Explore every episode of the podcast How Health Systems Work

Most health systems have spent the past two decades consolidating around acute care and shedding post-acute and senior living operations. Sun Health took the opposite path. In 2008, the organization merged its hospitals into Banner Health and restructured entirely around senior living, wellness coordination, and community-based health services. Today it operates five life plan communities in the Phoenix market, serves a growing population through its Sun Health at Home program, and is building toward an individualized health span model.

In this episode, Jim Burke and Steven Pratt speak with Mark Reifsteck, vice chair of the Sun Health board and a retired healthcare executive, and Joe [Last Name], Sun Health's CEO for over three decades. The conversation covers how the transition from acute care was structured and why the financing model enabled it, what daily life and care coordination look like across Sun Health's campuses, how the at-home and Vibrant Life Choices programs extend services beyond campus walls, and where the organization sees its model heading over the next five to ten years, including connections to research institutes, value-based arrangements, and expansion to younger demographics.

Whether you lead a health system evaluating its post-acute strategy, sit on a nonprofit board navigating mission and sustainability, or work in senior living operations, this episode offers a detailed look at an organization that built a successful model around the parts of the continuum most systems have abandoned.

Health systems depend on legal counsel for everything from physician agreements and regulatory compliance to middle-of-the-night operational crises. How that legal function is organized, and how in-house and outside counsel work together, has a direct impact on the quality and speed of the advice reaching executive teams.

In this episode, Jim Burke and Steven Pratt speak with Susan James, a healthcare attorney who has moved between in-house general counsel positions and law firm practice multiple times over a career spanning decades. She is now at Hall Render, where she is also partially seconded to a health system building out its legal function.

The conversation covers what in-house counsel gains from being physically embedded in operations, how general counsel should evaluate when to send work outside and select the right attorney, the distinction between treating outside counsel as a partner versus a commodity, what health systems lose when legal departments centralize or go fully remote, and the tension between the in-house standard of good enough and the law firm pursuit of precision. Susan also shares firsthand accounts from on-call rotations that illustrate why proximity to the client matters.

Whether you manage a health system legal department, serve as outside counsel to health systems, or lead an organization that relies on both, this episode offers a practical perspective from someone who has operated on each side.

AI tools in clinical settings are getting easier to use, but ease of use does not mean safe use. Automation bias, hallucinations that look convincing, and the risk of de-skilling are real concerns as health systems move from pilot deployments to broader adoption.

In this episode, Jim Burke, Steven Pratt, and Michael Batt speak with Dr. Nadia Smati, an internal medicine physician and faculty member at Houston Methodist who also serves as an advisor and capital partner working with healthcare AI startups. Dr. Smati has practiced under the UK's National Health Service, Kaiser Permanente, and Houston Methodist, giving her a comparative view of how different systems approach technology adoption and value-based care.

The conversation covers how AI is influencing clinical decision-making beyond documentation, the de-skilling risk observed in procedure-based specialties, a practical framework for treating AI output like a trainee's note, vendor transparency and the evolving question of liability, and whether AI will close or widen the equity gap between well-resourced and under-resourced health systems.

Whether you lead clinical operations, manage AI governance, or are thinking about workforce training strategy, this episode addresses the questions that follow deployment.

AI tools in health systems have moved well beyond ambient listening. Organizations with the infrastructure to adopt are now deploying AI across clinical documentation, coding support, order entry, chart summarization, and revenue cycle operations. The gap between those organizations and the ones still trying to begin is widening.

In this episode, Jim Burke, Steven Pratt, and Michael Batt speak with Dr. Mark Mabus, CMIO and SVP of the EHR at Parkview Health in Fort Wayne, Indiana. Dr. Mabus is a practicing family medicine physician boarded in clinical informatics and was recognized by Epic as Physician of the Year in 2024.

The conversation covers how Parkview scaled AI features through its existing vendor ecosystem, the cognitive shift from note authoring to note editing, monitoring for clinician autopilot behavior, building ROI cases that justify investment, and the growing inequity of AI access facing smaller and rural hospitals. It also addresses what independent and community physicians should keep in mind as they begin exploring AI tools outside of a large system's support structure.

Whether you lead a health system weighing how to move from pilot to full deployment, or a smaller organization trying to figure out where to start, this episode offers practical guidance from someone who has done both.

Season 2 begins with a three-part series exploring one of the most significant transitions facing healthcare today: the rise of artificial intelligence in patient care and health system operations.

In Part 1, Jim Burke and Steve Pratt are joined by healthcare attorney Mike Batt for a wide-ranging discussion on how AI is already reshaping clinical care, operational decision-making, governance, and healthcare strategy.

The conversation examines how health systems are approaching AI adoption, the emergence of “shadow AI” inside organizations, the growing role of ambient listening technologies, and the challenges healthcare leaders face balancing innovation, safety, and liability.

The episode also explores the widening gap between organizations with the infrastructure to implement AI effectively and those struggling to keep pace, particularly smaller community hospitals and rural providers.

Rather than focusing on hype, this discussion centers on a practical question healthcare leaders must answer:

What problem is the organization actually trying to solve with AI?

Topics discussed in this episode include:

• AI at the bedside and clinical decision support

• Ambient listening and medical documentation

• Human oversight and “human in the loop” governance

• AI bias and clinical safety concerns

• AI governance infrastructure inside health systems

• The emergence of “shadow AI”

• Risk, liability, and evolving regulatory concerns

• AI adoption challenges for rural and community hospitals

• The future of healthcare operations and patient care

This episode is Part 1 of the series:

The AI Era in Healthcare: AI at the Bedside

Guests:

Jim Burke

Steve Pratt

Mike Batt

#Healthcare #ArtificialIntelligence #DigitalHealth #HealthSystems #HealthcareLeadership

In this episode of How Health Systems Work, Jim Burke and Steve Pratt talk with Todd Nova, a nationally recognized attorney at Hall Render and one of the foremost legal experts on the 340B drug pricing program. Todd brings his two decades of experience advising hospitals, health systems, and safety-net providers to help unpack the complex reality of 340B — its origins, its current pressures, and how health systems can navigate it responsibly and strategically.

The conversation spans a wide range of topics, including how 340B savings impact financial sustainability, why program participation is often misunderstood, and the operational and legal risks of aggressive optimization tactics. Todd explains the practical link between Medicaid reimbursements, disproportionate share hospital (DSH) thresholds, and the survival of inpatient psychiatric and maternal health programs in underserved communities. He also lays out what hospital leadership must understand about compliance, strategy, and governance when engaging with 340B.

Whether you’re at the start of your 340B journey or already deeply involved, this episode is a valuable roadmap for aligning compliance with mission — and ensuring your organization doesn’t leave critical value untapped.

From cyber‑risk and patient privacy to post‑shutdown policy drama — this episode brings together regulatory insight from a privacy lawyer and legislative specialists to help health systems anticipate what’s next.

As healthcare becomes more digital and data-driven, the risks around privacy and cybersecurity grow.

In this episode, privacy and security attorney Mark Swearingen joins Jim Burke and Steve Pratt to unpack how health systems can protect themselves from breaches, ransomware, and vendor risk — while navigating the next frontier of data use in AI and analytics.

How does a small rural hospital maintain five-star performance for six straight years?
In this episode, Carthage Area Hospital CEO Ada Bair joins hosts Jim Burke and Steve Pratt to share how strong culture, creative workforce strategies, and deep community partnerships are helping rural health systems not just survive—but thrive.

In this episode of How Health Systems Work, Jim Burke and Steve Pratt sit down with Pamela Jones, Vice President & General Counsel at Reed Health and former long-time GC at Franciscan Health. Pamela brings a unique blend of legal insight, rural health experience, and a deep commitment to community-driven care.

Pam shares the challenges and opportunities she’s tackled moving from a large, urban hospital system to a rural one—where recruitment, behavioral health, and reimbursement dynamics are persistent headwinds. Among other topics, she talks about:

• How Reed Health is addressing “frequent flyers” in the emergency department through integrated community services, patient navigation, and value-based physician incentives

• The complexities of involuntary psychiatric commitments, guardianship processes, and statute-driven decisions that can make or break patient care

• Strategies for engaging state legislators and telling the hospital’s story amid financial pressures

• The importance of physician governance in small systems, and how to meaningfully involve physicians in strategic decisions

• Advice for young lawyers aiming for in-house roles, rooted in both law firm rigor and servant leadership

If you serve in legal, operational, or leadership roles at rural or mid-sized health systems, this conversation is full of hard-earned wisdom and real-world strategies you can use.

Former SSM Health General Counsel Doug Long joins hosts Jim Burke and Steve Pratt to discuss the economic pressures reshaping healthcare today.

From AI implementation and behavioural health challenges to hospital-at-home services and new Medicare payment models, Doug shares insights from leading legal operations at a $12 billion health system.

The conversation covers essential leadership lessons for healthcare CEOs and practical advice for in-house counsel navigating an increasingly complex regulatory landscape.

In this episode, Jim Burke and Steve Pratt discuss the intricacies of Value-Based Enterprises (VBEs) in healthcare, focusing on their regulatory framework, key components, and practical applications. They explore the differences between Stark Law and AKS Safe Harbor, the importance of risk models, and how to effectively engage physicians in these initiatives. The conversation also highlights common mistakes in implementing VBEs and emphasizes the need for credible data and physician leadership to ensure success.

In this episode of How Health Systems Work, hosts Jim Burke and Steve Pratt sit down with Gwen Sandifer, interim president at Henry Ford Genesis Hospital and founder of Loud Minds. Gwen brings over 25 years of experience in healthcare administration and a deeply personal perspective shaped by her upbringing in a small rural town.

She shares powerful stories—from a near-paralyzing injury in high school to her mother’s struggles accessing mental health services—that inspired her mission to improve healthcare systems. Gwen discusses how the sector has evolved, what’s stayed the same, and why relationships and real conversations remain at the core of progress.

We dive into everything from the loss of informal collaboration spaces to the challenge of truly centering the patient in a fragmented system. Gwen offers bold ideas for healthcare transformation, including radically shifting incentives to put consumers in control of their care. Her perspective is rooted in deep compassion, operational experience, and a clear-eyed view of what’s not working.

In this episode of How Health Systems Work, Jim Burke and Steve Pratt are joined by Andrew Dick, a healthcare real estate attorney with 18 years of experience helping hospitals and health systems navigate complex property decisions.

Andrew breaks down why real estate strategy is no longer just about buildings—it’s about survival. From the explosive growth of ambulatory surgery centers (ASCs) to the shifting role of nonprofit ownership, Andrew explains how health systems can strengthen their financial position, improve patient access, and avoid costly pitfalls.

The conversation explores:

• Why ASCs are transforming care delivery and hospital margins

• How partnerships, acquisitions, and management companies can help health systems adapt

• What health systems should know about property tax risks and pilot agreements

• How nonprofit foundations can help structure smarter real estate deals

• Why health systems need to critically assess what they own, what they lease, and how they use it

Whether you’re a healthcare executive, board member, or operations leader, this episode offers practical guidance on using real estate strategy as a tool for resilience and growth.

In this conversation, Dr. Larry Bucshon shares his extensive experience in healthcare, discussing the evolution of payment systems, the impact of government regulations, and the importance of collaboration between physicians and hospitals. He emphasizes the need for alternative payment models, the role of data in improving healthcare quality, and the unique challenges faced by rural healthcare. Dr. Bucshon also highlights the significance of physician leadership in reform discussions and the implications of immigration policies on the healthcare workforce. The conversation concludes with insights on the path forward for healthcare reform, focusing on transparency, regulatory review, and consumer involvement.

In this episode, Jim and Steve talk with James Junger, a healthcare attorney at Hall Render who works with hospitals and health systems to strengthen their operations through strategic compliance and data-driven decision-making.

Drawing from his work with safety-net providers, James explains how health systems can better leverage programs like 340B and provider-based rural health clinics, not just for compliance, but as essential tools for sustainability. He discusses how claims data, payment analysis, and regulatory alignment can uncover new opportunities for financial stability in even the most resource-limited environments.

This is a practical, insight-packed episode for healthcare leaders working to make every dollar count while staying mission-aligned.

In this episode, Jim and Steve sit down with Bain Farris, a veteran healthcare executive with decades of leadership experience across hospitals, health systems, and payers. Bain shares what he learned over a career spent building stronger partnerships between hospital leadership and physicians—and why real engagement is key to meaningful change.

From the early days of physician-hospital collaboration to today’s push toward ambulatory and home-based care, Bain discusses what’s worked, what hasn’t, and what future leaders need to understand about how healthcare delivery is shifting. Along the way, he reflects on the transition from hospital-centered care to a more distributed system and how systems must adapt if they want to stay relevant.

If you’re leading or working inside a healthcare organization today, Bain’s stories and insights offer lessons that are as relevant now as ever.

In this episode, healthcare attorney Mike Greer from Hall Render joins the show to help health system leaders understand how federal antitrust enforcement is shifting—and what it means for provider networks, hospital partnerships, and managed care contracts.

With deep experience advising systems, hospitals, and physicians, Mike breaks down the key changes happening at the FTC and DOJ, including the withdrawal of prior guidance, the use of new merger guidelines, and what triggers scrutiny in today’s regulatory climate. He also unpacks how clinical integration, managed care contracting, and network formation can be structured to avoid antitrust violations while still achieving strategic alignment.

Whether you’re working on a CIN, PHO, or MSO—or just trying to make sense of what’s safe to build—this conversation delivers clear, grounded insight on how to move forward without stepping into legal risk.

In this episode, Jim and Steve talk with Anthony Long, partner at Pinnacle Healthcare Consulting, about one of the most critical challenges facing healthcare organizations today: the growing disconnect between system leadership and frontline teams.

Anthony shares what he’s seeing inside hospitals and health systems across the country—from strained physician relationships and stagnant strategies to the gaps in communication that derail progress. He makes the case for shared governance, stronger physician engagement, and the kind of operational discipline that turns big goals into practical results.

Drawing on decades of experience in value-based strategy, cost reduction, and system redesign, Anthony offers a candid, practical look at what’s holding health systems back—and what it will take to move forward.

In this episode, healthcare attorney Amy Mackin joins us to unpack what’s changing in the world of healthcare contracting. From shifting payer dynamics to negotiating under tighter regulatory scrutiny, Amy offers practical insights for health systems and providers navigating today’s complex environment.

Amy Mackin’s practice focuses on healthcare regulatory law for hospitals, health systems, clinical laboratories, and other providers. She brings deep expertise in managed care contracting, advising providers on negotiations with both commercial and governmental health plans. Her work spans reimbursement models like capitation and pay-for-performance, contract disputes, out-of-network transitions, and compliance with fraud and abuse laws, privacy regulations, EMTALA, and more. She also regularly advises on physician contracting and professional service agreements.

Whether you’re in legal, strategy, or operations, this episode will sharpen your understanding of what it takes to negotiate and manage healthcare contracts in today’s evolving landscape.

This podcast episode features a discussion on the evolving landscape of healthcare, focusing on the importance of quality in patient care and the challenges of aligning physician incentives with quality goals. The guests share insights on how healthcare delivery is influenced by reimbursement policies and the need for a collaborative approach to improve patient outcomes. In this conversation, Brian Betner discusses the critical gaps in clinical leadership and the importance of understanding success and failure in quality initiatives. He emphasizes the need for cultural change within healthcare organizations and the role of Value-Based Enterprises (VBE) in redefining physician engagement. The discussion also highlights the significance of actionable data in quality improvement and looks ahead to the future of healthcare, focusing on the evolving expectations of patients and the necessity for healthcare systems to adapt.

In this episode, we introduce Steve Pratt, co-host of How Health Systems Work. Steve shares his perspective on the evolving landscape of healthcare, from shifting payment models to the challenges and opportunities ahead for hospitals and providers. Join us as we set the stage for what’s to come—real conversations, expert insights, and a deep dive into how healthcare systems navigate change.

In this introductory episode of 'How Health Systems Work', host Jim Burke outlines the purpose and vision of the podcast, emphasising the importance of sharing insights from leaders in the healthcare sector. He discusses his background in healthcare consulting and leadership, and the need for innovative ideas to address the challenges facing health systems today. The podcast aims to provide listeners with practical stories and strategies from industry leaders, fostering a community of change-makers in healthcare.