Modern Healthcare's Healthcare Insider Podcast: Daily Summaries Delivered

Protecting Healthcare Payments: New Strategies to Reduce Fraud Risk

In this episode of Healthcare Insider, Sarah Loeffler, host with Modern Healthcare's Content Studio, speaks with Yusuf Qasim, President of Payments Optimization at Zelis, about how health plans can strengthen payment security without sacrificing speed. Drawing on insights from one of the nation's largest payer and provider payment networks, the conversation explores why traditional fraud strategies are no longer enough and what leading organizations are doing differently. You'll Learn: Why fraud prevention must extend beyond claims integrity into the payment lifecycle. How fraudsters exploit gaps between claims review and payment execution. The role of real-time intelligence, provider validation and network-wide data in identifying payment risk. How health plans can accelerate digital payments while maintaining strong security controls. Practical strategies for building a more proactive, scalable approach to payment integrity.

Advancing cancer care through foundational research and immunotherapy

Breakthroughs in cancer care often begin long before a therapy reaches patients. Foundational research into disease biology, cellular mechanisms and immune system function continues to drive innovations that are transforming how cancer is understood and treated. In this episode of Healthcare Insider, Shannon Mortland sits down with Dr. Siddharth Balachandran, PhD, of Temple Health's Fox Chase Cancer Center, to discuss the scientific discoveries helping fuel the future of cancer immunotherapy. The conversation explores how research into influenza viruses and cell death pathways contributed to advances in immunology, why foundational science remains critical to clinical innovation, and how today's laboratory discoveries are informing tomorrow's cancer treatments. What You'll Learn How foundational research helps drive breakthroughs in cancer care The connection between influenza research and advances in immunology Why basic science remains essential to developing new therapies How immune system discoveries are influencing cancer immunotherapy The role of translational research in bringing innovations from the lab to patients What emerging research may mean for the future of cancer treatment and clinical trials

Modernizing Healthcare Infrastructure in a High-Cost Environment

Hospitals are under pressure to maintain safe, efficient care environments while managing rising operating costs, aging infrastructure and limited capital budgets. In this episode of Healthcare Insider, Christy Fetsch and Michael Pickard of Trane discuss how healthcare leaders can rethink deferred maintenance, evaluate the hidden cost of inaction and structure facility investments in more predictable, budget-friendly ways. The conversation explores how aging building systems can affect patient care, why emergency repairs often cost more than planned modernization, and how aligning facilities, finance and clinical leaders can help organizations move from reactive spending to strategic infrastructure planning. What You'll Learn How deferred maintenance can disrupt clinical operations and patient environments Why aging infrastructure may affect lending, bond ratings and long-term financial risk How flexible financing can help turn large capital projects into predictable payments Ways to align facility upgrades with patient care, safety, resilience and operating performance

Rethinking Affordability in Healthcare

Leading the Next Era of Lung Transplant Care

What does the future of lung transplantation look like? In this new podcast episode, Dr. Rachel Ann Criner of Temple Health explores how one of the nation's leading transplant programs is advancing pulmonary care through innovation, operational excellence and research-driven treatment strategies. The conversation examines how Temple Health is expanding transplant eligibility, integrating clinical research into patient care and supporting increasingly complex patient populations through coordinated multidisciplinary care. Listeners will hear insights on: Advances in lung transplant technology and donor organ innovation How leading programs are redefining transplant candidacy The role of coordinated care and remote monitoring in improving outcomes Why clinical trials and targeted therapies are reshaping pulmonary medicine Tune in to learn how Temple Health is helping redefine what's possible in complex pulmonary and transplant care.

How AdventHealth is Scaling Cancer Risk Assessment Across a Health System

Health systems are under increasing pressure to detect cancer earlier and deliver more personalized care, but scaling those capabilities across a large organization remains a complex challenge. In this episode, leaders from AdventHealth share how they are addressing that challenge through their Genomics Risk Assessment for Cancer and Early Detection (GRACE) program, an initiative designed to identify high-risk patients earlier and guide them into appropriate care pathways. Dr. Wesley Walker, vice president of genomics and precision health, and Dr. Clark Rogers, medical director of the GRACE program, explain how the model integrates risk assessment seamlessly into routine clinical workflows. They also share how health systems can successfully implement a similar program at their own organization.

CVS Caremark's Strategy for Managing Chronic Conditions

Chronic disease management is growing more complex as new therapies reshape the treatment landscape. In this episode, Dr. Michelle Gourdine, senior vice president of CVS Health and chief medical officer of CVS Caremark, discusses how pharmacy leaders are balancing access to innovative treatments with long-term affordability and clinical outcomes. As more options emerge for conditions such as diabetes and heart disease, Gourdine outlines how evidence-based benefit design can help improve access while managing cost. She also explores the role of coordinated pharmacy support in improving medication adherence.

How Procurement Systems Grow Lung Transplant Access

Lung transplantation is often associated with surgical expertise, but expanding access depends just as much on the systems behind donor identification, evaluation and transport. Daniel Remer, transplant procurement manager at Temple University Hospital, explains why procurement serves as the operational engine of a transplant program and why strong systems are essential to helping more patients reach transplant. Remer also shares how donor evaluation has evolved over the past decade and how technologies such as ex vivo lung perfusion and portable organ preservation systems are allowing transplant teams to safely consider lungs that may once have been declined.