Healthcare is Hard: A Podcast for Insiders

Seth Hain has spent two decades at Epic, watching the electronic health record evolve from digital filing cabinet to care-delivery platform. Now he thinks the entire stack of software is being re-imagined, only this time it isn’t mobile or cloud driving the change, but generative AI.    In a conversation with Keith Figlioli, Hain explains how new tooling, cheaper compute and larger context windows are pushing healthcare toward an “agentic” era, where software can collect context, ask clarifying questions, and tee up next-best actions before the clinician even walks into the room. He argues that the real breakthrough isn’t documentation speed-ups, but the chance to embed a learning health system directly into daily workflows.  Central to that vision is Cosmos—a dataset of 15 billion encounters from more than 250 health systems that is already powering condition-specific growth charts and real-world evidence studies. The next step: piping those insights back to the bedside at scale.    Yet technology alone won’t deliver. Hain and Figlioli dig into:  A real “health grid” is starting to form. Hain envisions a network that connects life-science companies, health-system clinicians and tech builders so discoveries can move from bench to bedside without today’s data hand-offs and delays. Epic’s role is to lower the technical friction, so researchers can spot patterns, then surface the insight inside everyday workflows. The long-term bet: once the pipes are in place, bespoke therapies (even gene treatments) could be developed and delivered in one coordinated loop rather than siloed phases.  Agentic AI is rewriting the user interface, not just speeding up notes. Hain argues the shift from cloud/mobile to generative agents is “noticeably different” because large-context models can listen, remember, reason and suggest next steps in real time. That opens the door to smart exam rooms that combine ambient voice, vision and wearables, and to workflows that provide clinicians with a complete picture before they walk in the patient's room. As UI layers splinter, the possibility of deep insights from longitudinal data is becoming reality, and vendors who overlook this shift will quickly fall behind.   AI as a Force Multiplier for a Shrinking Workforce. With demand still rising faster than the workforce can grow, Hain sees AI as a supplement, not a head-count replacement: think follow-up calls, patient triage or ambient documentation that frees staff to practice at the top of their license. But he’s clear that hype won’t bend the curve; the industry has to measure quality gains, time saved and patient outcomes before claiming ROI. Governance must evolve in parallel so speed doesn’t outrun safety or equity and incumbents that ignore this shift do so at their peril.  Throughout, Hain balances optimism with realism: the models are improving fast, but value will hinge on measurable outcomes, thoughtful deployment, and collaboration across an industry that often works in silos.   To hear Seth Hain and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Brian D. Pieninck didn’t take a conventional path to healthcare leadership. He started his career as an 18-year-old IT contractor and spent two decades working across the industry before becoming President and CEO of CareFirst Blue Cross Blue Shield. He now also serves as Chair of the Blue Cross Blue Shield Association, bringing both local and national perspective to the role.  In this episode, Keith Figlioli speaks with Pieninck about what it means to lead a not-for-profit regional payer at a time of seismic change. With 3.6 million members and coverage that spans commercial, Medicare, and Medicaid, CareFirst has become a vital part of healthcare access and infrastructure across the Mid-Atlantic. Pieninck reflects how demographic shifts, rising costs, and policy uncertainty are challenging how healthcare organizations evolve, while staying focused on long-term outcomes.   Pieninck and Keith discuss:  Advancing health equity as part of the community. Pieninck sees CareFirst not just as a payer, but as part of the region’s civic infrastructure, creating economic opportunities, delivering care through primary and urgent care locations, and supporting long-term health equity initiatives across Maryland, DC, and Northern Virginia.  Medicaid coverage and its downstream impact. With nearly half of children in Maryland and DC relying on Medicaid, Pieninck warns that cuts or disruptions don’t reduce the need for care; they push it into higher-cost, less coordinated settings like emergency departments.  The balloon effect in healthcare financing. As costs are squeezed in one area, they inflate in another. Pieninck challenges the idea that market forces can realign care efficiently. He discusses how efforts to contain spending in one area often lead to inefficiencies elsewhere, and the system ends up paying more later because early, lower-cost interventions are underfunded or inaccessible.   Innovation that simplifies the system. Through CareFirst’s innovation arm, Healthworx, Pieninick highlights the need to design a system that works for people by reducing complexity and embedding support directly into the healthcare experience.  AI and infrastructure: opportunity meets readiness. With nearly three decades of experience on the technology side of healthcare, Pieninck is bullish on AI’s potential—especially now that it's available at a price point that can scale. Real progress, he notes, will depend on thoughtful governance, better interoperability, and models built around human needs.  This episode offers a look at how one regional plan is thinking through the tensions between access, affordability and innovation, and what that means for the broader system.   To hear Brian D. Pieninck and Keith discuss these challenges in depth, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Kody Kinsley has been called many things—operator, innovator, Medicaid “nerd”—but above all, he’s a fierce advocate for the health and well-being of the populations Medicaid serves. Now a senior advisor at the Milken Institute and recently North Carolina’s Secretary of Health and Human Services, Kinsley joins Keith Figlioli for a wide-ranging conversation about how Medicaid works, why it matters, and where innovation is reshaping its future.  A native of North Carolina, Kinsley brings personal experience and professional depth to his perspective. Growing up uninsured, he watched his mother navigate pediatric clinics, sliding-scale providers, and supply closets offering free samples to keep her kids healthy. That formative exposure ultimately propelled him into a career spanning healthcare operations, behavioral health, public policy, and government leadership.  As North Carolina’s health secretary, Kinsley led one of the country’s largest and most complex human services agencies, overseeing everything from Medicaid operations and public health to psychiatric hospitals and child welfare. He played a central role in advancing Medicaid expansion in the state—an achievement shaped by bipartisan negotiation, careful balancing of federal and state resources, and a deep understanding of the healthcare landscape.  In this episode, Kinsley and Keith cover:  The structural realities behind state Medicaid programs. Kinsley describes how mega-agencies like North Carolina’s bring together financing, public health, regulation, and direct care delivery—touching millions of lives daily, often invisibly.  Federal-state dynamics and looming policy shifts. From federal match rates to provider taxes and budget triggers, Kinsley explains the intricacies of how money moves between federal and state governments—and what’s at stake when Congress debates Medicaid cuts or structural reforms.  The human cost behind budget debates. Behind every line item is a person: whether it’s dental coverage, hospice services, or in-home care, Kinsley argues that policymakers must weigh the downstream impacts of funding decisions on real lives and long-term system costs.  Bright spots and innovation. Kinsley highlights North Carolina’s “Healthy Opportunities” pilot—one of the first initiatives nationally to use Medicaid dollars for non-medical needs like food, housing, and transportation. Early results show promise, including improved outcomes and significant cost savings, suggesting a roadmap for other states.  Looking forward. While political winds may shift and financial pressures mount, Kinsley remains optimistic. He points to growing public support for Medicaid and hopes the nation can move beyond divisive debates over whether healthcare is a right or privilege—focusing instead on smarter, more sustainable ways to deliver care.  To hear Kody Kinsley and Keith Figlioli unpack these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders. 

Dr. Ali Khan has spent his career at the intersection of medicine, public policy, and value-based care. He’s also been at the forefront of some of the country's most innovative care delivery models—from Iora Health and CareMore to Oak Street Health and now Aetna, where he serves as Chief Medical Officer of Medicare at Aetna, a CVS Health company. In this episode, Keith Figlioli sits down with Dr. Khan for a conversation about Medicare’s future—and what it will take to make the promise of better, more affordable healthcare a reality.  A general internist by training, Dr. Khan’s path into healthcare began with a deep curiosity about the broader systems shaping people’s health. That curiosity took him from Harvard Kennedy School to the exam room to health plans and startups focused on reimagining the primary care experience for complex, underserved populations. Throughout his career, he’s gravitated toward organizations trying to solve public-sector problems with private-sector solutions—building care models that prioritize trust, access, and long-term outcomes.  Now at the helm of a Medicare Advantage program serving 4.2 million members, Dr. Khan brings a unique vantage point. In this conversation, he shares hard-earned lessons on care model design, what payers and providers need from each other, and why Medicare is at an inflection point. He makes a compelling case for a renewed focus on the fundamentals—not just risk adjustment or benefit design, but operational follow-through, last-mile care coordination, and culturally grounded team-based models that scale.  Dr. Khan and Keith discuss:  Building care models that hold up under pressure. From Iora to Oak Street, Dr. Khan has seen firsthand that delivering better outcomes at scale requires more than mission—it takes structural rigor. He unpacks four key dimensions—cultural, clinical, operational, and technological—and explains why lasting impact depends on aligning all of them. Whether it's equipping care teams to deliver in complex communities or building systems that can flex and scale, success hinges on getting the foundation right.  Why affordability isn’t enough—and where Medicare Advantage must go next. With over half of Medicare beneficiaries now enrolled in MA plans, Dr. Khan argues it’s time to move beyond the value prop of supplemental benefits and zero-dollar premiums. The next chapter is about proving clinical excellence at scale. That means prioritizing follow-through over features—removing last-mile barriers, improving care coordination, and designing experiences people actually trust.   From transactional to transformative: the evolving role of health plans. Plans have long relied on contractual structures to drive change, but Dr. Khan believes that era is fading. To deliver on the promise of value-based care, plans must shift from passive administrators to proactive partners—investing in infrastructure, surfacing actionable insights, and enabling providers to succeed across Medicare, Medicaid, and commercial populations alike.  Where AI meets care delivery. Dr. Khan reflects on the potential of AI to reduce clinical variation, improve medication management, and drive better follow-up for patients—especially those with chronic conditions. But he cautions that technology alone won’t move the needle. To truly unlock AI’s value in Medicare, plans and providers must embed it within human-centered systems, coordinate care in real time, and ensure new tools support—not replace—the relationships that matter most.  As Dr. Khan notes, we’re entering a “put up or shut up” era for Medicare Advantage, where scrutiny is high and proof points matter. Yet within that pressure lies opportunity—particularly for those willing to do the unglamorous work of identifying barriers, building connective tissue, and supporting clinical teams in the trenches.