Quest Diagnostics CMO Dr. Yuri Fesko joins Value Health Voices to decode the Clinical Laboratory Fee Schedule, the impact of PAMA and SALSA, and the future of precision medicine.

Episode Resources:

• Learn more about Quest Diagnostics
• Explore Quest's Consumer-Initiated Testing

How does a flawed government policy threaten the very foundation of modern medicine? Nearly every clinical decision, from a routine check-up to advanced cancer treatment, begins with data from a lab test. But the system that determines the value and payment for these critical services is under threat. In this episode, we explore the complex world of clinical laboratory services policy and payment with an unparalleled expert, Dr. Yuri Fesko, Chief Medical Officer of Quest Diagnostics. We uncover how a poorly designed law could cripple patient access to testing, especially in rural communities, and stifle the life-saving innovation happening in diagnostics.

This deep-dive conversation with Dr. Yuri Fesko breaks down the most pressing issues facing clinical laboratories today. We start with the Clinical Laboratory Fee Schedule (CLFS) and the disastrous impact of the Protecting Access to Medicare Act (PAMA). Dr. Fesko explains how PAMA’s flawed data collection, which surveyed only the largest, most efficient labs, has led to proposed reimbursement cuts of up to 15% annually, threatening the viability of smaller hospital and independent labs across the country. We then discuss the bipartisan RESULTS Act, a proposed solution to create a more accurate and equitable system. The discussion also tackles the immense administrative burden of prior authorization for lab testing, a major friction point for clinicians that delays diagnoses and care. We explore how technology, like Quest’s adoption of the Epic EMR system, aims to streamline this broken process. A significant portion of our conversation focuses on the challenges surrounding reimbursement for advanced diagnostics. Dr. Fesko provides a fascinating look into cutting-edge innovations like Minimal Residual Disease (MRD) testing in oncology, a revolutionary tool that can detect trace amounts of cancer DNA in the blood to help guide treatment decisions and avoid unnecessary, toxic chemotherapy. We also navigate the intricate landscape of laboratory-developed tests (LDT) regulation, weighing the pros and cons of proposed FDA oversight versus the existing accreditation framework. Finally, we touch on patient-centric improvements like price transparency, the power of lab data in public health initiatives, and the critical importance of interoperability in ensuring patients own and control their health records. This episode is an essential guide to understanding the policy, payment, and innovation that will define the future of diagnostic medicine.

About Our Guest:

Dr. Yuri Fesko is the Chief Medical Officer of Quest Diagnostics. With a background in internal medicine, hematology, and oncology, Dr. Fesko leads Quest's medical groups, payer access and reimbursement strategies, and research activities. He brings a unique perspective from the front lines of both clinical practice and the leadership of one of the world's largest laboratory services companies, offering deep insights into the regulatory and financial pressures impacting patient care and diagnostic innovation.

Timestamps:

(00:00) Why Lab Testing is the Foundation of Medicine

(05:43) The Clinical Laboratory Fee Schedule (CLFS) Explained

(09:22) PAMA: A Flawed Law Threatening Lab Services

(14:51) The RESULTS Act: A Bipartisan Fix for PAMA

(18:24) The Burden of Prior Authorization for Lab Testing

(26:07) Improving the Patient Experience with Price Transparency

(30:56) Innovation: Reimbursement for Minimal Residual Disease (MRD) Testing

(41:52) The Complex Regulation of Laboratory-Developed Tests (LDTs)

(46:15) Big Data: How Lab Results Shape Public Health

(55:49) Future Risks & Opportunities for Clinical Labs

Dr. Roger Seheult makes the clinical case for sunlight therapy. Discover the evidence for using infrared light to reduce hospital stays by 30% and cut costs.

Episode Resources:

• Learn from Dr. Seheult on his YouTube Channel
• Explore MedCram's Health Optimization Courses (CME available)
• Watch the Guy Foundation's Autumn Series on Light & Health
• Read the Glen Jeffery study in Nature Scientific Reports
• Explore the Swedish study on sun exposure and all-cause mortality

Could a simple, free resource dramatically reduce hospital stays and save the healthcare system billions? In this episode, we explore the powerful clinical case for sunlight therapy with one of the most respected medical educators online, Dr. Roger Seheult. He begins with the astonishing story of a 15-year-old boy given two days to live due to a flesh-eating fungal pneumonia, who made a miraculous recovery after one simple request: to go outside. This episode confronts the "magical thinking" skepticism head-on, presenting a data-driven argument that hospitals and policymakers can't afford to ignore.

We're joined by Dr. Roger Seheult - a quadruple board-certified physician in pulmonary, critical care, and sleep medicine, and the founder of Medcram - to dissect the science behind sunlight and infrared light. Dr. Seheult breaks down the groundbreaking randomized controlled trials, including recent studies in Nature, that demonstrate the profound link between infrared light and mitochondrial function. Learn how specific wavelengths of light can pass through the human body, making our cellular batteries (mitochondria) more efficient, boosting ATP production, and impacting the root cause of many chronic diseases. This robust photobiomodulation evidence suggests we've overlooked a fundamental element of human health.

The discussion pivots from cellular mechanics to systemic impact, focusing on the staggering potential for reducing hospital length of stay. Dr. Seheult cites multiple studies showing that patients exposed to more sunlight or targeted infrared light are discharged 3-4 days earlier - a reduction of over 30%. We analyze the immense financial implications, calculating potential savings of $5,000-$7,500 per admission for hospitals operating on bundled DRG payments. The episode tackles the practical and bureaucratic hurdles, from the inertia of hospital administration to the need for a new light therapy reimbursement policy. We explore actionable pathways for change, including updates to CPT codes, integration into CMMI value-based care models, and the power of the HCAHPS patient satisfaction survey to drive adoption. This conversation makes a compelling case that adopting light therapy isn't just good medicine; it's a financial and ethical imperative.

About Our Guest:

Dr. Roger Seheult is a quadruple board-certified physician (Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine) and an Associate Clinical Professor at the UC Riverside School of Medicine and on faculty at Loma Linda University. As a critical care doctor, he sees the sickest patients in the hospital, which pushed him to explore foundational health principles that could pull patients back from the brink. He is the co-founder of MedCram, a leading online medical education platform with millions of viewers, where he excels at explaining complex medical topics in a clear and accessible way.

Timestamps:

(00:00) A Miraculous Recovery: The Case of the Boy with a Flesh-Eating Fungus

(02:49) The Science and Finance of Light Therapy

(03:55) Deep Dive: A 15-Year-Old's Fight Against Fungal Pneumonia

(11:10) The Clinical Case for Light Therapy: Examining the Evidence

(15:22) How Infrared Light Boosts Mitochondrial Function

(19:51) Sunlight Exposure, All-Cause Mortality, and Global Health Patterns

(26:40) The Financial Impact: Reducing Hospital Length of Stay by 30%

(31:28) Practical Implementation: How to Prescribe Light Therapy in a Hospital

(34:40) Overcoming Barriers: The Financial and Logistical Case for Change

(44:14) Pathways to Reimbursement: New Policy and Payment Models

(47:35) Rediscovering Old Wisdom: The History of Heliotherapy

(56:21) Actionable Resources & How to Get Involved

Is the rapid rise of artificial intelligence a threat to medicine or its greatest hope? In this episode, we tackle the massive hype and complex reality of AI in oncology with one of the leading voices in the field, Dr. Sanjay Juneja, also known as TheOncDoc. We break down what this technological revolution truly means for cancer patients, doctors, and the healthcare system at large. From uncovering hidden patterns in cancer data that defy human intuition to the practical challenges of implementation, we explore how AI is set to transform everything we thought we knew about medicine.

Join us as we separate fact from fiction in the world of medical AI. Dr. Sanjay Juneja, a medical oncologist and VP of Clinical AI Operations at Tempest, shares his journey from social media educator to a trailblazer in health technology. We dive deep into how AI can address the "unwarranted variation in care" that leads to inconsistent patient outcomes across the country. Dr. Juneja explains how machine learning models can analyze vast datasets to find novel insights, much like Google's AlphaGo made a move in the game of Go that was inconceivable to human grandmasters. This episode explores the incredible potential of the future of AI in healthcare, from AI scribes developed to combat AI and physician burnout to new diagnostic tools that can predict hyperglycemic events from the sound of your voice or determine a tumor's molecular features from a simple pathology slide.

However, the conversation doesn't shy away from the serious challenges ahead. We confront the "garbage in, garbage out" problem, discussing how biases in training data can lead to flawed or inequitable conclusions. A core part of our discussion focuses on the critical need for validating AI models in medicine before they are widely deployed, ensuring that these powerful tools are both safe and effective. We also explore the nuanced impact of AI and the doctor-patient relationship, debating whether an algorithm can truly be more empathetic than a human physician and what happens to trust when patients suspect their doctor's messages are AI-generated. Finally, we unpack one of the biggest hurdles to adoption: the issue of liability for AI in healthcare. When an AI model makes a mistake, who is responsible—the developer, the hospital, or the clinician who acts on its recommendation? This is a must-watch for any clinician, patient, or technologist seeking to understand the real-world implications of AI in oncology today and in the near future.

About Our Guest:

Dr. Sanjay Juneja (@TheOncDoc) is a triple board-certified medical oncologist who has become a leading global authority on the application of AI in medicine. He serves as the Vice President of Clinical AI Operations at Tempest, is a contributing writer for Forbes, and was credentialed by Harvard Medical School's inaugural "AI in Healthcare" executive program. Through his massive social media presence and podcast, Dr. Juneja has a unique talent for simplifying complex medical and technological topics for a broad audience.

Timestamps / Chapters:

(00:00) Introduction: Separating Hype from Reality in AI and Oncology

(02:41) From Social Media Influencer to AI Trailblazer: Dr. Juneja's Journey

(06:14) Tackling Unwarranted Variation in Cancer Care with AI

(10:35) The Devil's Advocate: Bias, "Garbage In, Garbage Out," and AI's Flaws

(19:10) Real vs. Hype: Current AI Applications Changing Medicine Now

(24:22) Systemic Hurdles: Data Privacy, Reimbursement, and AI Adoption

(33:30) Can an AI Be More Empathetic Than Your Doctor?

(41:35) AI in the Clinic: Improving Workflow and Reducing Physician Burnout

(47:15) Who's to Blame? Unpacking the Liability of AI in Healthcare

(52:06) The 2-to-5-Year Future of AI in Oncology

Episode Resources:

• Follow Dr. Sanjay Juneja on LinkedIn
• Follow Dr. Sanjay Juneja on Instagram
• Follow Dr. Sanjay Juneja on TikTok
• Follow Dr. Sanjay Juneja on YouTube
• Check out Dr. Juneja's Podcast

From a government shutdown halting FDA approvals to the looming expiration of ACA subsidies threatening to raise insurance premiums for millions, the American healthcare system is facing a perfect storm. These mounting US healthcare policy challenges are creating unprecedented uncertainty for patients, providers, and innovators alike. In this episode, we're joined by healthcare regulation and policy expert Matt Wetzel, a partner at Goodwin Procter LLP, to dissect the interconnected crises plaguing Washington, D.C. and what they mean for the future of your healthcare.

We connect the dots between the federal shutdown, expiring ACA enhanced premium tax credits, clandestine pharmacy benefit manager (PBM) practices, and Medicare's latest payment cuts. Why can't Washington compromise, and who is feeling the most pain? We explore the real-world consequences, including delays for companies seeking approvals for new drugs and devices, the degradation of hospital payer mix due to rising uninsured rates, and the political maneuvering that leaves everyday Americans caught in the middle. This discussion on US healthcare policy challenges uncovers the systemic dysfunctions, from legislative gridlock to the "wrecking ball" approach to policymaking that prioritizes disruption over stability.

This episode provides a comprehensive breakdown of the most pressing issues in healthcare today. We uncover the truth behind Pharmacy Benefits Managers (PBMs) and the bipartisan push for PBM reform, exposing their fundamental conflicts of interest, the dirty tricks of "spread pricing" on generic drugs, and why their business model drives up costs for everyone. We also analyze the controversial Medicare efficiency adjustment included in the latest Medicare Physician Fee Schedule—a "lazy" blanket cut that penalizes specialists and creates further uncertainty in the medical technology market. If you want to understand the forces driving up your insurance costs and creating chaos in the US healthcare system, this is a must-watch conversation that unpacks the complex US healthcare policy challenges we all face.

About Our Guest:
Matt Wetzel is an attorney and Partner at Goodwin Procter LLP, based in Washington D.C. He is a leading expert in medical device and healthcare regulation, working with numerous biotech, medtech, and digital technology companies. As a seasoned health policy commentator, Matt provides deep insights into the administrative and regulatory hurdles impacting the healthcare industry, from the FDA and CMS to the NIH.

Timestamps:
(00:00) Introduction: A System in Crisis
(01:55) The Government Shutdown's Widespread Impact on Healthcare
(05:05) How the Shutdown Halts FDA Approvals for New Drugs & Devices
(09:25) The Crushing Weight of Uncertainty on the Healthcare Business Community
(11:34) The Looming Expiration of ACA Enhanced Premium Tax Credits
(14:28) Why Can't Congress Agree on Extending ACA Subsidies?
(20:09) The Hidden Bureaucracy Driving Up Health Insurance Costs
(26:15) Decoding PBM Reform: Conflicts of Interest and Hidden Costs
(33:24) The PBM Conflict of Interest: Serving Two Masters
(37:50) PBM Trick Explained: What is "Spread Pricing"?
(41:00) The "Halloween Surprise": Unpacking the Medicare Efficiency Adjustment
(49:09) What's Next? Biotech, National Security, and Future Healthcare Legislation

Learn More From Our Guest / Episode Resources:

• Learn more about Matt Wetzel's work at Goodwin Procter LLP

One of America's largest pharmacy benefit managers (PBMs) just announced they'll stop taking rebates from drug manufacturers. The Senate's response? "Not impressed."

Why? Because rebates are just one of five profit driving "tricks" PBMs use to quietly inflate your drug costs.

In this episode, Dr. Anthony Paravati breaks down the real money flow behind prescription drug pricing, how a system designed to reduce costs does the exact opposite

You'll learn:

• The 7-player money map that explains where every healthcare dollar really goes

• The 5 PBM "tricks" that turn generics into goldmines

• How "spread pricing" means employers (and ultimately you) pay huge markups on actual drug cost

• Why regulatory capture keeps this system legal

• And why this reform moment in Washington matters right now

If you're an employer, benefits consultant, or policymaker, this episode will change how you see pharmacy costs forever.

If you're a patient, you'll finally understand why your prescriptions keep getting more expensive.

Because every dollar diverted to middlemen is a dollar not going to care, wages, or innovation.

🎧 Listen now to understand the role PBMs have played to drive annual healthcare spend in the US to a ridiculous $4 trillion.

The 340B drug pricing program was created to help safety-net hospitals and clinics stretch their resources to care for low-income and uninsured patients. But has it spiraled out of control? Originally a modest plan, the program has exploded into a $130 billion market, leading to a fierce debate over who truly benefits from the massive discounts. Is it the patients, as intended, or are for-profit corporations, PBMs, and large hospital systems capturing the profits? In this episode, we unpack the controversy and explore the future of 340B.

Joined by two of the nation's leading experts on the topic, we dissect the complex mechanics of the 340B drug pricing program and the powerful financial incentives that drive it. We explore how the program has grown exponentially, fueled by rising drug costs and the explosion of 340B contract pharmacies. This discussion sheds light on the central question: who benefits from the 340B program? Our guests break down how pharmacy benefit managers (PBMs) and major chains like CVS and Walgreens have become major players, diverting funds that were meant for patient care. We provide a clear, step-by-step example of how the money flows for a single prescription, revealing the winners and losers in this system.

A significant focus of our conversation is on 340B in oncology, where high-cost drugs create enormous financial spreads for participating hospitals, often without any direct savings for the cancer patient. This raises critical questions about whether the program encourages the use of more expensive drugs and consolidates cancer care into large hospital systems. We also dive deep into the push for 340B program reform, covering the recent Senate hearings, the legal battles over state laws restricting manufacturers, and the debate over moving oversight from HRSA to CMS. We analyze proposals like a rebate model and increased transparency requirements to understand what the future may hold for this vital, yet deeply flawed, healthcare program.

About Our Guests:

Ted Okon: As the Executive Director of the Community Oncology Alliance (COA), Ted Okon is a nationally recognized voice on the policy and politics of cancer care. He is a frequent presence on Capitol Hill, advocating on critical issues like drug costs, Medicare reimbursement, and the changing economics of oncology.

Amanda Smith: Amanda is Counsel at K&L Gates in their healthcare and FDA practice, with a specialized focus on the federal 340B drug pricing program. She advises clients on complex regulatory, legislative, and litigation matters related to the program and previously served as a healthcare law clerk for the U.S. Senate Committee on Finance.

Timestamps / Chapters: (00:20) Understanding the 340B Drug Pricing Program (07:24) How the 340B Program Really Works (09:29) Who Truly Benefits from 340B Discounts? (12:03) The Financial Impact: How 340B Influences Drug Prices (16:33) Navigating the Regulatory Landscape: HRSA's Role and Limitations (22:03) The Rise of 340B Contract Pharmacies & PBM Influence (25:26) The Legal Battleground: State Laws and Lawsuits (30:21) FOLLOW THE MONEY: A $10,000 Drug Example (36:11) Hospital Eligibility and the Lack of Transparency (44:26) The Future of 340B Program Reform: Rebates, CMS Oversight & More (59:45) PREDICTIONS: What Will 340B Look Like in 2 Years?

Learn More From Our Guests / Episode Resources:

• Learn more about the Community Oncology Alliance (COA)
• Learn more about K&L Gates' Healthcare Practice
• Subscribe to our channel
• Follow us on TikTok
• Follow us on LinkedIn

How do we deliver high-quality cancer care in a system under pressure? Meagan O'Neill, Executive Director of the Association of Cancer Care Centers (ACCC), joins us to talk about workforce empowerment, technology as a multiplier, and building sustainable oncology systems for the future.

Meagan shares her journey from oncology business consulting to national advocacy, shaped by her own personal experience with cancer care. With two-thirds of U.S. cancer programs in its network, ACCC plays a pivotal role in driving change across the oncology landscape.

In this episode, we discuss:

• Why personal experience can reshape how we design cancer care

• Strategies to address workforce shortages through empowerment

• Using technology to amplify—not replace—clinical teams

• Building upstream cancer care capacity to improve community health

• Making value-based care real in oncology practices

• Interoperability and integrated models for better patient outcomes

• The role of diversity in improving adherence and patient engagement

Key Takeaways

• Workforce empowerment is essential to meet rising patient needs.

• Technology should act as a force multiplier for clinicians.

• Patient-centered care must be prioritized at every level.

• Interoperability and upstream investment are critical for sustainable oncology systems.

About the Guest Meagan O'Neill is the Executive Director of ACCC, which represents more than two-thirds of U.S. cancer programs. She previously worked in oncology business consulting and brings both professional and personal perspectives to driving systemic change in cancer care.

Chapters 00:00 – Introduction to ACCC and Meagan O'Neill 04:58 – A Personal Cancer Journey 12:11 – Workforce Empowerment in Oncology 20:19 – Building Capacity in Cancer Care 25:25 – Patient-Centered Care 26:12 – Data-Driven Approaches 28:10 – Expanding Capacity with Nursing and APPs 30:37 – Leveraging Technology 34:36 – Navigating Claims and Denials 37:18 – Interoperability and Integrated Care 39:02 – Tailoring Oncology Models 43:09 – Telehealth and E-Consults 45:39 – Designing Future Oncology Care 51:35 – Reflections on ACCC's 50th Anniversary

Keywords ACCC, cancer care, oncology, workforce empowerment, technology in healthcare, patient experience, healthcare systems, cancer treatment, healthcare innovation, patient-centered care, value-based care, interoperability, nursing, APPs, telehealth