Payment integrity is top of mind as insurers face growing pressure to eliminate fraud, waste and abuse. Successful programs require investment in technology and expertise to analyze trends and identify abnormalities. The team at Optum Insight works closely with insurers across the healthcare system to examine this data

In this episode of "Podnosis," Fierce Healthcare senior writer Paige Minemyer sits down with Steve Yurjevich, CEO of the payer market at Optum Insight, to discuss the challenges and solutions in this space.

To learn more about the topics in this episode: 
'Well-intentioned, poorly executed waste': How tech companies aim to reduce billions in wasteful spending
New Mountain Capital merges Apixio, Varis and The Rawlings Group in $3B deal
CMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial tool
Industry Voices—We need to fight fraud the right way

Payment integrity is top of mind as insurers face growing pressure to eliminate fraud, waste and abuse. Successful programs require investment in technology and expertise to analyze trends and identify abnormalities. The team at Optum Insight works closely with insurers across the healthcare system to examine this data
In this episode of "Podnosis," Fierce Healthcare senior writer Paige Minemyer sits down with Steve Yurjevich, CEO of the payer market at Optum Insight, to discuss the challenges and solutions in this space.
To learn more about the topics in this episode:&nbsp;
<ul>
<li><a href="https://www.fiercehealthcare.com/payers/how-payers-and-providers-should-think-about-payment-integrity">'Well-intentioned, poorly executed waste': How tech companies aim to reduce billions in wasteful spending</a></li>
<li><a href="https://www.fiercehealthcare.com/health-tech/new-mountain-capital-merges-apixio-varis-and-rawlings-group-3b-deal">New Mountain Capital merges Apixio, Varis and The Rawlings Group in $3B deal</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/cms-sets-real-time-medical-fraud-center-doge-federal-contractor-rolls-out-commercial-tool">CMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial tool</a></li>
<li><a href="https://www.fiercehealthcare.com/payer/industry-voices-we-need-to-fight-fraud-right-way">Industry Voices&mdash;We need to fight fraud the right way</a></li>
</ul>

Podnosis: the pulse of the healthcare industry. Every week, journalists from Fierce Healthcare dive into some of the industry’s biggest trends. We talk to the experts about what’s important now so you can prep for the future. Hear about all things healthcare, from physician practices to hospital chains and insurance giants—and those that mix all three—plus the tech they use, disruptors looking to compete and people moving the sector forward. Follow Podnosis on Apple Podcasts, Spotify, Amazon or wherever you get your podcasts.

Podnosis: the pulse of the healthcare industry. Every week, journalists from Fierce Healthcare dive into some of the industry’s biggest trends. We talk to the experts about what’s important now so you can prep for the future. Hear about all things healthcare, from physician practices to hospital chains and insurance giants—and those that mix all three—plus the tech they use, disruptors looking to compete and people moving the sector forward. Follow Podnosis on Apple Podcasts, Spotify, Amazon or wherever you get your podcasts.

Podnosis

Podnosis: the pulse of the healthcare industry. Every week, journalists from Fierce Healthcare dive into some of the industry’s biggest trends. We talk to the experts about what’s important now so you can prep for the future. Hear about all things healthcare, from physician practices to hospital chains and insurance giants—and those that mix all three—plus the tech they use, disruptors looking to compete and people moving the sector forward. Follow Podnosis on Apple Podcasts, Spotify, Amazon or wherever you get your podcasts.

Rethinking payment integrity 

Employers are in a tough spot. Healthcare costs are rising, while insurance plan options may seem overwhelming or inadequate. The need for real value has never been more apparent. What if there were a way to optimize an existing provider network for quality?

Garner Health helps employers address these pain points. By finding the best-performing doctors in a given network and incentivizing members to see them, Garner claims to help clients save costs and achieve better health outcomes.

To break it down, Fierce Healthcare's Anastassia Gliadkovskaya talks to Garner Health founder and CEO Nick Reber.

To learn more about the topics in this episode: 
Employers brace for 6.7% increase in health benefits costs
Report: Payers need to do more to demonstrate value to plan sponsors
Industry Voices—Maximizing your benefits investment: Why health insurance literacy is the missing link

Employers are in a tough spot. Healthcare costs are rising, while insurance plan options may seem overwhelming or inadequate. The need for real value has never been more apparent. What if there were a way to optimize an existing provider network for quality?
Garner Health helps employers address these pain points. By finding the best-performing doctors in a given network and incentivizing members to see them, Garner claims to help clients save costs and achieve better health outcomes.
To break it down, Fierce Healthcare's Anastassia Gliadkovskaya talks to Garner Health founder and CEO Nick Reber.
To learn more about the topics in this episode:&nbsp;
<ul>
<li><a href="https://www.fiercehealthcare.com/payers/employers-brace-67-increase-health-benefits-costs-next-year-mercer">Employers brace for 6.7% increase in health benefits costs</a></li>
<li><a href="https://www.fiercehealthcare.com/payers/report-payers-need-do-more-demonstrate-value-plan-sponsors">Report: Payers need to do more to demonstrate value to plan sponsors</a></li>
<li><a href="https://www.fiercehealthcare.com/payers/industry-voices-maximizing-your-benefits-investment-why-health-insurance-literacy-missing">Industry Voices&mdash;Maximizing your benefits investment: Why health insurance literacy is the missing link</a></li>
</ul>

Cutting employer costs by steering patients to top docs

Since the Trump administration took office in January, healthcare policy has been moving quickly, with changes touching Medicaid funding, ACA subsidies, hospital finances and the federal government’s approach to health technology.

This week on "Podnosis," we’re bringing you a recording from a live roundtable at the Fierce Health Payer Summit on Dec. 4, where members of the Fierce Healthcare editorial team unpacked the policy and funding shifts already underway. The discussion covers Medicaid cuts and coverage losses, how hospitals are preparing for reduced government funding, CMS’ new health tech ecosystem and where PBM reform stands after years of scrutiny.

To learn more about the topics in this episode: 
Crapo, Cassidy introduce ACA subsidy plan that leans on HSAs
AHIP presses for ACA subsidy extension, further program integrity measures
Medicaid work rules exempt the 'medically frail.' Deciding who qualifies is tricky
When the hospital leaves town
Many urban safety-net hospitals threatened by OBBBA's Medicaid cuts: analysis
Industry Voices—3 major changes to Medicare Part B payment policies coming for 2026
'Come fight with me'—Oz courts physicians skeptical of Medicaid cuts, MAHA's criticisms
KFF: States brace for increasing Medicaid costs even as enrollment stays flat
All 50 states submit applications for $50B Rural Health Transformation Program
The policies top of mind for healthcare stakeholders right now
Hospital M&A continues to rebound as policy uncertainty clears

Since the Trump administration took office in January, healthcare policy has been moving quickly, with changes touching Medicaid funding, ACA subsidies, hospital finances and the federal government&rsquo;s approach to health technology.
This week on "Podnosis," we&rsquo;re bringing you a recording from a live roundtable at the Fierce Health Payer Summit on Dec. 4, where members of the Fierce Healthcare editorial team unpacked the policy and funding shifts already underway. The discussion covers Medicaid cuts and coverage losses, how hospitals are preparing for reduced government funding, CMS&rsquo; new health tech ecosystem and where PBM reform stands after years of scrutiny.
To learn more about the topics in this episode:&nbsp;
<ul>
<li><a href="https://www.fiercehealthcare.com/regulatory/crapo-cassidy-introduce-aca-subsidy-plan-leans-hsas">Crapo, Cassidy introduce ACA subsidy plan that leans on HSAs</a></li>
<li><a href="https://www.fiercehealthcare.com/payers/ahip-presses-aca-subsidy-extension-further-program-integrity-measures">AHIP presses for ACA subsidy extension, further program integrity measures</a></li>
<li><a href="https://www.fiercehealthcare.com/regulatory/medicaid-work-rules-exempt-medically-frail-deciding-who-qualifies-tricky">Medicaid work rules exempt the 'medically frail.' Deciding who qualifies is tricky</a></li>
<li><a href="https://www.fiercehealthcare.com/hospitals/when-hospital-leaves-town">When the hospital leaves town</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/many-urban-safety-net-hospitals-threatened-obbbas-medicaid-cuts-analysis">Many urban safety-net hospitals threatened by OBBBA's Medicaid cuts: analysis</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/industry-voices-three-major-changes-medicare-part-b-payment-policies-coming-2026">Industry Voices&mdash;3 major changes to Medicare Part B payment policies coming for 2026</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/come-fight-me-oz-courts-physicians-skeptical-medicaid-cuts-maha-criticisms">'Come fight with me'&mdash;Oz courts physicians skeptical of Medicaid cuts, MAHA's criticisms</a></li>
<li><a href="https://www.fiercehealthcare.com/payers/kff-states-brace-increasing-medicaid-costs-even-enrollment-stays-flat">KFF: States brace for increasing Medicaid costs even as enrollment stays flat</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/cms-opens-state-applications-50b-rural-health-transformation-program">All 50 states submit applications for $50B Rural Health Transformation Program</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/policies-top-mind-healthcare-stakeholders-right-now">The policies top of mind for healthcare stakeholders right now</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/hospital-ma-continues-rebound-policy-uncertainty-clears">Hospital M&amp;A continues to rebound as policy uncertainty clears</a></li>
</ul>

A Fierce federal health policy checkup

Each year, Fierce Healthcare’s Women of Influence special report asks a simple question: Who is actually reshaping healthcare from the inside? This year brought a record number of nominations and a list that reflects how broad that influence has become, across health systems, payers, tech, policy and advocacy.

In this episode, Fierce Healthcare's Heather Landi and Paige Minemyer talk about why this recognition still matters, even as women make up nearly half of managerial and executive roles but remain scarce in CEO positions. They get into what the nomination surge tells us about where change is happening, how roles and titles are evolving and why so many of the most interesting ideas in healthcare are being led by women who are still fighting for a true share of power.

To learn more about the topics in this episode: 

Fierce Healthcare's Women of Influence 2025

Each year, Fierce Healthcare&rsquo;s Women of Influence special report asks a simple question: Who is actually reshaping healthcare from the inside? This year brought a record number of nominations and a list that reflects how broad that influence has become, across health systems, payers, tech, policy and advocacy.
In this episode, Fierce Healthcare's Heather Landi and Paige Minemyer talk about why this recognition still matters, even as women make up nearly half of managerial and executive roles but remain scarce in CEO positions. They get into what the nomination surge tells us about where change is happening, how roles and titles are evolving and why so many of the most interesting ideas in healthcare are being led by women who are still fighting for a true share of power.
To learn more about the topics in this episode:&nbsp;
<a href="https://www.fiercehealthcare.com/special-reports/2025s-women-influence">Fierce Healthcare's Women of Influence 2025</a>

Rethinking payment integrity

In 1 playlist(s)

Podnosis

Social links

Follow podcast

Recent clips