Evan Sussman: Expanding Access to Fertility Drugs

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.‌

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. Our guest today is Evan Sussman, but first, we like to check in on current or hot topics in health and healthcare. What do you want to cover today, Harlan?‌

Harlan Krumholz: Well, you asked me what’s on my mind. There’s so much going on in so many different places in healthcare right now, and I know you usually get to the policy side, so I’m going to stay with the whimsical, but I don’t know how you’re going to react to this, but I’m going to talk about Elon Musk. You know who that is?‌

Howard Forman: I’ve heard of him. Yeah. I don’t remember who.‌

Harlan Krumholz: The amazing thing about Musk is this sort of plethora of companies that he’s got. And the one that sort of caught my eye this week and I wanted to just see what you’re thinking about it, is Neuralink. So he announced this week on a livestream YouTube town hall that Neuralink, his company, will do its first human trial of its Blindsight device. This is a device aimed at restoring vision to people who are blind. And if it works, it’s supposed to be able to give sight to people born blind, bypassing the eyes entirely. And this is crazy, really, right? It’s like science fiction. And so the tech involves implanting microelectrode arrays in the brain, specifically the visual cortex for blindsight. And these electrodes stimulate neurons, directly bypassing the eyes in the optic nerve to create visual sensations.‌

In essence, it’s seeing with your brain, not your eyes. And for the Blindsight devices, this could allow blind individuals, even those with no functioning eyes or optic nerve, to gain rudimentary vision. And the company says it would be low-res sort of Atari-like graphics, but future versions might detect infrared, ultraviolet, radar wavelengths. I mean, this is sort of like for those of you who remember the show The Six Million Dollar Man or all this kind of stuff, it’s like Iron Man, you’re able to see stuff that other people can’t see. Now the FDA granted “breakthrough device designation” for this in September 2024, and a Canadian clinical trial approval for their broader BCI tech, the implant, and a robot was announced in November 2024 with trademark filings. And again, you know, this idea of a trial, the big question, is this really revolutionary or is it hype? Can it possibly be real?‌

One of the things is, this FDA breakthrough device designation helps fast-track development, but it doesn’t mean it’s safe or effective yet. I mean, it’s actually no judgment on actually what it is. People think that you get this FDA breakthrough device designation and the FDA has blessed it. They haven’t blessed it at all. They’ve just said, “Look, we can put it on a fast track. We think it’s promising. It doesn’t have another analog. This is something we should be looking at.” The issue is there’s no peer-reviewed data or published preclinical evidence, no details on how it translates vision into perceptual patterns. It’s unclear how it relates to this brain-computer interface that’s been used for cursor control, which is, by the way, also pretty amazing. And some of the experts are skeptical.‌

As I look through the literature, people saying things like, “It might transform lives, but it won’t produce normal vision. This is an assistive device, not a cure for blindness. There’s no published evidence.” Somebody else said, “That’s skepticism.” But I’m telling you, even if they get only a short way towards this, even if people can only see in very rudimentary ways, it would be a home run, but this is a guy who wants to go to Mars. I’m not even talking about the DOGE stuff or all that other stuff. But it is pretty amazing that they take on some of the biggest challenges. I don’t know, have you thought about this at all?‌

Howard Forman: Yeah, the one aspect of it that’s interesting to me is he is incredibly successful at starting companies. There are a few that may not have been successful, but in general, the companies he starts have done extremely well to a degree that most people would never imagine. And because of that, his cost of capital is actually dramatically lower than anybody else’s cost.‌

Harlan Krumholz: Just to pull you back, you’re saying his companies have done very well. Some people will say that what he’s done very well is at raising money and then he leverages the valuation in one company to have a lot of capital for another company. Right? That’s—‌

Howard Forman: Let’s just step away from the raising of the capital. SpaceX is the most successful modern rocket company bar none. There’s nothing that really competes with it yet. Maybe we’ll see some real competition. There’s a couple of—Blue Horizon or whatever it’s called [Blue Origin] is a competitor and there’s yet another one. So there may be competition, but right now he is at the top of that heap. Tesla was the first most expansive, commercializable, affordable electric car, and he was involved in the original PayPal. So he has a track record, and right now he has almost mythic status, as you’ve pointed out. It allows him to raise money in ways that nobody else ever could. And once you raise that type of money, you’re able to do sort of astonishing things. And so I’m not sure that the special sauce here is that he’s the best innovator, but he definitely has the lowest cost of capital of anybody trying to innovate.‌

Harlan Krumholz: Yeah. So we’ll just have to keep our eyes on this. Look, it should be pretty obvious pretty quickly. I mean, you’ve seen this stuff where you saw the gene therapy where people could all of a sudden hear. There’s stuff that’s amazing that’s out there. You could never imagine some of the stuff that’s going on.‌

Howard Forman: I do think that whatever he does here, we will benefit from. We’ll learn something from—‌

Harlan Krumholz: I mean, what kind of trial do you need? I mean, either people are getting this and then they can see or they don’t see. I mean it’s like you don’t even need two arms and double blind. I mean it’s like there’s no control necessary. People are blind and the question is, can you help them see?‌

Howard Forman: See something.‌

Harlan Krumholz: Like I said, but it’s really remarkable to think that within eight, nine months, we may get news about whether this thing actually works.‌

Howard Forman: Yeah, no, look, I think you have to separate his politics and other things from him, from the fact that he is one of the greatest innovators of our time. And yes, a lot of it is through his ability to access financing, but the scope and the scale of what he’s done can’t be ignored.‌

Harlan Krumholz: Yeah. So it’s pretty cool. Anyway, yes, was on my mind when I saw that come by.‌

Howard Forman: Yeah, and that’s great talk—‌

Harlan Krumholz: I thought like, whoa—‌

Howard Forman: Appreciate that.‌

Harlan Krumholz: ... I can’t wait to see whether that really works. All right, let’s get onto our guest.‌

Howard Forman: Evan Sussman is the CEO and co-founder of Granata Bio, a biopharma company focused on women’s health and infertility. Founded in 2018, Granata Bio aims to improve access to care for fertility patients by identifying and in-licensing medications used in in vitro fertilization outside the U.S. for clinical development and commercialization in North America. Prior to founding Granata Bio, Sussman held several leadership positions at EMD Serono, including business unit head for fertility technologies. He’s also served in the Corporate Council of RESOLVE: The National Infertility Association and the American Society of Reproductive Medicine.‌

Sussman obtained his bachelor’s degree in organizational behavior and management from Brown and completed an MBA from the Yale School of Management in the healthcare leadership program in 2014. And that is in fact where I first met you and what makes the story of Granata Bio so exciting is that you co-founded this. Two of the three co-founders are graduates from the same class. So first I want to welcome you to the podcast, and I want to understand a little bit more about what is the theme of this company more than just fertility. Tell us more about what the thesis was.‌

Evan Sussman: Yeah, no, thanks, Howie. And it’s more than anything great to just reconnect with you. I have such a fond memory of our first meeting in the Yale MBA offices when I was evaluating the program and you were very bullish on that. I could do it, but a very cautious to ensure that I had the time, bandwidth, and sort of willingness to really devote the time to that. And I remember driving home feeling over the moon that this was going be something in the realm of possibility for me. ‌

So Granata Bio is a biopharma company focused exclusively on developing medications for IVF and fertility and in particular we’re focused on developing those medications for approval and commercialization in the U.S. As you mentioned in my bio there, I spent the better part of a decade at EMD Serono, which is a division of Merck KGaA and the world leader in IVF medication development and commercialization. But really I was feeling like the field was relatively neglected.‌

There are a battery of drugs available for IVF. They’ve been approved, some of which—Clomid—probably goes back to the ’60s, like the gonadotropins in the early 2000s. But really there weren’t a lot of companies working on developing new medications. And the IVF markets were relatively stagnant and I felt at the time, and so 2018 was really the incubation of Granata, that there was an opportunity to bring new medications in particular to the U.S., which if you looked at U.S. markets, they’re relatively unsaturated to the markets in the rest of the world in terms of available medications for patients. And so felt there was an opportunity to develop some of those medications in the U.S. and really to do so in a right-sized biopharma company. Not an over-bloated, 300 sales reps, $300 million in funding kind of company, but really do it in a kind of a right-sized manner.‌

And just one other note. IVF should be a really good place in which to do studies if you design studies that patients are going to do well in because there’s a huge proportion of patients for whom IVF is out of reach financially. And if we feel like our drugs are safe and effective and are going to lead patients with a high likelihood of getting a market chance of pregnancy and live birth, there should be sort of a beneficial triangle between the sponsor, the IVF clinic, and the patient wherein studies can be done relatively efficiently. So those are probably all of the thesis. There’s a business opportunity, there’s an opportunity to bring new drugs for patients, and that clinical trials should be relatively feasible in this population with nice binary outcomes.‌

Harlan Krumholz: Uh-huh, really. Oh, that’s cool. So why do you think IVF is so underused in the U.S. despite the high infertility rates? And when I think about societal policy, there’s obviously concern about the fertility rates writ large within societies. So you would think that this was something that you would want to make widely available, help support people, but really not used as much as people might think, right?‌

Evan Sussman: Yeah. Right now there’s sort of two constraints. The largest one is just the cost of infertility treatment in the U.S. is quite high. So capitated utilization in the U.S., if you divide it into an area that patients who are insured, we’re kind of right in the middle of the pack globally. If you look at uninsured patients, where patients have to pay out of pocket, we’re amongst the lowest in the developed world. So really number one is cost. Number two is we’re resource-constrained. So I think they’re only graduating somewhere in the neighborhood of 30 to 50 fellows every year, which is one resource constraint. So, physician constraint. Secondly, embryology constraints. So patients are utilizing embryology services at a higher rate than before for things like genetic testing and other therapies and so the actual embryology lab is a constraint as well. And there’s some unique programs going on to address that, but I think there’s probably a combination of the two. So if you took away the cost obstacle, you’re still pretty resource-constrained and capacity-constrained at the clinic level.‌

Harlan Krumholz: Is the issue that it’s not really considered a medical condition by many insurers so that it’s sort of an optional extra, it’s sort of like plastic surgery. I mean, is that the problem, or is it that so many people don’t have insurance?‌

Evan Sussman: Yeah, I think it was maybe 10, 15 years ago. And that, I think, perception has been evaporated at some level. Okay. And then secondly, the way insurance companies were originally charging employers for this was on a per-patient per-month basis, not a utilization basis or per-head per-month, or per-capita per-month. And so the charge to employers was probably outsized. But what we saw 10 or 15 years ago was the rise of companies like Progyny is one I would highlight that really designed smart benefits, utilization design benefits that sort of demystified that demand elasticity.‌

So if you introduce an infertility benefit, you don’t all of a sudden have patients making the really complicated decision to say “I want to start a family” or “I want to grow my family.” So the demand elasticity was likely overstated there, and companies like Progyny, Carrot, Kindbody really came into this space and designed benefits that were much more efficiently designed, designed to reduce time to pregnancy within the benefit and I think have really succeeded over the last five to 10 years in attracting employers to carve out that benefit with a smart fertility design insurance.‌

Howard Forman: You come from the class of 2014, which to me there must’ve been something in the air or the food or something for that class because the innovation that has come out of that class and the entrepreneurial spirit is pretty high. Neel Butala and Amit Garg, Amit Garg was in your class and you started this with two classmates, but you didn’t start it during the schooling. You started it four years later, which speaks to the depth of the friendships that you formed with your two classmates. You want to just tell us how that happens and how you’re able to pull in people to do something big and bold like this that you just met in school?‌

Evan Sussman: I would say anecdotally, Howie, I’m glad that you know Granata is doing well and that my professional career is doing well because I’m not sure how much I distinguished myself academically at Yale. That said, Mark Chung and David Paller and I were on a project team together working on what eventually became an orthopedic company called Miach. It’s a repair technique for ACL. So we did a business plan for them when that company was in its infancy, and we found that we had a symbiotic working relationship and we’re always looking for an opportunity to do something together. Dave and I went on to do some work for another orthopedic company—that’s Dave’s background, in orthopedics.‌

And of course, I’d spent the bulk of my career in fertility, and I think we saw enough opportunity in my time at Serono that crossed my desk or that at least I was aware of that there was opportunity to start a company like Granata, and it was a natural thing. I actually remember I was on a train, and I called Dave and Mark and I said, “I think I’ve got our thing. I think I’ve got our company here.” And that was in ’16 where we just started to think about it and it took me the better part of a couple of years to get the guts to leave where I was quite comfortable and then do it.‌

Harlan Krumholz: Can you just give the listeners a sense of the special sauce? So what was your central thesis? Because there were other groups out there doing this. So when you said “No, there’s an area we can compete in—in fact, we can excel and we can win in,” what did you see?‌

Evan Sussman: Yeah, we felt that... well, first of all, there was just this odd disparity between European markets that were really saturated with drugs—not oversaturated, but they just had more drugs that we knew were safe and effective, had been on the market for a number of years, and a U.S. market with yes, a different regulatory threshold. So let me just talk about that for a second. Generally, FDA demands clinical pregnancy or live birth endpoints in a clinical trial. So what does that do? It extends the timeframe, makes them more complex, and where the European markets may look at for a stimulation medication, the number of eggs collected, they may accept sort of an intermediate endpoint that’s a little more pharmacodynamically related. So we felt like we knew these drugs were safe and effective. We knew there were clinics who had an appetite to do clinical trials.‌

Really all it was was getting deals, business development deals that made sense for both parties that really the innovator company, the inventor company of the asset doesn’t have access to the largest fertility market, largest pharmaceutical market in the world, in the U.S., and the U.S. market doesn’t have access to medications. And so there was really, I think, a pretty obvious opportunity there. Now the fear was that there had been a number of failed clinical trials in the 2010s, and I think we felt, looking at those studies, that there was an opportunity to optimize the design of those studies to de-risk those programs and give patients a market-level chance of getting pregnant and having a live birth therein and that was probably our secret sauce is in the clinical trial design.‌

Harlan Krumholz: So was the key that you had to figure out, how do I make relationships with these IVF clinics so that you have access to patients?‌

Evan Sussman: Yeah, Harlan, we had those. So I spent the better part of a decade there. So it was really like we have a great penetration into the market. We understand it well. We understand what is going to be acceptable from a clinical trial design that patients will enroll, that the clinics will enroll. And really the innovation was, okay, we understand FDA’s sandbox, how do we optimize within that sandbox so that we’re de-risking the trial? We know based on 10 years of European commercial data that this drug is safe and effective. How do we prove it in the U.S.?‌

Harlan Krumholz: I see. You can leverage that information from Europe and say, “We know what the results are going to be because we already know how it works in Europe. So then let’s just go.”‌

Evan Sussman: Yeah, essentially, and I should say that when we started the company, nobody cared, right? So keep in mind, these are capital markets that are super frothy. They’re looking to take huge bets on companies that are a much higher ceiling than an IVF medication, think the Modernas of the world, right? So when we went to venture capital early on, it was really like a shoulder shrug. Yeah, it’s de-risked. Yeah, you’ll likely succeed if you get the money. However, we need to take 10 huge bets here, not 10 modest bets. So it took us, we ended up earning our way through with a lot of sweat equity in the beginning and signing deals that were, work for a fee in the beginning before the company really started to take off and the approach to venture capital in biopharma got a little bit more tempered, I would say.‌

Howard Forman: You do have a number of molecules that are in process now and being commercialized and you have $14 million that you raised last January. Life sciences companies are notoriously very cash-hungry. I mean, they need to consume a lot of cash until they start to generate cash. What does that look like for you in the current environment? Are you constantly having to go out and raise more money? How difficult is it right now?‌

Evan Sussman: The short answer is no. The way we ended up building the company—and it wasn’t intelligent design, it was just what we had to do to survive—was we had this fee-for-service model or a co-development model. Then we acquired the rights to one asset that’s with the agency right now and another asset that’s approved, and those are revenue-generating for us. So we were revenue-positive quite early in our company lifecycle, which was the exact opposite of most biopharma companies. Modestly revenue-generating, right? We’re not overflowing with the revenue dollars. When we built the portfolio enough where we needed substantial additional capital, we then raised a Series A a year ago, led by Google Ventures and supported by Cooper, which is a Connecticut-based company as well, who’s in the IVF space, in the device and diagnostics area. And we extended that Series A to another $15 million. So we’ve raised over $30 million now, and that was really to codify the work that we had done there. So we had some revenue-generating assets that offset our spend in R&D.‌

Howard Forman: Then just to follow up on that, so there’s the fundraising issue, which sounds like you have pretty well handled, and then there is the ongoing regulatory issues, which you seem to have a lot of expertise in, but there’s a lot of turnover and changes going on at the FDA now. How do you navigate that as a company—any company, whether you’re big or small right now, at this moment in time?‌

Evan Sussman: Yeah, I think it’s certainly a lot of noise in the space. We do have one program where we anticipate an approval or at least a judgment here in June. We did check in with the agency at that point to make sure the project team was still working on it, that they were going to hit the GDUFA date there. We got a confirmation that everybody was still there, they were still reviewing it. Obviously a delicate conversation because people are losing jobs and losing coworkers and that kind of thing. I think our approach is to operate as if business is as usual. In fact, we’re going to submit a request for advice here in a couple of days, and then, until we learn differently, go with that approach.‌

Harlan Krumholz: As we get to the end here, I wanted to ask you just quickly, what do you think listeners should take away about the future of fertility care? Where do you think it’s going, and what do you think it’s likely to look like in five years, for example?‌

Evan Sussman: Yeah, I think utilization will continue to go up. People are having children later, which is great financially but poor biologically, and so I think the utilization will continue to go up. I think the insurance coverages continue to drive. The current administration has put forth that they would like to support IVF. What we’re hearing anecdotally is that there are concrete plans behind that. It’s not just signaling and that there are material plans to kind of increase the coverage rates there. We saw something similar happen in Japan recently where they had a state-mandated, state-funded insurance coverage for IVF. So I think the utilization will continue to go up, and those of us in the drug development and the device development, diagnostic development are working to maximize success rates and shorten time to live birth or pregnancy for patients.‌

Howard Forman: Among many people, you have said in previous interviews that, “If I knew then what I know now, maybe I wouldn’t have done this.” Meaning that it’s a lot harder than it looks at times. What advice do you have for people who are in your shoes, let’s say 10 years later or a little bit more than that even, who are looking to start new companies? What’s the best lesson that you remember from this experience to offer them?‌

Evan Sussman: Yeah, I think it’s be willing to do the work yourself. I think the larger the company gets, the slower they are to do things, the more decision-making gets slowed down. If you can just put pen to paper, whether that’s drafting a regulatory document, designing a clinical study, giving a provocative business development deal, you’re ahead of the game. So this thought, I think one of the things that we struggled with at the start of the company was Mark, David, and I are peers, right? We graduated together, and so making sure that there’s enough people that are willing to put pen to paper and do the work is really the key to it. But I heard a great, and I’m going to butcher the quote, but there was a quote from somebody that said, “If you knew exactly how difficult things would be, you’d never take the leap.” And it’s that delusion that things will be easy that gets you into the game and then once you’re there you say, “Okay, it’s way harder than I thought, but it’s achievable.” And so you can get there. It’s just a lot more work than you’d initially forecast.‌

Howard Forman: Well, you’ve accomplished an enormous amount in the last seven years, and we’re just so pleased to have you as a graduate and alum. I know you’re going to come back here this year and wishing you all the best of luck in the future.‌

Harlan Krumholz: Yeah, kudos on your success.‌

Evan Sussman: Yeah, I was super happy to reconnect with the Yale community and looking forward to coming down there next year and speaking to everybody.‌

Howard Forman: Thanks.‌

Harlan Krumholz: Hey, that was a great interview, but now we have the part that Howie Forman does, and I’m really eager to hear what’s on your mind this week, Howie. There’s so much going on.‌

Howard Forman: This may confuse people a little bit. So I’m going to try to take it a little slow so there’s multiple news stories—‌

Harlan Krumholz: Because I need you to go just word by word just—‌

Howard Forman: I feel like I have been today—‌

Harlan Krumholz: Don’t try to confuse me here.‌

Howard Forman: Yeah, no, there’s multiple stories out of Washington, D.C., related to Medicare, and they all relate to one another one way or not. A Congressional Budget Office report from two weeks ago, but nobody sort of noticed it until the end of last week, reported that the Medicare trust fund, which we believed to be running out of money in 2035, so in the next decade, is now likely not to run out until 2052—17 years later. So that’s a very big deal, and CBO is very different from the trustees. The trustees are the ones who we rely on for that data point.‌

Usually, they’ll come out with their report in the next four to 12 weeks, and we’ll see if they agree with this 2052 figure. But they basically came up with this number based on the fact that Medicare is spending less money than they thought it would be at this time, and therefore it’s in better shape than it was. However, literally just days after that news came out, CMS, the Center for Medicare and Medicaid Services, increased Medicare Advantage payments way, way, way more than had been predicted, and even more than the most optimistic investment banks and analysts had hoped. So instead of a 2.2% increase, as the Biden administration had indicated at the end of their term. In their first disclosure of expected pricing, the new figure is well more than 5%.‌

Harlan Krumholz: So was the premise that United’s not making big enough profits? Is that the problem?‌

Howard Forman: We’re going to get to that.‌

Harlan Krumholz: All right. I can’t wait.‌

Howard Forman: I’m going to get to that.‌

Harlan Krumholz: All right.‌

Howard Forman: So The Wall Street Journal reported that this increase the difference between 2.2 and a little more than five would amount to 25 billion more dollars to these private plans, that our government is now going to spend an extra $25 billion for these private health insurance plans, including, the biggest among them, UnitedHealth Group, as you point out. And that this figure is more than twice the earlier estimate. CMS did retain some other cuts that had been proposed by the Biden administration, and the predicate for this new five-plus-percent increase is not political.‌

Apparently, it is tied to a benchmark, and that benchmark growth rate grew substantially higher than they thought, based on the earlier estimate. But it’s hard to square this circle because if as it now seems true, the CMS estimate is for faster growth in spending and higher Medicare Advantage costs, then the rationale for a longer-lasting trustee fund is flawed. So one of these stories is now completely at odds with the other. And to be fair, the CBO was using a stale figure, so maybe their number is a little out of date. And also to highlight, guess what happened yesterday to the major Medicare Advantage carriers, including UnitedHealth Group? What do you think happened?‌

Harlan Krumholz: I’m thinking they went up.‌

Howard Forman: They went up a lot. They went up in a time when the market was actually down. They went up by more than $30 billion in market capitalization. I mean, this was surprising to the market and obviously expected to be profitable to these companies.‌

Harlan Krumholz: So I still didn’t understand this exactly, Howie. Was this increase some sort of automated formula, or did someone in the government just decide they were going to do this? I still don’t understand this.‌

Howard Forman: I think it’s mostly supposed to be formulaic, but I have seen enough—‌

Harlan Krumholz: Is it opaque? We don’t know exactly why it went up.‌

Howard Forman: It’s not completely opaque. They claim that there’s a 9% adjustment rate instead of a 6% adjustment rate in the total cost that they’re now looking at, and that’s why they’re doing this.‌

Harlan Krumholz: But this will cost the government more money?‌

Howard Forman: Absolutely, absolutely. And it must draw down the trust fund faster than we otherwise would have expected.‌

Harlan Krumholz: Does this affect... I just want to get a little bit into the weeds here with you. So when we talk about the national deficit, because there’s a trust fund, does drawing down on the trust fund more mean that it doesn’t show up on the national deficit because it’s a separate accounting issue?‌

Howard Forman: Yes and no. It depends on whether you’re looking at the accumulated total government obligations or whether you’re looking at just the federal deficit. The Trust Fund—‌

Harlan Krumholz: But when we talk about the federal debt, does the Medicare part come into that?‌

Howard Forman: Not yet. But when the CBO reports a deficit, a long-run deficit in the trustees report, they will say there is a $2 trillion hole that needs to be filled and effectively you’re saying that’s an ongoing deficit.‌

Harlan Krumholz: Sometime we’ll have to fix that.‌

Howard Forman: Exactly. Exactly.‌

Harlan Krumholz: But it doesn’t show up when we say, “Here’s our national debt numbers.”‌

Howard Forman: No. No.‌

Harlan Krumholz: So that’s so interesting. We say we actually have this amount of debt, but there’s actually more obligations sitting in the trust fund that’s not even on the books.‌

Howard Forman: But the trust fund is relatively small right now. It’s basically like three months’ worth of payments or it’s a couple hundred billion dollars. It’s not like it used to be where the trust fund was more than we were spending every year. Now the trust fund is a few months of overall Medicare spending, and let me just point out one last thing since you alluded to it. Medicare Advantage plans are still under enormous scrutiny by Congress in both parties in Congress because the gaming does continue. Annals of Internal Medicine this week had another paper pointing out that UnitedHealth Group appears to disproportionately benefit from the coding issues that we’ve talked about numerous times on the podcast. So this is going to continue to draw scrutiny, and we need to address this.‌

Harlan Krumholz: Okay, so I’ve got one more question that’s something I should definitely know. Do our tax dollars support CMS or is it the money from our paychecks that... I mean, I know those are still taxes, but what I mean is our sort of annual IRS money, does that go to CMS or it’s only the stuff that’s coming from our payroll taxes?‌

Howard Forman: It’s a really good question. So the payroll taxes flow into the trust fund, which pay for Part A of Medicare, which is the hospital insurance part of it, which includes graduate medical education. What we pay out of our federal taxes, so federal taxes go to pay for Part B and Part D—‌

Harlan Krumholz: That’s right.‌

Howard Forman: ... the physicians and the drug benefits.‌

Harlan Krumholz: Yeah. Yeah. Thanks for reminding me about that. It always gets a little confusing. Thanks. Great topic. ‌

You’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman.‌

Howard Forman: So how did we do? To give us your feedback or to keep the conversation going email us at health.veritas@yale.edu or follow us on any social media, including LinkedIn or Bluesky.‌

Harlan Krumholz: Yeah. And give us your feedback. We’d love to hear from you. It helps people find us. We learn from our listeners and we usually respond.‌

Howard Forman: Absolutely. And if you have questions about the MBA for Executives program, as with our guest today at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.‌

Harlan Krumholz: Health & Veritas is sponsored by the Yale School of Public Health and the Yale School of Management. We are very fortunate to work with superstar students that Howie somehow seems to find from among the Yale undergraduates, Inès Gilles, Sophia Stumpf, Tobias Liu, and somehow we found one of the most amazing producers of all time, Miranda Shafer, who somehow makes us sound much better than we actually do when we record the show.‌

Howard Forman: Grateful for them all.‌

Harlan Krumholz: Talk to you soon, Howie.‌

Howard Forman: Thanks, Harlan. Talk to you soon.‌