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Archelle Georgiou, MD shared thisI talk to a lot of men with prostate cancer. A recurring pattern is that they spend months — sometimes up to a year — trying to figure out what to do. That's not a health insurance issue (I know, that's what I usually write about) Its a system issue. Here's the gap: Prostate cancer has several reasonable treatment paths, and the standard of care is "shared decision-making" — patient and doctor weighing options together. But in practice, there's rarely a real process for it. Patients often see multiple specialists who each recommend their own approach, with no one helping the patient weigh the tradeoffs across all of them at once. My latest guest, an engineer, built his own process in that vacuum — researched everything himself, asked hard questions, made peace with his decision. It worked out for him. But he shouldn't have had to build that infrastructure himself. 🎧 Link to the full conversation in the comments. #ProstateCancer #SharedDecisionMaking #CancerTreatment #PatientAdvocacy #SecondOpinion #MensHealth
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Archelle Georgiou, MD shared thisYesterday's Senate vote allowing the #WISeR model to continue was disappointing. When the program launched in January 2026, the rationale was reasonable: use AI-supported prior authorization in #TraditionalMedicare as a demonstration project to determine whether it could reduce unnecessary spending. But within months, studies showed that patients were experiencing prior authorization delays 2–4 times longer than those seen in Medicare Advantage. At the same time: • Policymakers are increasingly holding large #MedicareAdvantage insurers accountable for their prior authorization practices. • There is bipartisan scrutiny of MA plans' use of AI in #priorauthorization. Sen. Richard Blumenthal (D-CT) and Josh Hawley (R-MO) have jointly requested information from major insurers following an HHS Office of Inspector General report showing that 95% of appealed skilled nursing facility prior authorization denials were ultimately overturned. Here's what concerns me: A demonstration project is, by definition, an experiment. And healthcare experiments should not continue unchanged when the evidence points to adverse consequences for patients. Whether prior authorization occurs in Medicare Advantage or Traditional Medicare, the standard should be the same: follow the evidence, measure the impact on patients, and be willing to adjust when the data warrant it. Patients deserve consistency. These aren't partisan concerns. They're patient care concerns. https://lnkd.in/gbmfGf3d #Medicare #HealthPolicy #EvidenceBasedPolicy #PatientAdvocacy #HealthcareQualitySenate Republicans block Dem attempt to end AI prior authorization in MedicareSenate Republicans block Dem attempt to end AI prior authorization in Medicare
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Archelle Georgiou, MD shared this“We mistake sophistication for progress.” Technology solutions (“innovation!” )often look for a problem to solve. Sachin suggests that we’ll make real progress in healthcare with something simple: having each individual know the date of their next primary care appointment. Great article.Archelle Georgiou, MD shared thisHealthcare is full of goals. Lower costs. Better outcomes. Greater access. Health equity. Better patient experience. Less burnout. More innovation. They’re all important. But I’ve come to believe that we’ve made healthcare improvement far more complicated than it needs to be. We chase dozens of metrics while missing the one objective (*read my article below to find out what it is*) that would make nearly all of them easier to achieve. I’d love to hear whether you agree—or what goal you would choose instead. Read the full piece here: https://lnkd.in/gYUPuGhWThe One Healthcare Goal That Could Change EverythingThe One Healthcare Goal That Could Change Everything
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Archelle Georgiou, MD shared thisAbout 1 in 8 adults is currently taking a GLP-1 drug like Ozempic or Mounjaro for weight loss. But what happens when it's not enough? My guest Protodeacon Dana Bichler (a former power lifter) tried these medications and they worked temporarily. For others, they work well but don't achieve enough weight loss. For some, these meds are not covered but other treatments are so affordability becomes the deciding factor. The key takeaway from this segment is that there is a range of obesity treatment options — from GLP-1 drugs to balloons to endoscopic sleeves to gastric bypass . Patients deserve knowing all the options. 🎧 Link to the segment is in comments. Many thanks to Alicia Bardaro at Boston Scientific for introducing me to Dana — his story was so good, I had to share it. This episode was not sponsored. #Obesity #GLP1 #Ozempic #WeightLoss #ObesityTreatment #BariatricSurgery #PatientAdvocacy #SpeakUpForYourHealth #HealthcarePodcast #MensHealth #FattyLiverDisease #PatientEmpowerment
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Archelle Georgiou, MD shared thisPrior authorization is broken. But eliminating it isn't the answer. Some services deserve clinical review before they are approved. The challenge is distinguishing appropriate prior authorization from unnecessary burden. The first step: measuring that burden. That's why I developed the Friction Index—a single number calculated from four publicly available prior authorization measures. Because it's based on objective data, it provides a transparent and reproducible way to measure administrative burden across health plans and insurance products. By making administrative burden measurable, the Friction Index gives health plans, employers, researchers, and policymakers a common way to evaluate utilization management and determine whether efforts to reduce friction are actually working. Thank you to Managed Healthcare Executive for publishing my latest article, "Prior Authorization Isn't Broken. It's Unmeasured." I hope it helps shift the conversation from frustration to evidence-based solutions. 🔗 Link in comments. #PriorAuthorization #HealthPolicy #MedicareAdvantage #ValueBasedCare #HealthcareInnovation Emma Lyon Rational 360
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Archelle Georgiou, MD shared thisDo for-profit Medicare Advantage plans create more friction than nonprofit plans? That seemed like a reasonable assumption to me. Nonprofit insurers don't answer to shareholders, so perhaps they rely less on prior authorization. Rather than speculate, I analyzed 157 Medicare Advantage plans representing nearly 12 million members using the Friction Index. At first glance, the data appeared to confirm that assumption. But when I separated nonprofit plans into two distinct operating models, the story changed. Nonprofit plans operating in a network model had virtually the same friction as for-profit plans. Non-profit plans that were integrated with their care delivery system had significantly lower friction. The analysis suggests we're asking the wrong question — and should be paying much closer attention to whether the people approving care and the people delivering it are on the same team. I've shared the full analysis (including the data and methodology) in this week's Substack essay. Link is in the comments. #MedicareAdvantage #HealthPolicy #PriorAuthorization #ValueBasedCare #HealthcareInnovation
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Archelle Georgiou, MD shared thisMany Americans wonder whether a single-payer healthcare system would solve some of the problems we face today. My latest podcast guest, James Yersh, has a unique perspective: Living in Canada, he was fully covered by the country's universal healthcare system. Yet after years of worsening hip pain, he ultimately paid $25,000 out of pocket for a hip replacement because he couldn't keep waiting for surgery. Since he's worked for US based companies, he understands our market-based healthcare system. His conclusion: Every healthcare system makes tradeoffs between cost, access, and coverage—and no system is perfect. Link to episode is in the comments. James Yersh, FCPA, FCA #Healthcare #PatientAdvocacy #HealthcarePolicy #HealthSystems #HealthLeadership
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Archelle Georgiou, MD shared thisThe NYT and Washington Post covered this week's federal report on Medicare Advantage denials for skilled nursing facilities. OIG's analysis covered one month (June 2024). Neither story extrapolated the findings to an entire year. Here it is: --Annualized, the 19 largest Medicare Advantage plans are denying approximately 161,000 skilled nursing facility stays per year. --95% of patients who appealed won. The plans reversed their own decisions. --The majority didn't appeal. And, for those who didn't their families became unpaid, untrained caregivers overnight — while insurers absorbed $1.25 billion in savings. I've translated what these findings actually mean for you and your family — including the three things you should do right now if you or someone you love gets denied. 🔗 Link to the Substack article is in the comments. #MedicareAdvantage #PriorAuthorization #SkilledNursingFacility #PatientAdvocacy #Medicare #Caregiving Reed Abelson Christopher Rowland Better Medicare Alliance LeadingAge Healthy Aging Coalition RISE-Health HHS Office of Inspector General
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Archelle Georgiou, MD shared thisA study just published in Annals of Internal Medicine by researchers at Stanford University School of Medicine, Georgetown University and UnitedHealth Group measured the overlap of PA requirements across three major commercial insurers (Aetna, Humana, UnitedHealthcare). Top Line Finding: Only 14% overlap. Other findings: • Out of 4,645 healthcare services requiring PA, only 638 (14%) had agreement across all 3 insurers • Number of medical-surgical services requiring PA varied dramatically: Humana: 2,660 | UnitedHealthcare: 2,247 | Aetna: 573 • Criteria for approval differed across all 3 insurers • PA services performed by outside vendors were excluded. Translation: real-world friction is likely even greater My take: When the rules vary by insurer, by plan, and by service — with no consistent clinical rationale — patients and physicians are navigating a maze that was never designed to be navigable. Metrics like the Friction Index can help us measure how much unnecessary administrative burden individual plans are creating. But measurement alone won't fix this. There needs to be collaboration across payers and standardized criteria — or regulation when collaboration takes too long — for what requires PA and how it gets approved. Clif Gaus & Allison Brennan, thank you for re-posting my recent piece on prior auth and the #FrictionIndex. I hope this offers some additional insight. #PriorAuthorization #HealthcarePolicy #HealthInsurance Aya ZAARI JABRI, Jacob Asher, Kevin Schulman David Scheinker
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Congratulations Jonathon! With your smarts, your heart and your innovative thinking…LifeBridge is poised for a great new chapter with you as its President!
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Archelle Georgiou, MD liked thisArchelle Georgiou, MD liked thisJust came out of a briefing with UnitedHealth Group's Chief Analytics Officer, Craig Kirschwell, and walked away with some numbers every employer and plan sponsor needs to see. Healthcare trend has moved from a pre-COVID baseline of 4-6% to high single or double digits today. Four things are driving that shift: 📈 Cancer is becoming a chronic condition, not an episodic one. Prevalence is up 13%, but costs are up 47% — largely due to a 70% jump in chemotherapy costs. Breakthrough treatments mean patients live longer, which means claims that used to resolve now run $100K-$500K+ a year, indefinitely. 🧠 Behavioral health has broken into the top five cost categories. Autism costs are up 200%, anxiety costs are up 225% — and this isn't a "young generation" story. It's rising across every age group. 💰 "Upcoding" is quietly adding about a full point to trend. In 2023, 30-minute office visit codes overtook 20-minute codes for the first time — accelerated by AI-assisted documentation and PE-backed provider groups optimizing reimbursement. 📉 Plan sponsors are absorbing more of the cost curve. Deductibles haven't kept pace with medical inflation — member cost-sharing has actually dropped from 17% to under 15% since 2019. And then there's GLP-1s, the topic every client is asking about right now: • 80% of users stop within two years, often with no lasting medical ROI on the spend • Total cost of care for these members is up 91%, with a real spike in gallbladder surgery and GI complications • Medical cost offsets only fully cover the drug price for the highest-risk patients (risk score 7+) — under 1% of the population The takeaway for employers: this isn't a "wait and see" trend. Coverage design decisions on GLP-1s and behavioral health network strategy are where the real cost management conversations need to happen right now. Grateful for partners like UHG who bring this level of data transparency to the table, it makes for much sharper conversations with the clients we serve here in Las Vegas and beyond. #EmployeeBenefits #HealthcareCosts #GLP1 #BehavioralHealth #BrokerLife #LasVegas
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Archelle Georgiou, MD liked thisTHANK YOU, MN Wild Foundation!! 💙💜🩵Archelle Georgiou, MD liked thisThank you, Minnesota Wild Foundation!💙🏒Recently, they donated $150,000 to support our child and family services program, made possible through their 2025 Minnesota Wild Foundation Gala. The Minnesota Wild Foundation's generosity helps us provide vital services, support and comforts for the whole family, made possible only through philanthropy.
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Archelle Georgiou, MD liked thisArchelle Georgiou, MD liked thisSat down with Kevin O'Leary on Health Tech Nerds to talk about a question I often get: what do you have to give up to serve people with I/DD well? Nothing. The trade-off is a misnomer. A person with I/DD spends about a month a year in inpatient and the ER and most of it avoidable. The second leading cause of death in this population is sepsis from a UTI, because someone who is nonverbal can't tell you their bladder hurts. Pain shows up as behavior, behavior gets met with antipsychotics, and the infection keeps going. We can screen for a UTI from a toilet. We can put a member's history in front of their DSP. This is low-hanging fruit. You can expand benefits and save states money. It was never either/or. Deon Health Shane Spotts Anna Moore Anna Fagin Jesse Morris Town Hall Ventures First Trust Capital Partners Difference Partners Solome Tibebu
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Archelle Georgiou, MD liked thisArchelle Georgiou, MD liked thisMy key lecture "Is There a Place for Body Positivity in Weight Management?" is sure to challenge you in unexpected ways. I hope you will join me on Saturday Nov 14th during Obesity Week.
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Archelle Georgiou, MD liked thisArchelle Georgiou, MD liked thisYou do not have to be the CEO to make an impact on someone’s future. That was one of the thoughts I shared this week while speaking at New York City’s Department of Social Services for Women’s Equality Day. You can make the introduction. You can recommend someone for the opportunity. You can offer the advice. You can make room at the table. And sometimes, you can simply stay at the table a little longer and listen. That idea connects to something else I’ve been thinking about lately: how quickly we move through our lives — from meeting to meeting, dinner to event, one obligation to the next. My latest Cat’s Corner is called “Don’t Rush the Check.” It’s about making room for conversation, practicing love as a craft, mentoring from wherever you sit — plus a little Olivia Dean and why it's a great time to be a sports fan! Would love to know what resonates with you. Link in comments.
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Archelle Georgiou, MD liked thisArchelle Georgiou, MD liked thisDid you know that up to 25% percent of adults 65 and older are living with a mental health condition such as anxiety or depression? September is Suicide Prevention Month. Join us and take away some very important information for those you love and serve who may need this help. The Healthy Aging Coalition invites you to join us virtually or in person (see flyer for details). September 15: 10-11:30 am ET. As usual, it's free to join this important conversation. Please share this to your network and invite folks to join us. We're pleased to welcome outstanding speakers who are leaders in behavioral and mental health: - Debbie Witchey, President and CEO, Association for Behavioral Health and Wellness - Wendy Martinez Farmer, Vice President, 988 Strategy, Quality Improvement & Clinical Standards, Vibrant Emotional Health - Nora Super, CEO, NS Ideas, LLC At the Healthy Aging Coalition, we believe better policy begins with informed discussion, thoughtful analysis, and a commitment to improving the lives of older adults. We look forward to the conversation. #HealthyAging #HealthcarePolicy #Medicare #HealthPolicy #AgingPolicy #Leadership #SuicidePrevention Vicki Shepard, Archelle Georgiou, MD, Dr. Joe Coughlin, Jeanette May
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Archelle Georgiou, MD liked thisI’m excited and grateful for the opportunity to lead LifeBridge Health Partners as President. I look forward to working with an incredible team to build on its success, drive innovation and growth, and help shape what’s next for LifeBridge Health Partners.Archelle Georgiou, MD liked thisLifeBridge Health Names Dr. Jonathan Thierman as President of LifeBridge Health Partners Read the full article: https://lnkd.in/dBuZeMSC Your go-to for local business news. Follow citybiz Jonathan Thierman, MD, PhD, Jennifer Nickoles, Leslie Simmons, RN, FACHE, Joseph K., Tressa Springmann, Lisa Whaley, Jason Weiner, James Roberge, Amy Shlossman, Craig Carmichael, MBA, CPA, CISA, Brian Cawley, Joan Pendergast Cox, CPXP, Julie Cox, CFRE, FAHP, Laura C., Jennifer Berkeley, Sybil Pentsil, Edgar Casner MBA, CMRP, Sharon McClernan MBA, BSN, Jennifer Witten, Adam Rosenberg
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