025

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10 min read

Earnings Notes: Ardent Health Q3 2025

Volume and revenue growth were as expected for the midsized urban market hospital operator, but cost pressures from professional fees and payer denials have caused them to revise their EBITDA guidance down for the year.

A discussion with Jeff Davis, Director at McDermott+

Nov 13, 2025

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3 min read

A discussion with Jeff Davis, Director at McDermott+

The complicated formula that CMS uses to compensate physicians got its annual update, including a raise for the first time in six years although not everyone is celebrating.

Weekly Health Policy Briefing 11/13/2025

Nov 13, 2025

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15 min read

Weekly Health Policy Briefing 11/13/2025

the HSA option, BearCare, and the trouble with policy making around the most or least sympathetic cases

A discussion with Lauren Makhoul, Sean Dillon, and Amy Hunsberger from Manatt Health

Nov 12, 2025

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3 min read

A discussion with Lauren Makhoul, Sean Dillon, and Amy Hunsberger from Manatt Health

Big changes in Medicare physician payment, drug and skin substitute pricing, and other insights from the 2,300-page Medicare Physician Fee Schedule, explained by regulatory experts from Manatt Health.

Jonathan Palisoc, health economist and Medicaid expert, on provider taxes and state directed payments

Nov 7, 2025

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3 min read

Jonathan Palisoc, health economist and Medicaid expert, on provider taxes and state directed payments

Provider taxes and state directed payments will pull over $40 billion a year out of Medicaid spending once they're fully implemented which will send ripples through the health care economy.

Nov 6, 2025

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2 min read

A discussion with Stacy Edgar, CEO of Venteur

Turmoil in the marketplaces, silver loading, and how insurance companies stack the shelves around open enrollment

Weekly Health Policy Briefing 11/06/2025

Nov 6, 2025

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14 min read

Weekly Health Policy Briefing 11/06/2025

tough choices for fragile state budgets, squeezing the Medicare balloon, and MA plans report earnings during a tricky year

Nov 5, 2025

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7 min read

Earnings Notes: Clover Health Q3 2025

Clover Health beats expectations on revenue but missed on adjusted EBITDA for the quarter. 2025 guidance was revised, lowering adjusted EBITDA and raising expected Benefit Expense Ratio.

A discussion with Joe and Wesley from Evensun Health

Nov 3, 2025

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2 min read

A discussion with Joe and Wesley from Evensun Health

What went wrong and what 2026 is looking like for the ACA individual market.

Positive Development: Initiation of Coverage Report

Nov 3, 2025

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11 min read

Positive Development: Initiation of Coverage Report

The company is offering an attractive pitch to state Medicaid agencies and Medicaid Managed Care Organizations: comparable clinical outcomes at half the cost of ABA. Their key challenge is overcoming the inertia of the status quo.

Earnings Notes: Alignment Health Q3 2025

Oct 31, 2025

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7 min read

Earnings Notes: Alignment Health Q3 2025

Alignment Health has raised EBITDA guidance 4x over the last year. How quickly can they grow, and can they sustain their performance as they do?

Weekly Health Policy Briefing | 10/30/2025

Oct 30, 2025

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16 min read

Weekly Health Policy Briefing | 10/30/2025

No one wants to be the cheapest ACA plan in 2026, Medicaid cuts as a headwind, and managing costs in the US health care system.

Physician shortages and nurse practitioner enablement with Meghan Jewitt of Prax Health

Oct 28, 2025

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10 min read

Physician shortages and nurse practitioner enablement with Meghan Jewitt of Prax Health

Untapped supply from NPs and ideas on how to unlock it

Weekly Health Policy Briefing | 10/23/2025

Oct 23, 2025

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15 min read

Weekly Health Policy Briefing | 10/23/2025

earnings season starts with Elevance and Molina, Cedar launches a digital safety net, and the ACA saved money but also made everyone angry

Provider consolidation and its malcontents: an interview Olivia Kosloff

Oct 21, 2025

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17 min read

Provider consolidation and its malcontents: an interview Olivia Kosloff

A discussion with the Acute Condition author and American Economic Liberties Project Senior Fellow on the alternatives to the increasingly corporate practice of medicine

Rachel Wilson, Co-founder and COO of Bluebird Kids Health on pediatric value-based care

Oct 20, 2025

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33 min read

Rachel Wilson, Co-founder and COO of Bluebird Kids Health on pediatric value-based care

The challenges and opportunities of Medicaid Managed Care for children, build versus buy decisions, and the opportunity for generational returns by investing in children’s health.

Weekly Health Policy Briefing | 10/17/2025

Oct 17, 2025

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17 min read

Weekly Health Policy Briefing | 10/17/2025

The subsidy shutdown drags on, Deloitte is in the hot seat, and a brief but big scare for Medicare provider billing