On January 1, CMS launched its latest alternative payment model: TEAM, the Transforming Episode Accountability Model. The mandatory program requires hundreds of acute care hospitals to participate in episode-based payments for five common, high-cost surgeries.

TEAM's goal is central to value-based care: improve quality while reducing Medicare spending. But the model has faced industry resistance. Critics argue it puts smaller, less-resourced hospitals at risk and should be voluntary. CMS maintains that the model builds on past voluntary programs and aligns with recommendations from federal partners.

To understand TEAM and what it demands of hospitals, senior writer Anastassia Gliadkovskaya talks with Jeff Gleason, M.D., the new chief medical officer of Navvis, a value-based care enablement company. He argues that hospitals that don't prepare now will struggle later.

To learn more about the topics in this episode:

• Hospitals rail against 'inadequate' pay bump, mandatory TEAM participation in IPPS comments
• Hospitals, health systems expect to ramp up value-based care in 2026, 2027
• CMMI to cut participation in payment models, estimates $750M in savings

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Employers are in a tough spot. Healthcare costs are rising, while insurance plan options may seem overwhelming or inadequate. The need for real value has never been more apparent. What if there were a way to optimize an existing provider network for quality?

Garner Health helps employers address these pain points. By finding the best-performing doctors in a given network and incentivizing members to see them, Garner claims to help clients save costs and achieve better health outcomes.

To break it down, Fierce Healthcare's Anastassia Gliadkovskaya talks to Garner Health founder and CEO Nick Reber.

To learn more about the topics in this episode:

• Employers brace for 6.7% increase in health benefits costs
• Report: Payers need to do more to demonstrate value to plan sponsors
• Industry Voices—Maximizing your benefits investment: Why health insurance literacy is the missing link

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Since the Trump administration took office in January, healthcare policy has been moving quickly, with changes touching Medicaid funding, ACA subsidies, hospital finances and the federal government’s approach to health technology.

This week on "Podnosis," we’re bringing you a recording from a live roundtable at the Fierce Health Payer Summit on Dec. 4, where members of the Fierce Healthcare editorial team unpacked the policy and funding shifts already underway. The discussion covers Medicaid cuts and coverage losses, how hospitals are preparing for reduced government funding, CMS’ new health tech ecosystem and where PBM reform stands after years of scrutiny.

To learn more about the topics in this episode:

• Crapo, Cassidy introduce ACA subsidy plan that leans on HSAs
• AHIP presses for ACA subsidy extension, further program integrity measures
• Medicaid work rules exempt the 'medically frail.' Deciding who qualifies is tricky
• When the hospital leaves town
• Many urban safety-net hospitals threatened by OBBBA's Medicaid cuts: analysis
• Industry Voices—3 major changes to Medicare Part B payment policies coming for 2026
• 'Come fight with me'—Oz courts physicians skeptical of Medicaid cuts, MAHA's criticisms
• KFF: States brace for increasing Medicaid costs even as enrollment stays flat
• All 50 states submit applications for $50B Rural Health Transformation Program
• The policies top of mind for healthcare stakeholders right now
• Hospital M&A continues to rebound as policy uncertainty clears

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Each year, Fierce Healthcare’s Women of Influence special report asks a simple question: Who is actually reshaping healthcare from the inside? This year brought a record number of nominations and a list that reflects how broad that influence has become, across health systems, payers, tech, policy and advocacy.

In this episode, Fierce Healthcare's Heather Landi and Paige Minemyer talk about why this recognition still matters, even as women make up nearly half of managerial and executive roles but remain scarce in CEO positions. They get into what the nomination surge tells us about where change is happening, how roles and titles are evolving and why so many of the most interesting ideas in healthcare are being led by women who are still fighting for a true share of power.

To learn more about the topics in this episode:

Fierce Healthcare's Women of Influence 2025

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It’s been a buzzy few years for prescription digital therapeutics, marked by bankruptcies, reimbursement policy changes and AI advancements.

At their best, DTx solutions can offer a more personalized, convenient and cost-effective care experience. But barriers to adoption remain. What are they, and what’s being done about them? Senior Writer Anastassia Gliadkovskaya explores these questions with Joseph Perekupka, CEO of Freespira, and Andy Molnar, SVP of industry affairs for the American Telemedicine Association.

To learn more about the topics in this episode:

• Access to Prescription Digital Therapeutics Act reintroduced in Congress
• How companies use scientifically informed music to impact health outcomes
• CMS puts forward meager offering for digital health in final Medicare physician fee schedule rule
• American Telemedicine Association's lobbying division acquires Digital Therapeutics Alliance

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Conduent is leaning into artificial intelligence to help clients navigate budget constraints, improve service quality and streamline operations, according to Mandy Huckaby, vice president and general manager of customer experience management.

Speaking on Fierce Healthcare’s Podnosis podcast, Huckaby said the company is focused on helping clients “do more with less” by integrating AI across customer-facing and back-office functions. She emphasized that AI is not new to Conduent, which has used the technology for more than a decade.

“AI is literally just having technology augment an interaction,” Huckaby said. “We’ve been doing technology augmentation with chat, digital landscaping and other services for a long time.”

Conduent’s AI strategy targets three areas: pre-engagement automation to help customers self-serve, agent support tools to improve response speed and quality, and back-office enhancements such as document processing and legal text analysis.

In healthcare, Huckaby said AI is being used to support nurses and HR representatives, among others. The company also partners with vendors like Microsoft to deliver sentiment analysis and quality audits.

Huckaby said clients are increasingly looking for creative problem-solving and authentic customer advocacy. “It can’t just be reading off a script,” she said. “Our customers are looking for empathy and understanding.”

As industries face rapid technological change, Huckaby said Conduent encourages its teams to remain agile and forward-thinking. “Change is inevitable,” she said. “It’s our ability to be flexible and agile through that change.”

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With the longest government shutdown in U.S. history as a backdrop, for-profit providers and payers detailed the continued regulatory uncertainty and pressures on their businesses in the third quarter.

In this episode of "Podnosis," Editor Dave Muoio and Senior Writer Paige Minemyer break down the key trends for the third quarter, including how insurers shed light on strategic priorities, the impact of the ACA subsidy conversation and why providers saw a surprise revenue windfall.

To learn more about the topics in this episode:

• Insurers slammed by medical costs, regulatory pressures yet again in Q3
• Tax credit turmoil, cost pressures set stage for tumultuous ACA open enrollment
• Amid shutdown, health IT vendors say hospitals are cutting back on spending

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In a recent episode of Podnosis, Dr. Jerilyn Morrissey, chief medical officer at CorroHealth, called for a strategic overhaul in how hospitals approach clinical documentation and payer denials.

“Documentation has become the battlefield where clinical, financial and payer priorities collide,” Morrissey said. Tracing the evolution of medical records from ancient Egypt to modern electronic systems, she emphasized that while technology has enabled better data sharing, it has also introduced administrative overload and clinician disengagement.

Morrissey challenged the common belief that denials stem from provider error. “Denials are a payer strategy,” she said. “They distract and delay, and they’re designed to do just that.” She urged healthcare leaders to shift from reactive to proactive strategies, focusing on clear expectations around reimbursement.

Hospitals spend nearly $20 billion annually fighting denials, often by adding more staff or vendors. Morrissey cautioned against this approach, noting that more resources rarely yield better outcomes. She also questioned the effectiveness of AI-generated appeal letters, citing a low success rate and rapidly changing payer policies.

Instead, Morrissey advocated for integrating technology earlier in the care process. “Denials don’t start when we submit a claim,” she said. “They start at the point of documentation and decision-making.”

Looking ahead, Morrissey sees promise in AI for clinical support, pattern recognition and denial prediction. But she warned that trust in technology must be earned. “AI works most of the time, but not all of the time,” she said. “We’re not yet at a point where we can remove the human from the loop.”

Her advice to healthcare executives: embrace innovation with creativity and collaboration, and aim to be “constructively destructive” in reshaping the system.

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