Advertise on podcast: Richard Helppie's Common Bridge

Independent doctors are being squeezed out of the market, and it’s not because they forgot how to practice medicine. It’s because the business side of healthcare has turned into a maze of Medicare fee schedule pressure, weak commercial payer contracts, delayed payments, denials, clawbacks, and rising costs that hit small practices the hardest. We’re joined by Preston Alexander of Forward Slash Health for a blunt, practical conversation about what it takes to keep physicians independent. We get into the mechanics: why “managing by bank balance” hides the truth, how revenue cycle management has to connect to a real profit and loss view, and what changes when you can estimate expected payment by CPT code and payer and match it to the true cost of delivering that visit. We also talk negotiation strategy, using price transparency data, joining a clinically integrated network, and the hard decision some practices face when a payer relationship guarantees losses. From there, we pull back to the bigger system. We debate what can actually move US healthcare, why for-profit insurers create foundational misalignment, and why employers controlling roughly a trillion dollars in spend may be the most powerful lever. We also dig into direct primary care and concierge medicine as a patient-centered model, while facing the uncomfortable reality of clinician shortages and a transition that won’t be painless. If you care about independent physician practices, patient access, and realistic healthcare reform, this conversation is for you. Subscribe, share this with a physician or practice leader, and leave a review so more people can find the show. Support the show Engage the conversation on Substack at The Common Bridge!

Politics gets dangerous when power is defended with vibes instead of verifiable facts. We take a hard look at how public figures talk about the courts, the Justice Department, and “deterrence” and what those words can mean for ordinary people who just want fair rules applied evenly. We start in Michigan with Alyssa Slotkin’s attempt to hold the center while raising alarms about ideological capture, then zoom out to the bigger institutional question: when does legitimate accountability turn into political intimidation? We also weigh comments around the DOJ and high-profile investigations, because trust in law enforcement and the legal system is hard to earn and easy to break. If you care about rule of law, nonpartisan analysis, and keeping government power in check, this conversation is for you. Then we confront viral rhetoric head-on, including Donald Trump’s claims about schools and youth gender transition, and compare the headlines to what state laws and district policies actually say. We discuss the broader debate over pediatric gender medicine and why clear definitions, accurate timelines, and honest data matter more than outrage. After that, we turn back to the Michigan Senate race and questions raised about Abdul El-Sayed, plus the strange aftertaste of celebrity endorsements and out-of-state political theater. We close with a quick tour of France’s unrest, Michigan’s K-12 performance and NAEP rankings, Social Security fearmongering, and a rapid set of headlines that show how messy the news cycle really is. If you got something out of this, subscribe, share the show with a friend, and leave a review so more people can find a calmer, fact-first place to think. Support the show Engage the conversation on Substack at The Common Bridge!

A leadership rule from the workplace turns out to be a surprisingly sharp way to think about politics: if you do not receive an award, it does not mean you did not deserve one. We start there, with the uncomfortable gap between contribution and recognition, then zoom out to how modern public life rewards the loudest claim for credit instead of the best result. If you care about clear thinking, civic responsibility, and nonpartisan analysis, this conversation is built to cut through the noise. History then becomes our stress test. We revisit the summer of 1864, when calls to stop the fighting sounded humane on the surface, but a ceasefire without conditions would have protected the Confederacy and locked slavery in place. Lincoln took the heat for a base requirement in any negotiation: slavery had to end. That principle sets up a modern national security question that keeps returning across administrations: what are the nonnegotiables when negotiating with Iran, and why has “Iran must never have a nuclear weapon” functioned as a bipartisan red line? We also talk through why Israel and Iran are not interchangeable in strategic intent, even when debates about nuclear capability get emotionally charged. We also look at the economics and human cost of war, including how inflation tracks with conflict, and why historical data can add perspective when today’s arguments feel overheated. From veterans housing investments to the Fort Hood attack and the failures of protection that followed, we ask what policy choices say about who we value and how seriously we take duty of care. The final segment tackles a darker cultural shift: the very idea of live streaming an execution, and what it does to national dignity when justice is repackaged as content. If this kind of careful, fiercely nonpartisan policy podcast is what you want more of, subscribe, share the episode, and leave a review. What should be a hard line for any leader, even when the crowd demands something else? Support the show Engage the conversation on Substack at The Common Bridge!

Healthcare is one of the only industries where buyers sign thousand-page contracts, can’t see what they’re actually paying for, and then get told the solution is “trust us.” Nathan Kaufman sits down with Mark Cuban for an unscripted, brutally honest look at the incentives driving high costs, denials, and the constant feeling that someone is skimming off the top. We dig into what Cuban calls “contractual terrorism” in PBM and ASO agreements: long, tricky benefit contracts where employers have to catch everything and the vendor only needs one loophole. We talk about vertically integrated insurance conglomerates that do business with themselves, why CEOs often never see denial realities affecting their own employees, and how rising deductibles can turn hospitals and physicians into subprime lenders. We also go beyond pharmacy headlines to unpack spread pricing in medical claims, infusion drug markups, and why “price transparency” is incomplete without contractual transparency and usable data. Then we get practical. Cuban explains how hospitals and physician groups can think like real businesses, build relationships with large self-insured employers, and pursue direct contracting, carve-outs, and simple capitation models that remove layers of friction. We also explore why rate setting gains traction when trust is gone, and why radical openness, down to the economic details, is the only durable counter. Finally, we lay out an immediate, actionable move for employers: use AI to analyze contracts, find the rip-offs fast, and push back on gag clauses and audit traps. Subscribe, share this with a benefits leader you know, and leave a review with the one change you think would create real price discovery in US healthcare. Support the show Engage the conversation on Substack at The Common Bridge!

Politics didn’t get more complicated, it got more tribal, and the incentives behind what you see and share are a big reason why. We kick off season eight of The Common Bridge by looking back at what we set out to do in 2019: build a fiercely nonpartisan space where people can talk policy without being forced to “join a team.” After hundreds of conversations and two presidential cycles, we’re more convinced than ever that the middle ground isn’t weakness, it’s where serious thinking lives. We dig into how legacy media and social media algorithms manufacture certainty, amplify outrage, and reward the most predictable takes. From COVID messaging and canceled experts to climate debates and distorted headlines, we talk about what happens when narratives come first and facts get buried. If you’ve ever wondered why you feel angry about people you’ve never met, we offer a simple filter: who profits when you stay mad, and what facts are missing? Then we look forward. Season eight leans into more Substack columns and more commentary, with policy experts featured when they can cut through the noise. We also zoom out to the issues that hit everyone: inflation, dollar confidence, the real cost of living, and the job upheaval coming as new industries and roles emerge. If you’re tired of red tribe versus blue tribe and want clearer thinking about where the country is headed, you’ll feel at home here. Subscribe, share this with a friend who argues in good faith, and leave a review with the question you want us to tackle next. Support the show Engage the conversation on Substack at The Common Bridge!

Health insurance is supposed to buy peace of mind, but too often it buys a new kind of stress: surprise bills, long waits, and prior authorization hurdles that hit when you’re already sick. We sit down with Nick Stefanizzi, president of Northwell Direct, to unpack a provider-led, direct-to-employer contracting model designed to lower healthcare costs while improving the actual experience of getting care. Nick explains how Northwell Direct serves self-funded employers and unions by building a high-performance network without becoming an insurance company. We dig into the practical “product stack” behind the scenes: third-party administrators for claims, PBMs for pharmacy, stop-loss and reinsurance to cap risk, and a broad wrap network that helps prevent out-of-network exposure. Then we get specific on benefit design and the two-tier network approach, including how lower copays and smarter incentives can move members toward high-value care without taking choice away. We also tackle the issues that decide whether any affordability strategy survives contact with real life: prior authorization burden, specialty access, wait times, and how you measure quality so cheaper care doesn’t become worse care. Nick shares how navigation teams, load balancing, and better data and analytics (including Epic EHR transformation) can support access and outcomes, plus what success looks like over months and years for employers, members, and the health system. If you’re an employer, broker, union leader, or just someone who wants healthcare to work like a normal service, this one is for you. Subscribe, share this episode with someone who deals with benefits, and leave a review with your take: what would it take for you to trust a direct-to-employer health plan? Support the show Engage the conversation on Substack at The Common Bridge!

If you’ve ever wondered what “access to care” really means, picture a region that holds 30% of Michigan’s land mass and just 3% of its population. From the Mackinac Policy Conference, we sit down with Tanya Darner, Market Chief Executive Officer at UP Health System, to unpack how a single regional hub in Marquette delivers Level II trauma services and specialty care for communities spread across the Upper Peninsula. We talk about the quiet backbone of rural healthcare in Michigan: critical access hospitals. Tanya explains why keeping those small hospitals open is essential, how collaboration across CEOs and presidents becomes a survival strategy, and where gaps appear when staffing, supply chains, and aging infrastructure collide. We also get practical about telemedicine and telehealth, because “just go virtual” breaks down fast when broadband and IT capacity are inconsistent across remote towns. Policy and logistics come into sharp focus as we discuss Medicare and Medicaid cuts, the downstream impact on skilled nursing placement, and the real-world barriers created by weather, bridge closures, and long-distance transport. EMS access, subsidized services, and transfer timing are not abstract topics here, they are the difference between waiting hours and getting the right level of care. If you care about rural hospitals, healthcare affordability, and Michigan health policy, listen now, then subscribe, share the episode, and leave us a review so more people can find these conversations. What should decision-makers understand first about healthcare in the UP? Support the show Engage the conversation on Substack at The Common Bridge!

Healthcare gets argued like a spreadsheet, but most of what matters shows up as a human moment: a parent trying to make sense of a diagnosis, a patient who just wants care close to home, a kid in a hospital room who lights up because it’s bingo time. From the 2026 Mackinac Policy Conference, we talk with Tina Freese Decker, president and CEO of Corewell Health, and Lamont Yoder, president of Corewell Health East, about what it really takes to improve healthcare access, affordability, and outcomes across Michigan.  We dig into how technology can lower the cost of care while making care simpler to reach. Think telehealth visits, remote clinical support across a 21-hospital system, and the operational work required to keep innovations safe for patients, clinicians, and communities. Tina also shares a striking example of focused ultrasound used to target a tiny area in the brain and eliminate a tremor, letting a patient walk out able to hold a cup again. That story is a reminder that healthcare innovation is not hype when it restores everyday life.  Then we zoom out to policy. We talk about the unusual power of getting insurers, providers, legislators, and partners in the same room, plus a concrete Michigan win: collaboration that helped authorize Medicaid payment for newborn genetic testing, a model other states have copied. We also tackle a topic many people avoid until it is too late: advanced care planning and end-of-life care. If we want real healthcare cost savings without sacrificing quality, we have to reduce stigma, start conversations earlier, and modernize regulations that no longer match today’s accountability and capabilities.  If you care about healthcare reform, patient-centered care, and practical policy that can actually move the needle, listen now. Subscribe, share this with a friend, and leave a review so more people can find the Common Bridge. Support the show Engage the conversation on Substack at The Common Bridge!

Seven days. That’s the average wait time Trinity Health Michigan says it takes to get a new patient in with a primary care doctor and it’s a clue to how affordability and access can actually improve at the same time. From the 2026 Mackinac Policy Conference, I sit down with Shannon Striebich, president and CEO of Trinity Health Michigan, to talk about what a modern health system has to do differently if we want shorter waits, stronger prevention, and healthier communities across the state. We start with Trinity’s “coast to coast” Michigan footprint and then get specific about what drives real patient access: expanding primary care, making scheduling easier with online tools, and keeping people connected to preventive care once they enter the system. Shannon makes a straightforward point that too often gets lost in policy talk: it’s cheaper to be healthy than to develop a significant illness. That idea becomes the thread running through the whole conversation on healthcare affordability, prevention, and total cost of care. Then we widen the lens to community health, including Trinity’s “food is medicine” work and hospital-based farms that provide tens of thousands of pounds of fresh produce to people facing food insecurity. Finally, we take on the hardest issue: healthcare payment reform. Shannon explains why today’s incentives still favor hospital-based care over community-based prevention, and why double digit healthcare inflation in pharmaceuticals and supplies makes the current patchwork funding approach feel unsustainable. If you care about Michigan healthcare policy, value-based care, and practical steps that can move outcomes fast, this conversation is for you. Subscribe, share this with someone who cares about health policy, and leave a review so more listeners can find the show. Support the show Engage the conversation on Substack at The Common Bridge!

Healthcare workforce shortages are not a single problem with a single fix, they are a pipeline problem. I’m joined by Russ Kavalhuna, President of Western Michigan University, to talk about what it looks like when a community decides to grow its own talent instead of hoping someone else moves in. From physicians and nurses to lab techs, radiology techs, OT, and PT, we dig into the roles that keep care available in real life, not just on paper.  We get specific about what Western Michigan University already has in place: a strong base of allied health education and a cutting-edge medical school, WMED, that attracts thousands of applicants for just 88 seats. Then we explore an ambitious idea that could change the math for Southwest Michigan: a healthcare talent pipeline that starts as early as eighth grade, moves students through high school and higher education, and connects them to local clinical training and employment. The Kalamazoo Promise adds a rare advantage by reducing tuition costs, making healthcare education more reachable for local families.  We also zoom out to the regional ecosystem. Kalamazoo’s two independent hospital systems, Bronson and Beacon, collaborate with the university and medical school, creating a foundation that employers care about when deciding where to invest and where to recruit. And because Michigan’s population is aging, we talk about healthy aging research, prevention, and why keeping people out of acute care can improve quality of life while easing staffing pressure.  Finally, we tackle policy: what incentives could actually keep graduates in Michigan after they train here? We discuss options like student debt relief, down payment support, and employer-friendly tools that help new clinicians put down roots. If you care about healthcare access, medical education, and smart workforce development, this conversation will give you a blueprint worth debating. Subscribe, share the show with someone building in Michigan, and leave a review with your take on what would make you stay. Support the show Engage the conversation on Substack at The Common Bridge!

Health care is not just a line item for employers, it’s a defining force in whether a region can grow, attract talent, and stay competitive. From the 2026 Mackinac Policy Conference, we sit down with Rick Baker of the Grand Rapids Chamber of Commerce to connect the dots between community investment and the health care systems that keep West Michigan working. We talk about what the Chamber actually does across 3,100 member businesses, then zoom in on what makes Grand Rapids “sticky” for graduates and early-career workers. Rick shares how quality-of-life investments and higher education partnerships help employers recruit and retain, and why hospitals and health systems are true community assets. We also explore the region’s long-term goal of becoming a destination city for health care, including the growth of the Medical Mile and the role of major institutions like Corewell Health, Michigan State University’s College of Human Medicine, and the Van Andel Research Institute. Then we get candid about the toughest issue: rising health care costs and the real impact on employer benefits and workforce decisions. We close with a hopeful shift, discussing how COVID-era awareness accelerated more open conversations about mental health and why “above the neck” care must be aligned with physical health to support whole-person outcomes. Subscribe, share this conversation with someone who cares about Michigan health care, and leave a review so more listeners can find the show. Support the show Engage the conversation on Substack at The Common Bridge!

A lot of health care headlines sound distant until you realize how quickly a policy tweak can turn into a long drive, a missed refill, or an ER visit that could have been prevented. From the Mackinac Policy Conference, we sit down with Monique Stanton, President and CEO of the Michigan League for Public Policy, to talk about why Medicaid is the number one health care issue for so many Michiganders and why people feel genuinely scared about what comes next. We get specific about what’s changing and what isn’t. Monique explains that Medicaid income eligibility in Michigan stays roughly at 138% of the federal poverty level, yet major barriers can still knock people off coverage, including work requirements, twice a year eligibility checks, and the paperwork that creates “churn” for families already stretched thin. We also dig into the potential impact of HR1, the “One Big Beautiful Bill,” and why advocates expect as many as 200,000 to 250,000 people in Michigan could lose coverage if rollbacks move forward. Then we zoom out to what these changes mean on the ground, especially in rural Michigan. When coverage shrinks, clinics and hospital service lines can close, and that hurts everyone, not only Medicaid recipients. A labor and delivery unit shutting down or a behavioral health clinic moving farther away can turn routine care into an hours long trip, making it harder to stay healthy, work consistently, and care for family. We also talk about why hospitals and the Michigan Health and Hospital Association are key partners, and how Healthy Michigan Medicaid expansion helped cut uncompensated care by about 50% while shifting chronic care from emergency departments to primary care. If you care about Michigan Medicaid, rural health care access, and practical health policy that improves real lives, you’ll want this conversation. Subscribe, share with a friend, and leave a review to help more people find the show. Support the show Engage the conversation on Substack at The Common Bridge!

A brand-new building can look like progress, but what happens when the real problem is leadership and accountability behind locked doors? From the Mackinac Policy Conference, we sit down with Michigan State Senator Michael Webber to talk candidly about state-run psychiatric hospitals, what he says he saw after taking a closer look, and why mental health care oversight can’t stay in the shadows. We get specific about patient safety and operational failures, including the fallout from a false active shooter drill at the Hawthorne Center, the cascading trauma it created for patients and families, and what that kind of breakdown signals about governance. Webber walks us through the push for an Auditor General review, the significance of multiple severe audit findings, and why agreeing with findings is not the same as fixing them. We also dig into recipient rights, patient advocacy, and how adding lived experience to oversight boards could change decision-making in behavioral health care. Then we zoom out to the economics: hospitals as major employers and community anchors across Metro Detroit and Michigan, and the affordability crisis constituents bring to lawmakers every day. Webber explains how well-intended insurance coverage mandates can still raise premiums, why transparency matters across hospitals, pharmaceutical companies, and health plans, and what happens when families face high deductibles and start avoiding care. If you care about Michigan health care policy, mental health reform, hospital accountability, and making coverage more affordable, this conversation will give you real stories and clear policy tensions to think about. Subscribe, share this episode with someone who cares about mental health care, and leave a review, what policy change would you want lawmakers to prioritize first? Support the show Engage the conversation on Substack at The Common Bridge!

Health care gets blamed on villains, but the harder truth is that most people are reacting to the incentives right in front of them. From the 2026 Mackinac Policy Conference, we sit down with Matt Elliott, founder of Blue Lake Ideas and former president of Bank of America Michigan, to ask the question that quietly reshapes every other debate: who is the customer in health care? Matt brings a leadership lens he calls the “Power of And” thinking that refuses to collapse decisions into either-or. If Michigan wants a stronger future, we have to execute today and invest for tomorrow. We have to take care of people and still deliver results. That mindset matters when the state is facing what many leaders describe as a “house on fire” moment: slipping educational and economic outcomes, rising cost pressure, and real threats to access, especially for rural hospitals that often serve as the largest employer in town. We also get concrete about health care cost transparency and pricing signals. Patients rarely see the real price of care, there often isn’t a usable price sheet, and even providers can be constrained by contracts and regulation. We talk about how benefit design and tax policy shape behavior, why clarity has to come before solutions, and what “winning” should mean if we want a health care system that works for patients and communities. Subscribe, share this conversation with someone who debates health care policy, and leave a review with your answer: who do you think the customer really is? Support the show Engage the conversation on Substack at The Common Bridge!

A kid walks into the ER because they thought a THC edible was candy, and the package did the lying. That’s one of the most unsettling through-lines in my conversation with Luanne Thomas Ewald, chief operating officer at CS Mott Children’s Hospital and Von Voigtlander Women’s Hospital at University of Michigan Health, recorded at the 2026 Mackinac Policy Conference with the Michigan Health and Hospital Association.  Luanne breaks down what’s new at Michigan Medicine, including how CS Mott keeps pushing pediatric innovation and measurable outcomes, and why a design choice matters more than a press release: the women’s hospital is built within the children’s hospital, so high-risk deliveries can move a newborn to specialized care in a one-minute elevator ride instead of an ambulance transfer. We also talk leadership and collaboration across Michigan as she reflects on nearly 34 years in children’s health and her role with MHA’s Council on Children’s Health, where hospitals step away from competition to focus on what’s best for kids statewide.  We dig into major child health policy issues that don’t always make headlines: Medicaid funding threats that squeeze working families caring for children with chronic conditions, and how housing support like Ronald McDonald House Ann Arbor becomes critical when a children’s hospital is consistently operating above capacity. If you care about pediatric patient safety, children’s hospital capacity, Medicaid policy, or practical regulation that prevents harm, this conversation is for you.  Subscribe for more healthcare leadership conversations, share this episode with someone who cares about kids’ health in Michigan, and leave a review so more listeners can find the show. Support the show Engage the conversation on Substack at The Common Bridge!