Can affordability, transparency, and physician leadership rebuild trust in American healthcare?

In this episode, Asbel Montes sits down with Brian J. Miller, M.D., M.B.A., M.P.H., Associate Professor of Medicine at Johns Hopkins and voting member of MedPAC, to explore the reality behind Medicare Advantage, prior authorization, and the future of value-based care. Drawing from his unique experience at CMMI, FTC, FCC, and FDA, Dr. Miller unpacks how policy, payment, and pragmatism can reshape the system from the inside out.

Together, they discuss why seniors often choose Medicare Advantage for affordability, how utilization review can be modernized through electronic prior authorization and AI-driven workflows, and why price and quality transparency must move in tandem. The conversation dives into EMTALA challenges, clinician-payer friction, and the need for smarter, program-level quality measurement. Dr. Miller also shares his perspective on how the Rural Health Transformation Fund could empower EMS professionals to deliver care closer to home—and how restoring physician agency through aligned incentives could redefine modern healthcare leadership.

What You'll Learn: ✅ Why affordability drives Medicare Advantage enrollment—and what reforms are still needed ✅ How to modernize prior authorization through e-PA, AI, and EHR integration ✅ Why price transparency alone isn't enough without clear quality transparency ✅ How clinician education and aligned incentives can reduce payer-provider friction ✅ A roadmap for smarter, program-level quality metrics across Fee-for-Service, MA, and ACOs ✅ How Rural Health Transformation can extend access and redefine EMS roles ✅ Why re-empowering physicians through shared ownership could spark real reform

Key Takeaways: ✅ Affordability remains the strongest driver of Medicare Advantage adoption ✅ Prior authorization is here to stay—so it must become digital, fast, and fair ✅ Price + quality transparency builds trust, competition, and better outcomes ✅ Quality should be measured at the program level—not by micromanaging clinicians ✅ Rural health innovation and physician agency can drive the next wave of transformation

If you're a healthcare leader, policymaker, or clinician looking to understand how policy meets practicality, this episode offers a candid, forward-thinking look at how data, design, and leadership can modernize American healthcare

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Links:

Asbel Montes LinkedIn - https://www.linkedin.com/in/asbel-montes-31027634

Dr. Brian Miller Linkedin - https://www.linkedin.com/in/brianjmillermd/

Solutions Group Services:

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