Healthcare is Hard: A Podcast for Insiders

From Pilots to Production: Boston Children’s John Brownstein on the Next Phase of AI in Healthcare

Dr. John Brownstein has been on the leading edge of digital health since medical school, where he was drawn to epidemiology because of the opportunity to use data sets for large-scale impact beyond the exam room. He’s been on a hunt for data ever since, shaping a career that has spanned public health, technology, startups, and healthcare innovation. Dr. Brownstein helped develop Google Flu Trends, served as a healthcare advisor to Uber, and launched one of the first data analytics companies in public health, where he applied AI long before it became today’s dominant topic. In 2015, he became Chief Innovation Officer at Boston Children’s Hospital, where he has helped turn it into a proving ground for emerging technologies. With its manageable size, nimble culture, and an administration willing to invest in innovation, Dr. Brownstein has helped turn Boston Children’s into an ideal setting for testing emerging technology. This environment, which put Boston Children’s on the front edge of healthcare IT for more than a decade, has positioned it to help lead the current AI wave. In this episode of Healthcare is Hard, Dr. Brownstein joined Keith Figlioli to discuss AI adoption, how it’s changing health systems, and what those changes mean for the companies selling to them. They discussed topics including: * The fast pace from pilots to production. Only half joking, Dr. Brownstein mentioned that his conversation with Keith would be outdated by the time the podcast aired. The reality is, everything related to AI is moving so quick – even in healthcare, which is bucking its reputation as a slow mover on tech adoption when it comes to AI. Health systems are no longer just dabbling in isolated pilots; they’re taking significant steps toward broad deployment, using AI for intelligent automation, workflow support, and clinical tools in ways that are beginning to produce measurable impact. * The build versus buy equation. After launching Boston Children’s innovation program, Dr. Brownstein recognized that having a large engineering team wasn’t sustainable and began turning to startups that could innovate and deploy quickly. But that tide is shifting again, with the ability to use AI for internal development. He hasn’t closed the door on startups, but says the bar is much higher. Companies selling into providers will need to show a stronger moat – whether through proprietary data, regulatory expertise, deep workflow integration, or some other advantage that cannot be easily recreated in-house. * Designing AI architecture. AI procurement has become much more strategic than investing in point solutions. Dr. Brownstein discussed how health systems need to think about foundation models, hyperscalers, core systems like Epic, and point solutions, and how they all fit together to benefit users including clinicians, researchers, patients and families. For startups and incumbents alike, success will depend not only on product performance, but on how well a solution fits into the broader technology stack health systems are now building around AI. * Why culture is just as important as capability. Even with strong interest in AI across healthcare, adoption is not purely a technical issue. Dr, Brownstein notes that while demand for AI tools is high, there are also signs of fatigue and anxiety as AI becomes an unavoidable topic in boardrooms, leadership meetings, and day-to-day work. With real questions about trust and job impact, organizations will need to pair technical progress with a thoughtful approach to culture, communication, and workforce readiness. To hear Keith Figlioli and Dr. John Brownstein discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

DC’s Ambitious Plans for Modernizing Health Tech: U.S. DOGE Service Administrator & CMS Strategic Advisor, Amy Gleason

The daughter of a hospital administrator, Amy Gleason never considered a career in the public sector – she went straight into healthcare. As an emergency room nurse, she started to see the dangers that unfold when healthcare providers don’t have access to the information they need to treat patients. Those experiences drove her towards a tech career in the emerging electronic health records space before a very personal experience altered her professional path yet again. Amy’s active and healthy 10-year old daughter began suffering unusual healthcare events, from rashes and headaches to broken bones. Eventually, she couldn’t walk. It took more than a year from the start of these symptoms for doctors to diagnose her with a rare autoimmune disease. Even then, it was an accidental diagnosis from a dermatologist conducting a skin biopsy. Amy attributes the delayed diagnosis to siloed data, not unsimilar to the challenges she experienced as a nurse and was working to solve in the EHR space. It motivated her to co-found a company focused on helping patients with chronic diseases access their data to share it with the providers and family members helping to navigate complex care journeys. In 2015, Amy’s work earned her an award from the White House for Champions of Change in Precision Medicine – her first foray into the public sector. By 2018, she entered civic service full time with a role at the United States Digital Service, which she describes as “DOGE 1.0.” In this episode of Healthcare is Hard, Amy talked to Keith Figlioli about the work she’s doing now as Strategic Advisor to CMS and Administrator of the U.S. DOGE Service, where her main mission is modernizing technology across government agencies for the millions of people who rely on federal services every day. This ranges from modernizing FAFSA and the student loan process, to improving the Visa system ahead of the World Cup, and work on various critical healthcare systems.  Some of the topics Amy and Keith discussed in this episode, include: * Bold plans for a Digital Health Ecosystem. Launched in July 2025, CMS’ Health Tech Ecosystem is a public-private partnership designed as a voluntary, fast-moving alternative to slow rulemaking. Rather than years of regulation, the program uses pledges, working groups, and short development cycles to put interoperability building blocks and real patient-facing use cases in place. The goal is to get usable capabilities into the market in months – not years – let the community iterate, and have baseline use cases live by March 31, 2026 with more advanced capabilities rolling out by July. * Carrots and sticks before regulation. Recognizing the limitations of regulation, Amy talked about a new philosophy for incentivizing the market to change behaviors on its own first. “Carrots” include the rural health transformation fund and the recently introduced ACCESS model, a 10-year pilot that, for the first time, lets tech-enabled services bill Medicare directly. “Sticks” include stricter enforcement of information-blocking rules. * Replacing the 1970s-era Medicare claims system. Amy discussed plans to replace Medicare’s decades-old COBOL-based adjudication platform. While it’s a stable platform, it can’t support real-time processing, AI, or rapid change. To replace it, CMS is looking to commercial, off-the-shelf solutions that operate at scale so claims processing can be modernized, made real-time, and integrated with new interoperability rails. It’s a concrete example of bringing modern engineering and product thinking to government technology. To hear Amy and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Glimmers of Nonpartisan Progress: Decoding ACCESS, TEMPO and the Latest Government Healthcare Initiatives

After three decades working to deliver easy, fast and cost-effective patient experiences through technology, Ryan Howells is more optimistic about the future than he’s ever been before. At a time when healthcare has been at the center of polarizing and partisan politics, Ryan is focused on an area foundational to digital health that he says draws consensus across party lines: data exchange and interoperability. Freely moving data can unlock innovation in technology, payment models, and regulation to make healthcare work better for everyone, and Ryan is extremely encouraged by the openness to ideas and volume of activity he’s seeing from the second Trump Administration in these areas. As Principal at Leavitt Partners since 2015, Ryan collaborates with the private sector, the White House, Congress, HHS, and the VHA to improve health care nationwide. For the past ten years, he has also led the CARIN Alliance, a bi-partisan, multi-sector alliance uniting industry leaders to advance the adoption of consumer-directed exchange across the U.S. In January 2023, Ryan joined Keith Figlioli on the podcast [https://www.lrvhealth.com/podcast/the-healthcare-data-goldrush-leavitt-partners-ryan-howells-imos-dale-sanders-lay-out-a-guide-for-prospectors/] to discuss the myriad of new possibilities emerging in healthcare as a result of better access to data. In this episode, he recounts the progress and obstacles since that conversation, but more importantly, helps unpack the flurry of new activity. Topics Ryan and Keith covered include: * ACCESS & TEMPO. These are the latest examples of two new government programs that Ryan believes will remove barriers to innovation. ACCESS is a CMS initiative that now makes it possible for technology companies to bill Medicare directly for digital health services – and get paid only when patients achieve specific, measurable clinical outcomes. Ryan explains how ACCESS is a breakthrough for transparency and has the potential to change contracting for digital health vendors as health system may now ask to share risk. TEMPO is a program from the FDA that complements ACCESS by allowing participating companies to bypass traditional device clearance processes through “enforcement discretion,” provided they share real time data with the FDA. Ryan explains how this oversight lowers cost and complexity for startups and accelerates the path to market for new digital health solutions. * Removing administrative roadblocks. In early 2025, Ryan’s team at Leavitt Partners published a paper [https://leavittpartners.com/federal-policy-and-industry-roadmap-to-accelerate-innovation-and-cut-administrative-waste/] titled, “Kill the Clipboard” that offered recommendations to cut administrative costs, lower the burden on consumers and providers, and modernize the health care data exchange ecosystem. Ryan discussed recommendations like the need for stronger enforcement of information blocking rules and suggestions for the government to change its certification program to focus on APIs, versus functionality of EHRs. He explained how these things would allow health systems to control their own data, build cloud-based workflows, and integrate with payers and innovative companies more easily. * Linchpins for data liquidity. Ryan believes that achieving true data liquidity in healthcare requires three foundational elements: a cloud-based data store, an API endpoint, and robust digital identity credentials. With these in place, he says organizations can exchange data securely and efficiently, supporting everything from public health to quality measurement and pharmacy exchange. He says these are the linchpins to finally achieve the data liquidity needed for innovation, interoperability, and improved patient outcomes. To hear Ryan and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for

340B Unpacked for the Holidays: Policy, Controversy, and Impact

Sitting at the intersection of healthcare policy, hospital finance, and patient access, the 340B drug discount program is a hot button issues in the pharmacy space. The program is critically important to providers that serve high volumes of low income and vulnerable patient populations, but it’s drawing increasing scrutiny. 340B was established in 1992 as part of the Public Health Services Act to help providers stretch scarce resources, expand services, and improve access to care for those most in need. It does this by requiring pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at significant discounts to safety net hospitals and other covered entities – including federally qualified health centers (FQHCs), HIV clinics, homeless clinics and more. Covered entities are reimbursed for the full cost of the medication and use that margin to offset losses from caring for low‑income, uninsured, and underinsured patients. It’s become a critical component to their operating budgets. The program has grown substantially since its inception, with increasing numbers of hospitals and entities participating. This expansion has led to questions about whether the program is being used as intended or stretched beyond its original purpose. Ted Slafsky – one of the nation’s leading experts on 340B – joined Keith Figlioli for this episode of Healthcare is Hard to unpack this complex and critical program. For 22 years, Ted served as president and CEO of 340B Health, a Washington D.C.-based association of over 1400 hospitals nationwide participating in the 340B program. In 2020, he started 340B Report [http://www.340breport.com/], the only news outlet in the country focused exclusively on the 340B program. Some of the topics Ted and Keith discussed include: * Balancing oversight and operational efficiency. The 340B program faces growing calls for transparency and accountability, with proposals for more detailed reporting on how hospitals and clinics use the savings. While oversight is important to ensure compliance and integrity, Ted warns that excessive administrative requirements could overwhelm providers and divert resources away from patient care. The challenge is finding a balance that promotes trust without creating an operational burden. * Dispelling Myths. One common misconception about 340B is that it’s a direct patient discount program. Ted addressed this myth, explaining how the discount is intended for providers to give them more resources to reach and serve more patients. The other myth Ted addressed is how the program is described – mostly by the pharmaceutical industry – as a “markup scheme.” He doesn’t think that’s a fair depiction and explained that revenue from commercially insured patients is essential for offsetting the cost of treating uninsured and underinsured patients, making the program a lifeline for safety-net providers. * An uncertain future. The 340B program faces significant uncertainty as policymakers consider major changes. Recent efforts to replace upfront drug discounts with a rebate model could strain the financial stability of small and rural providers, while federal proposals to cut Medicare Part B reimbursement add further pressure. At the same time, state legislatures are enacting a patchwork of laws to protect providers and restore contract pharmacy discounts, creating complexity across the country. Ted advises providers to not simply hope for the best. He urges hospitals and health centers to engage directly with lawmakers and their staff by inviting them to visit facilities where they can see the program’s impact and its role in supporting vulnerable populations. To hear Ted and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

The Big Beautiful Maze of Health Policy and Innovation

From being at the center of some of the most significant shifts in U.S. healthcare policy over the past two decades, Liz Fowler can offer valuable perspective in uncertain times. In her most recent government role, Liz served as director of the Center for Medicare and Medicaid Innovation (CMMI), an organization she helped create a decade earlier.  As Chief Health Counsel at the Senate Finance Committee, Liz played a major role in the drafting and passage of the Affordable Care Act (ACA) in 2010, which established CMMI. She then served as special assistant to President Obama on health care and economic policy at the National Economic Council to implement the ACA. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). Liz says she’s a public servant at heart, but credits her time in the private sector at Johnson & Johnson and WellPoint (now Elevance) for making her a more effective government leader. Today, Liz provides guidance, insight, and strategy for a broad array of health care stakeholders, including payers, health systems and providers, trade associations, technology companies and more as co-founder and managing partner of Health Transformation Strategies. Liz talked to Keith Figlioli for this episode of Healthcare is Hard to share insight and perspective as healthcare organizations navigate changing regulations, including those in the “Big Beautiful Bill.” Topics they discussed include: * The ROI of CMMI. Liz explained the difficulties tracking the savings that CMMI generates. She believes the mechanisms for measuring CMMI are too narrowly defined, making it hard to capture the full impact of its work. She advocates for a broader definition of success, emphasizing that innovation is a process—one where failure can provide just as much impact and opportunity for learning. * Limited bandwidth for innovation. It’s a challenging time for healthcare organizations that are scrambling to meet deadlines and ensure they’re in compliance with various regulations, including provisions of the “Big Beautiful Bill.” Liz believes this is pulling time and attention away from innovation and slowing progress toward advancing value-based care. Despite the overall constraints Liz sees with the current regulatory environment, she’s optimistic about rural health transformation funding and how that could spark some innovation. * The revolution that’s not coming. Throughout the conversation, Liz reiterated that “healthcare is hard.” She cautioned against expecting sweeping, revolutionary change, noting that progress in healthcare is incremental. Drawing on her 25+ years in health policy, Liz encouraged listeners to celebrate small victories and keep pushing forward, as real transformation happens step by step. To hear Liz and Keith discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.