In this episode of Analyzing Healthcare, Dr. Meena Seshamani, director of the Center for Medicare, discusses managing Medicare and Medicaid complexities in US Healthcare, initiatives to improve patient care, and the importance of transparency and engagement in healthcare policy. She elaborates on care transformation, Medicare Advantage challenges, and significant prescription drug pricing changes, emphasizing teamwork and collaboration. Dr. Meena Seshamani and Roy Bejarano discuss the complexities of drug pricing in America, Medicare’s role in negotiating drug prices, and the impact of pharmacy benefit managers on healthcare costs. They explore the need for transparency in drug pricing and the potential benefits of new market entrants. The discussion also highlights state-level healthcare innovations, particularly Maryland’s unique payment model, and the importance of focusing on prevention and chronic disease management. Meena shares her vision for the future of healthcare in Maryland, emphasizing a system that cares for individuals throughout their lives.

Title: She Transformed Medicare for 68 Million Americans—Now She Reveals What’s Next: A Discussion with Former Medicare Director, Dr. Meena Seshamani

Key Timestamps:

• • (00:00) Introduction To Medicare Leadership
  • (03:02) Understanding Medicare And Medicaid
  • (06:10) Transforming Care In Medicare
  • (09:06) Medicare Advantage And Transparency
  • (12:00) Prescription Drug Affordability Initiatives
  • (15:02) Engagement And Team Dynamics In Medicare
  • (18:01) Comparing Medicare With Other Payers
  • (20:46) Pricing Mechanisms In Medicare
  • (28:24) The Story Of Drug Pricing In America
  • (32:01) Medicare’s Role In Drug Negotiation
  • (37:03) The Impact Of Drug Pricing On Healthcare Costs
  • (40:27) New Entrants In The Drug Market
  • (47:38) State-Level Innovations In Healthcare
  • (54:06) Future Goals For Maryland’s Health System

Key Takeaways:

• • Medicare serves 68M+ Americans (65+), a federal program unlike state-run Medicaid.
  • Transforming care integrates behavioral health and community services.
  • Medicare Advantage needs transparency and better navigation.
  • The Inflation Reduction Act changed Medicare drug pricing.
  • Stakeholder engagement is key for policy.
  • Medicare pricing is statutory and budget-neutral.
  • The Medicare Shared Savings Program promotes value-based care.
  • Auditing and oversight are essential.
  • Collaboration enhances Medicare effectiveness.
  • US drug pricing is complex.
  • Pharmacy Benefit Managers (PBMs) significantly control drug purchasing.
  • Medicare negotiation can yield major savings.
  • Drug pricing transparency is vital for trust.
  • Healthcare markets differ from traditional ones.
  • State-level innovations can model reform.
  • Maryland’s payment model enables healthcare innovation.
  • Preventative care improves health outcomes.
  • Life expectancy needs context.
  • A holistic healthcare approach is necessary.

⁠linkedin.com/in/meena-seshamani-0679424 ⁠

⁠linkedin.com/in/roy-bejarano-a5669ba8⁠

⁠www.scale-community.com ⁠

About the Guest:

Dr. Meena Seshamani, former Director of the Center for Medicare at CMS, led transformative efforts in U.S. healthcare. A physician and health economist, she championed equitable access, prescription drug affordability, Medicare Advantage transparency, and community-based care. Her leadership helped implement the Inflation Reduction Act and drove Medicare’s shift toward value-based, patient-centered models, impacting over 68 million Americans.

Keywords:

Medicare, Medicaid, Healthcare, Prescription Drugs, Medicare Advantage, Healthcare Policy, Health Equity, Pricing, Healthcare Transformation, Patient Care, Drug Pricing, Medicare, Healthcare Costs, Pharmacy Benefit Managers, Health Economics, Drug Negotiation, Healthcare Innovation, Maryland Health System, Healthcare Transparency, Prescription Drugs, Analyzing Healthcare, Roy Bejarano, Jason Schifman, Healthcare, Healthcare Leadership, Healthcare Trends