Podcast Summary: Capital Hill, Payers, & the Future of Reimbursement in Healthcare

Becker’s Healthcare Podcast – February 25, 2026
Host: Erica Spicer Mason
Guest: Patrick Veliki, Chief External Affairs Officer, Halo MD

Episode Overview

This episode delves into current dynamics on Capitol Hill affecting payers and the future of healthcare reimbursement. Guest Patrick Veliki, an industry veteran in advocacy and healthcare policy, shares insights on recent Congressional hearings, challenges with payer-provider alignment, the status of the No Surprises Act, and practical guidance for healthcare leaders navigating the rapidly evolving reimbursement landscape.

Key Discussion Points and Insights

1. Recent Congressional Focus on Payers and Affordability

(00:40–03:51)

• Major attention on health insurance industry consolidation and affordability.
• Congressional leaders, particularly Chairman Smith (Ways and Means Committee), called out the growing vertical and horizontal consolidation, with large insurers acquiring pharmacies, PBMs, and physician practices.
• Raised key question: Is increased insurer control over care delivery beneficial for the healthcare system?
• Patrick notes a prevalent "deflection" in insurer testimonies regarding the No Surprises Act (NSA), especially concerning dispute volumes in the NSA’s Independent Dispute Resolution (IDR) process.
• Insurers perpetuate outdated claims that the IDR process was designed for only 17,000 annual disputes, which Patrick calls "debunked" and unhelpful for policy progress.

Notable Quote:

“To hear insurers kind of tout out that very outdated and like I said, debunked talking point around volume is, I think, indicative of some of that deflection that I don’t think resonates with policymakers or with the American people.”
— Patrick Veliki (02:48)

2. Implications for Healthcare Leaders: Importance of Engagement

(03:52–05:28)

• Ongoing hearings present a significant opportunity for healthcare organizations and leaders to engage in education and advocacy.
• Many healthcare leaders underestimate their own credibility and the value they bring when involved in policy conversations.
• Patrick urges leaders to recognize their influence as frontline care providers and to step into advocacy roles.

Notable Quote:

“...what this should demonstrate to healthcare leaders is that there is a real opportunity to engage and start working to improve the policy landscape.”
— Patrick Veliki (04:47)

3. Disconnect Between Payer Rhetoric and Provider Realities

(05:29–07:41)

• Providers on the ground face decreasing reimbursement rates and increasing financial challenges, with many hospitals operating on thin margins or facing distress.
• Payers publicly frame themselves as cost defenders, but providers experience mounting administrative burdens and difficulty maintaining staff and services.
• The administrative load, such as prior authorizations, detracts from clinical care—contradicting providers’ motivations for entering the field.

Notable Quote:

“There’s a real disconnect there in what plans claim to be attempting to accomplish and what physicians are actually feeling on the ground. And we’ve got to cut through that and figure out how to ensure physicians can do what they got into medicine to do, actually provide care without having to worry about keeping the lights on.”
— Patrick Veliki (07:20)

4. Legislative Opportunities: Reforming No Surprises Act (NSA) and IDR Process

(07:42–11:32)

• Congress is increasingly attentive to challenges with the NSA’s IDR process, especially regarding timely payment of arbitration awards to providers.
• Bipartisan legislation, the “No Surprises Act Enforcement Act,” seeks to:
  • Create penalties and interest for delayed payments after successful arbitration.
  • Level penalties for violations of patient protections (i.e., ensuring patients are only charged in-network rates as the law intends).
• Evidence points to persistent payer non-compliance with the NSA, justifying stronger enforcement.
• Patrick is optimistic about legislative momentum, highlighting that these proposals, if enacted, could ensure actual implementation matches Congressional intent.

Notable Quote:

“So the real legislative opportunity here is when it comes to the No Surprise Act, if Congress is interested in doing anything at all, it’s in ensuring that what they pass in the first place actually goes into effect, actually enforcing those patient protections and the expectation that payment is made and made timely once the IDR process is utilized.”
— Patrick Veliki (10:25)

5. Role of Organizations like Halo MD in Navigating Reimbursement Uncertainty

(11:33–13:30)

• Organizations such as Halo MD can relieve physicians, especially independent groups, of administrative burdens tied to complex reimbursement and dispute resolution processes.
• Relieving these pressures is crucial for the survival of independent practices, which often lack back-office infrastructure to handle administrative demands.
• Supporting independent providers helps preserve choice and reduces forced consolidation with hospitals or insurers.

Notable Quote:

“So I think what Halo MD offers here is that ability to remain independent and let someone else handle administrative burdens while you handle healthcare delivery.”
— Patrick Veliki (13:22)

6. Final Thoughts: Optimism for the Practice of Medicine

(14:02–14:41)

• Patrick underscores optimism for future improvements in healthcare policy, believing thoughtful implementation can align intentions and outcomes.
• He encourages leaders to persist, confident in the system’s capacity for positive evolution and stability.

Notable Quote:

“I think there are a whole lot more reasons to be optimistic about improvements to the system writ large than reasons to be pessimistic. We’ve got to stick the landing on some of these things and really make sure that outcomes and implementation match intention.”
— Patrick Veliki (14:10)

Memorable Moments by Timestamp

• [01:03] — Patrick breaks down Congressional hearings on insurer consolidation and affordability.
• [02:48] — Refuting outdated payer talking points on NSA dispute volumes.
• [04:47] — Encouragement for leaders to engage in advocacy.
• [07:20] — Candid assessment of disconnect between payers and providers.
• [10:25] — Emphasis on enforcing Congressional intent behind NSA.
• [13:22] — Importance of administrative support for independent practices.
• [14:10] — Patrick’s closing message of optimism for healthcare reform.

Summary Takeaways for Leaders

• Congressional scrutiny of payers is intensifying, focusing on affordability, consolidation, and accountability for processes like the NSA.
• Healthcare leaders have both a stake and influence in policy reform—advocacy is valuable and impactful.
• Disconnect remains between payer narratives of stewardship and provider realities of financial strain and administrative overload.
• Bipartisan legislative efforts (notably around NSA enforcement) could reshape reimbursement pathways and protect both providers and patients.
• Support systems—such as partners to offload administrative work—are key to preserving independent medical practice amidst mounting external pressures.
• The tone remains cautiously optimistic: with the right engagement and enforcement, reforms can meaningfully improve healthcare delivery and sustainability.