Turn on the Lights Podcast

Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has selected one of our most impactful and widely listened-to conversations from the archives to revisit. He introduces this timely discussion with Chris Van Gorder, which explores how cost shifting, regulatory mandates, and Medicare Advantage risk transfer are pushing healthcare toward structural unaffordability.

Summary:

Leading a major health system today means juggling patient-first ethics with a financing model that keeps tightening the screws.

In this episode, Chris Van...

Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, is revisiting some of the most impactful conversations from the archives. For this episode, he selected a standout discussion with Dr. Michelle Schreiber and Brenna Rabel, exploring how quality measures are developed, adopted, and implemented across Medicare and Medicaid programs.

Summary:

How do we decide what “good care” looks like, and who gets to choose the scorecard?

In this episode of Turn on the Lights, Kedar Mate speaks with...

Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has hand-selected one of our most-listened-to and impactful conversations from the archives to highlight once again. Dr. Philip brings back to attention this conversation with Dr. Ben Sommers on how Medicaid work requirements and reduced ACA subsidies are driving coverage losses through administrative barriers, with far-reaching consequences for patient health and the stability of safety-net hospitals and communities.

Summary:

Millions of Americans could lose health coverage in the coming years...

Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has hand-selected one of our most-listened-to and impactful conversations from the archives to highlight once again. Dr. Philip introduces this essential dialogue with Professor Charles Vincent, reflecting on why its core message, moving past basic compliance toward true, real-time healthcare improvement, is so vital to where the podcast is headed next.

Summary:

Blame rarely makes care safer, but understanding the system usually does.

In this episode, Professor Charles...

Welcome back to a special encore presentation of Turn on the Lights!

As we continue our transition series, our new host, Dr. Philip, has hand-selected one of our most-listened-to and impactful conversations from the archives to highlight once again. Dr. Philip introduces this essential dialogue with Dr. Vivek Garg, reflecting on why its core message, moving past basic compliance toward true, real-time healthcare improvement, is so vital to where the podcast is headed next.

Summary:

Quality measurement matters only if it helps patients and clinicians deliver better care in real...

Healthcare improvement is never just about systems, measures, policies, or processes; it is fundamentally about people. In this special transition episode, Dr. Philip McAdoo introduces himself as the new host of Turn on the Lights, a podcast by the Institute for Healthcare Improvement (IHI). He honors the foundational work of previous hosts Don and Kadar while laying out an expansive vision for the podcast’s next chapter.

To bridge where the show has been with where it is going, Philip announces a summer series re-broadcasting the five most popular episodes from the past year. These episodes cover cr...

What happens after 150 conversations about the future of health care?

In this episode, co-hosts Dr. Don Berwick, Former Administrator and CMS President Emeritus at IHI, and Dr. Kedar Mate, Founder & CMO of Qualified Health-genAI for Healthcare and Former CEO of IHI, look back on more than 150 conversations exploring health care reform, patient advocacy, medical debt, AI, and global health systems. They discuss how the podcast evolved into a platform for making complex health care topics more understandable through candid conversations and personal storytelling. The hosts also announce a transition as the podcast continues under the Institute for...

What happens after 150 conversations about the future of health care?

In this episode, co-hosts Dr. Don Berwick, Former Administrator and CMS President Emeritus at IHI, and Dr. Kedar Mate, Founder & CMO of Qualified Health-genAI for Healthcare and Former CEO of IHI, look back on more than 150 conversations exploring health care reform, patient advocacy, medical debt, AI, and global health systems. They discuss how the podcast evolved into a platform for making complex health care topics more understandable through candid conversations and personal storytelling. The hosts also announce a transition as the podcast continues under the Institute for...

Health care should not be designed around fragments of a person’s life. It should be built around the whole person, with data, intelligence, and ownership working together.

In this episode, Nasim Afsar, author of Intelligent Health and former Chief Health Officer at Oracle Health, joins Don Berwick and Kedar Mate to discuss how technology can transform healthcare from reactive and fragmented to personalized and proactive. Drawing on her experience as a hospitalist, quality leader, health system COO, and health tech executive, Dr. Afsar explains why healthcare systems often fail when they prioritize institutional needs over patient re...

Health insurance policy is complicated, but the consequences are deeply human.

In this episode of Turn on the Lights, Professor Jonathan Gruber, Ford Professor of Economics and Chair of the Economics Department at MIT, joins Don Berwick and Kedar Mate to explore the history, structure, and future of health reform in the United States. Drawing on his work shaping Massachusetts health reform and the Affordable Care Act, Gruber explains the three-legged stool of reform: ending insurance discrimination, requiring broad participation, and making coverage affordable through subsidies. He also reflects on the political battles behind the ACA, the...

AI may be the breakthrough that finally helps a deeply strained health care system do what clinicians and patients have needed all along.

In this episode, Dr. Bob Wachter, Professor and Chair of the Department of Medicine at UCSF, examines why artificial intelligence marks a pivotal shift in health care and what it means for clinicians, patients, and care delivery. He draws on past transformations, like hospital medicine and electronic records, to explain why AI stands apart as a fundamentally different force. The conversation highlights where AI is already adding value, including medical scribes, chart summarization, and...

Public health is easiest to overlook when it is doing its job well, and hardest to defend when uncertainty is unavoidable.

In this episode, Dr. Rochelle Walensky, former CDC Director and infectious disease physician, reflects on the leadership challenges, pressure, and public scrutiny she faced during the height of the COVID-19 pandemic. She discusses the difficulty of communicating evolving science in real time, preparing for congressional hearings, and rebuilding morale within an agency under intense strain. Dr. Walensky also highlights lesser-known public health efforts, including the CDC’s work to prevent measles spread during the Afghan evacuation. Sh...

Why does public health so often get neglected until a crisis makes its value impossible to ignore?

In this episode, Dr. Tom Frieden, President and CEO of Resolve to Save Lives, former CDC Director, and former New York City Health Commissioner, reflects on a career spent trying to close the gap between what we know saves lives and what we actually do. He shares how his father’s example shaped his commitment to evidence-based medicine and public service, and he explains the framework behind his new book, The Formula for Better Health, see, believe, create. The conversation ex...

What if one of the biggest barriers in health care is not access to treatment, but access to your own data?

In this episode, Hugo Campos, patient advocate, creative strategist, and participant ambassador, shares how his diagnosis with hypertrophic cardiomyopathy led him to advocate for patient agency and access to personal health data. After receiving an implantable cardioverter defibrillator, he discovered that data from his own body was shared with clinicians and manufacturers, but not with him. This realization sparked his work in data liberation and his challenge to traditional health care models. He explores how withholding...

What happens when a practicing surgeon, health economist, and federal policymaker brings all those perspectives into one leadership role?

In this episode, Dr. Meena Seshamani, Secretary of Health for Maryland, discusses how her journey across clinical care, health system leadership, and public service has shaped her approach to health care transformation. She reflects on leading Medicare during a time of major change, including expanding support for caregivers and community health, improving prescription drug affordability, and advancing drug price negotiation. Dr. Seshamani also explains how Maryland’s unique global budget model is helping shift hospital incentives toward keeping pe...

If public health is the foundation for individual health, why is it still treated like a “nice to have” until a crisis hits?

In this episode, Michelle Williams, an epidemiologist and public health leader, and Linda Marsa, a health care journalist, discuss what public health actually is, why it matters for human thriving, and how it differs from medical care that treats one patient at a time. They unpack how incentives often push resources toward reactive, profit-driven care instead of prevention, even though social determinants like housing and clean air drive most health outcomes. The conversation traces recu...

Blame rarely makes care safer, but understanding the system usually does.

In this episode, Professor Charles Vincent, a clinical psychologist and leading patient safety researcher, explains how harm often emerges from a chain of small breakdowns, not from a single “bad” decision, and why the better question is “what in the system allowed this to happen?” He unpacks how the fixation on individual error can miss deeper contributors, such as fatigue, poor supervision, weak monitoring, clunky equipment design, noise, distraction, and communication that is not truly heard. You will hear why disrespectful behavior and hierarchy are safety risks, h...

Stories can help people understand why health care keeps failing both patients and clinicians. 

In this episode, Shantanu Rai, a primary care physician and novelist, discusses how his medical thriller, A Dangerous Diagnosis, became a way to explore moral injury, physician burnout, concierge medicine, worsening access to specialty care, fragmented treatment, and the financial and administrative pressures reshaping modern practice. He reflects on what he sees in safety-net primary care, why more physicians are considering escape routes from traditional medicine, and how payment models can make care feel rushed and transactional. Shantanu also explains why he chose f...

How do we decide what “good care” looks like, and who gets to choose the scorecard?

In this episode of Turn on the Lights, Kedar Mate speaks with Dr. Michelle Schreiber of the Centers for Medicare & Medicaid Services and Brenna Rabel of Battelle about how quality measures are developed, adopted, and applied across Medicare and Medicaid programs. They explore why measurement is essential for accountability, patient choice, and improvement, while also acknowledging its vulnerability to politics, feasibility constraints, and “teaching to the test.” Using diabetes and sepsis as examples, they explain how performance cutoffs are established, why “all-or-non...

How do health care quality measures get created, and are we measuring too much?

In this episode, Jeff Geppert, Senior Research Leader at Battelle Memorial Institute, discusses the lifecycle and future of health care quality measurement in value-based care. He explains how measures move from multi-year development and evidence testing through endorsement and CMS rulemaking before being implemented in federal programs. He addresses concerns about measurement overload, noting that health care complexity has driven the growth in measures but that rising infrastructure costs, interoperability demands, and AI adoption may force greater focus and parsimony. He also shares...

What would it look like if aging in America came with a real plan instead of a quiet free fall?

In this episode, Dr. Joanne Lynn, a longtime geriatric and hospice physician and elder-care policy leader, explains how longer lives have outpaced the systems people rely on when disability arrives. She highlights how ageism and invisible, unpaid caregiving strain families, often forcing them to drain savings before support becomes available. She also examines staffing shortages in nursing homes, limited geriatric training for clinicians, and gaps in long-term care infrastructure. Finally, she shares promising solutions, including community villages...

Leading a major health system today means juggling patient-first ethics with a financing model that keeps tightening the screws.

In this episode, Chris Van Gorder, President and Chief Executive Officer of Scripps Health, explains why health care is becoming structurally unaffordable amid soaring premiums, uncompensated emergency care, and rising input costs. He describes how hospitals have become the default safety net as county systems disappear, while underpayment by Medicare and Medicaid forces cost shifting onto employers and commercially insured patients. Van Gorder also highlights California’s seismic rebuilding mandates, which create massive capital pressure without matching reimbursement. He...

What does it take to reimagine aging services in a complex health and social care system?

In this episode, Marta Corvêlo, President & Chief Executive Officer at Somerville-Cambridge Elder Services, talks about her journey into health and human services and her approach to transforming community-based aging support. She shares how her upbringing in Portugal and early work with refugee families shaped her commitment to social impact and equity. Marta explains the mission of SCES and how its home-based, wraparound services help older adults, people of all abilities, and caregivers age with independence and dignity. She also discusses o...

America’s drug crisis isn’t a science problem; it’s a pricing and policy problem that blocks patients from medicines that already exist.

In this episode, Dr. Jerry Avorn, a professor of medicine and leading expert in pharmacoepidemiology and medication policy, discusses why many patients still can’t afford essential treatments even as breakthrough drugs for cancer and inflammatory disease proliferate. He shares a personal case where “nonadherence” was really unaffordability, then unpacks how US exceptionalism in drug pricing, patent “thickets,” and delayed competition keep costs unsustainably high. Dr. Avorn also contrasts access failures with overuse concerns, explor...

Mindfulness isn’t a “nice-to-have”; it’s a low-cost public health lever that changes how people handle pain, emotions, and community life.

In this episode, Brother Phap Luu, a monk in the Plum Village tradition founded by Thich Nhat Hanh, discusses how mindfulness can be practiced as “everyday meditation” through breathing, walking, eating, and even cultivating awareness of dreams. He shares his personal journey from activism and disillusionment to depression, and then to healing through mindful breathing and finding community at Plum Village. Brother Phap Luu explores the roots and global reach of Plum Village, why mindfulness naturally fo...

Quality measurement matters only if it helps patients and clinicians deliver better care in real time, not just prove compliance after the fact.

In this episode, Vivek Garg, President and CEO of NCQA, reflects on how growing up with an immigrant physician father, living with his mother’s undiagnosed bipolar disorder, and training in internal medicine shaped his commitment to patient-centered improvement. He explains why he pursued “edge-case” primary care roles at innovative organizations and how those experiences led him to focus on quality, value-based care, and complex populations. Vivek also clarifies NCQA’s role in convening standard...

Millions of Americans could lose health coverage in the coming years, and the consequences may be more profound than most people realize.

In this episode, Dr. Ben Sommers, the Huntley Quelch Professor of Health Care Economics at the Harvard T.H. Chan School of Public Health, and professor of medicine at Harvard Medical School and Brigham & Women’s Hospital, talks about how new federal policies, including Medicaid work requirements and the rollback of Affordable Care Act subsidies, are reshaping access to health insurance in the U.S. Drawing on extensive research, he explains why these changes are ex...

Trust in health care AI won’t happen by hype. It will be earned through transparent standards, independent evaluation, and real-world performance monitoring.

In this episode, Dr. Brian Anderson, President & CEO and Co-Founder of the Coalition for Health AI (CHAI), discusses why health care needs a technically specific, use-case-by-use-case definition of “good” AI and how CHAI is building voluntary consensus-driven guidelines around fairness, transparency, safety, robustness, and privacy. He shares how his frustration with bloated EHR workflows pushed him into digital health innovation, then into pandemic-era public-private coordination during Operation Warp Speed, where rapid collaboration revealed what’s possib...

What happens when a health system decides that quality comes first?

In this episode, Dr. Gary Kaplan, who retired as the longtime CEO of Virginia Mason and currently serves on the Board of Stewardship Trustees of CommonSpirit Health, discusses leading one of America’s most influential physician-led health systems through a radical transformation focused on quality, safety, and patient-centered care. He reflects on Virginia Mason’s roots as a Mayo Clinic–style group practice and why shared purpose and clinician leadership created a fundamentally different culture of care. Dr. Kaplan explains how adopting Lean management principles reshaped chaoti...

The energy is electric at the IHI Forum, even before the forum officially begins.

In this episode, co-hosts Kedar Mate and Don Berwick discuss how AI, patient safety, and administrative waste are shaping the future of health care. They explore the excitement and uncertainty around AI’s growing role in diagnostics, coordination, and clinical decision-making. They discuss why clinicians need real training to use AI safely and effectively, and how learning health networks are driving continuous improvement. They also delve into the persistent administrative burdens, especially in Medicaid and fee-for-service systems, that hinder true efficiency in health ca...

What happens when clinicians stop hearing the very people they’re trying to help?

In this episode, Dr. Rageshri Dhairyawan, a Consultant Physician in Sexual Health and HIV Medicine at Barts Health NHS Trust and Deputy Director of the SHARE Collaborative at Queen Mary University of London, discusses how patients are often disbelieved or dismissed in healthcare. She shares her own experience of being ignored during a painful hospitalization, which revealed how difficult it can be for even a senior doctor to speak up when vulnerable. Dhairyawan argues that medicine has a long-standing culture of skepticism toward pa...

The collapse of a major hospital system set off one of the most complex healthcare emergencies Massachusetts has ever faced.

In this episode, Dr. Gregg Meyer, Incident Manager for the Massachusetts Department of Public Health, discusses how the state responded to the unprecedented Steward Health Care crisis and worked to protect patients, communities, and hospital staff. He explains how years of debt, real estate deals, and private equity extraction destabilized the system and pushed it into bankruptcy. He shares what it took to manage a months-long VUCA public health emergency, including on-site monitoring, emergency closures, and the...

Medicaid is a massive, life-sustaining program whose new work requirements and funding cuts risk stripping coverage from millions of people who can’t afford to lose it.

In this episode, Cindy Mann, partner at Manatt Health and former director of the Center for Medicaid and CHIP Services, explains how Medicaid was created alongside Medicare in 1965 and has grown into the nation’s largest public coverage program, serving nearly 80 million people across diverse populations. She details the state–federal financing structure, explains why match rates vary, and highlights how Medicaid remains foundational to the Affordable Care Act’s coverage...

What if the biggest threat to our survival isn’t the next virus, but our failure to learn from the last one?

In this episode, Dr. Michael Osterholm, Regents Professor and Director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, explains why America’s public health system is dangerously underprepared for the next major outbreak. He shares how misinformation and political interference have eroded confidence in science, leaving critical institutions like the CDC and NIH struggling to fulfill their missions. Dr. Osterholm discusses lessons from COVID-19 and why failing to appl...

A nation’s promise to those who served becomes a lesson in how health care can truly heal.

In this special Veterans Day episode, Dr. David Shulkin, the ninth Secretary of the U.S. Department of Veterans Affairs in the Trump Administration and VA’s Under Secretary of Health in the Obama Administration, talks about the mission, history, and transformation of the Veterans Health Administration, one of the nation’s largest and most innovative health systems. He shares how his time leading the VA changed his perspective on what effective, compassionate care looks like, highlighting the system’s holisti...

Our information environment has become a social determinant of health.

In this episode, Joshua Sharfstein, a public health leader and professor at Johns Hopkins, and Joanne Kenen, journalist in residence at the Johns Hopkins Bloomberg School of Public Health, discuss how the collapse of local journalism, the design of social media algorithms, and politicization have created an “information sickness” that undermines personal and public health. They explain that traditional reporting once filtered out false claims through rules and accountability, while today’s engagement-driven platforms reward emotional misinformation that quickly becomes “sticky.” The guests explore the consequences of vaccine re...

“I just went there for a routine knee replacement, or so I thought.”

In this inspiring episode, Rosie Bartel, a patient partner and advocate, educator, and survivor, shares her journey from a devastating MRSA infection acquired during a routine knee replacement to becoming a global voice for patient safety and health care reform. After surviving 58 surgeries, more than 200 hospitalizations, and multiple amputations, she transformed her pain into a mission to prevent others from enduring the same experience. Rosie explains how being invited to her hospital’s root-cause investigation empowered her to advocate for systemic change and demonstrate the po...

The healers we need now don’t stop at the exam room; they go upstream to the causes of suffering and make safety, dignity, and trust part of the clinical job.

In this episode, Dr. Sandeep Kapoor, a physician and academic leader, calls for a broader, more human-centered definition of health care, one that addresses substance use, firearm injuries, pain, and the social realities that shape well-being. Drawing on personal experiences and systemic insight, he advocates for harm reduction, trust-building, and courageous leadership that transforms stigma and obstacles into opportunities for progress.

Tune in and le...

The integrity of evidence-based policy is under threat when political agendas override scientific rigor.

In this episode, Dr. Robert Califf, former FDA Commissioner and cardiologist, reflects on his experience leading the FDA and the agency’s critical role in protecting public health through rigorous, science-based regulation across multiple sectors. He warns that political interference, disinformation, and mistrust threaten health outcomes but believes meaningful collaboration can still restore integrity and progress.

Tune in and learn how protecting science-based regulation may be one of the most important public health actions of our time!

Le...

The corporatization of health care is driving a mass exodus from primary care, creating a crisis that affects both physicians and patients alike.

In this episode, Dr. Peter Grinspoon, a physician and advocate, discusses the worsening state of American primary care, shaped by burnout, poor pay, and a loss of autonomy, while sharing how his recovery from opioid addiction inspired him to support other physicians. He also explores the stigma surrounding mental health in medicine, stalled union efforts, and the need for better education and regulation around the safe use of medical cannabis.

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