Covering the American well being care system means we inform some scary tales. This episode of “An Arm and a Leg” seems like an actual horror film.
It makes use of considered one of Hollywood’s favourite tropes: machines taking up. And the machines belong to the non-public medical health insurance firm UnitedHealth Group.
Host Dan Weissmann talks to Stat News reporter Bob Herman about his investigation into Medicare Advantage plans that use an algorithm to make selections about affected person care. The algorithm is owned by a subsidiary of UnitedHealth Group.
Herman tells Weissmann that a few of UnitedHealth’s personal workers say the algorithm creates a “moral crisis” through which care is unfairly denied.
Scary stuff! Such reporting even has caught the attention of highly effective folks in authorities, placing Medicare Advantage plans underneath scrutiny.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a workers reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Emily Pisacreta
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Adam Raymonda
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Ellen Weiss
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Transcript: Son of Medicare: Attack of the Machines
Note: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a instrument however test the corresponding audio earlier than quoting the podcast.
Dan: Hey there–
So that is sort of a horror story. But it’s not fairly the sort of story it’d sound like at first.
Because at first, it’d sound like a horror story about machines taking up, making all the choices– and making horrible, horrifying selections. Very age-of-Artificial Intelligence.
But that is actually a narrative about selections made by folks. For cash.
It’s additionally sort of a twofer sequel– like these films that pit two characters from earlier tales towards one another. Like Godzilla vs King Kong, or Alien vs Predator.
Although on this case, I’ve gotta admit, the 2 monsters aren’t essentially preventing one another.
Let’s get reacquainted with them.
On one aspect, getting back from our final episode, we’ve acquired Medicare Advantage: This is the model of Medicare that’s run by non-public insurance coverage firms.
It’s acquired a vivid and interesting aspect, in comparison with the normal Medicare program run by the federal authorities, as a result of: It can value quite a bit much less, month to month — saving folks cash on premiums. And it usually comes with further advantages, like dental protection, which conventional Medicare doesn’t provide. [I know.]
But Medicare Advantage can have a darkish aspect, which is mainly: Well, you find yourself coping with non-public insurance coverage firms for the remainder of your life. You want one thing — a check, a process, no matter — they may resolve to not cowl it.
Which might be scary.
Our different returning monster — am I actually calling them a monster? — properly, final time we talked about them, in 2023, we had an knowledgeable calling them a behemoth. That’s United HealthGroup. You would possibly keep in mind, they’re not solely one of many greatest insurance coverage firms
— and perhaps not-coincidentally the very greatest supplier of Medicare Advantage plans —
they’ve additionally acquired a complete different enterprise– underneath the umbrella identify Optum. And Optum has spent the final bunch of years shopping for up a gazillion different well being care firms of each variety.
That contains medical practices — they make use of extra docs than anybody else, by an enormous margin. It contains surgical procedure facilities, and home-health firms, and each sort of intermediary firm you possibly can think about that works behind the scenes — and have their arms in an enormous proportion of physician payments and pharmacy visits.
A number of years in the past, United purchased an organization known as NaviHealth, which gives providers to insurance coverage firms that run Medicare Advantage plans.
NaviHealth’s job is to resolve how lengthy somebody wants to remain in a nursing residence, like if you happen to’re discharged from a hospital after surgical procedure, however you’re not able to go residence but.
And the horror story– the tales, as dug up by reporters — begins after United purchased NaviHealth.
And in keeping with their studies, it includes folks getting kicked out of these nursing properties who aren’t able to go residence.
People getting despatched residence who can’t stroll up the steps of their home. Who can’t stroll in any respect. Who are on feeding tubes. People who NaviHealth’s personal workers are saying, “Wait. This person isn’t ready to go home.”
But their new bosses have informed them: You’re not likely making these selections anymore.
This is the place machines do enter the image.
NaviHealth’s distinctive providing has all the time been its proprietary algorithm– an algorithm that makes predictions about how lengthy any given affected person would possibly want to remain.
Before United purchased the corporate, that algorithm was used as a information, a first-guess. Humans weighed in with their very own judgment about what sufferers wanted.
After United purchased the corporate, folks inside have informed reporters, that modified: The new house owners mainly informed their workers, If the algorithm says somebody can go residence after x days, that’s once we’re chopping them off.
Like just about any horror film, this story’s acquired folks operating round making an attempt to inform everybody: HEY, WATCH OUT! THERE’S SOMETHING BIG AND DANGEROUS HAPPENING HERE.
And on this case, they’ve truly gotten the eye of some individuals who might need the facility to do one thing about it. Now, what these folks will do? We don’t know but.
And, by the way in which: Yes, I stated on the finish of our final episode that we’d be speaking about Medicaid this time round. That’s coming! But for now, strap in for this one.
This is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will perhaps do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So our job on this present is to take one of the enraging, terrifying, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
So. I stated that, like each horror film, this one has people who find themselves seeing what’s occurring and try to warn all people?
Like these films, we’re gonna comply with a type of folks, watch them uncover the issue, see how deep it goes, and begin ringing alarm bells. Let’s meet our man.
Bob Herman: My identify is Bob Herman. I’m a reporter at STAT News
Dan: Stat is a tremendous medical information publication. Bob covers the enterprise of medication there. Bob began engaged on this story in November 2022, after speaking to a supply who runs nursing properties. Bob’s supply was complaining about Medicare Advantage.
Bob Herman: There have been a whole lot of fee denials. They simply weren’t capable of receives a commission. And simply offhandedly, the supply talked about like, um, you already know, they usually’re attributing all the pieces to this algorithm. This algorithm stated, You know, solely 17 days for our sufferers after which time’s up and I went operating to Casey Ross
Dan: Casey is a reporter at Stat who focuses on tech and AI in healthcare. Bob stated, hey, what do you consider this? Wanna group up?
Bob Herman: And he was hooked.
Dan: They began speaking to individuals who labored at nursing properties, speaking to specialists, and speaking to households. And it was clear: They have been onto one thing.
Bob Herman: It took so many households without warning to be like, what do you imply we’re going residence? The, you already know, my husband, my spouse, my grandma, my grandpa, they will’t go to the lavatory on their very own. Like, what do you? It was simply, it was so complicated to folks. It appeared like such a, a chilly calculation,
Dan: One individual they ended up speaking with was Gloria Bent. Her husband Gary was despatched to a nursing residence for rehab after mind surgical procedure for most cancers. He was weak. He couldn’t stroll. And he had one thing known as “left neglect”: His mind didn’t register that there was a left aspect of his physique. Here’s Gloria testifying earlier than a Senate committee about how — when Gary arrived on the nursing residence — the very first thing he acquired was a discharge date. That is…
Gloria Bent: Before the workers of the power might even consider my husband or develop a plan of care, I used to be contacted by somebody who recognized themselves as my Navi Health Care Coordinator
Dan: Gloria says when she informed the nursing residence workers she’d heard from NaviHealth, they groaned. And informed her what to anticipate.
Gloria Bent: I used to be informed that I had simply entered a battlefield, that I might anticipate a sequence of notices of denial of Medicare fee accompanied by a discharge date that will be two days after I acquired that discover.
Dan: Yeah, they stated she’d get two days discover. Gloria says the nursing residence workers informed her she’d have 24 hours to enchantment every of these, however even when she received, the denials would maintain coming. In truth, they stated,
Gloria Bent: If we received a few appeals, then we might anticipate that the frequency with which these denials have been going to come back would enhance.
Dan: All of which occurred. NaviHealth began issuing denials July 15, 2022, after Gary had been on the residence for a month.
Gloria appealed. She informed senators what the physician who evaluated the enchantment discovered: Gary couldn’t stroll. He couldn’t even transfer — like from mattress to a chair — with out assist from two folks.. That reviewer took Gloria’s aspect.
Her husband’s subsequent denial got here per week after the primary. Gloria received that enchantment too. She says the reviewer famous that Gary wanted most help with actions of day by day residing.
The third denial got here 4 days later, and this time Gloria misplaced.
Gary got here residence in an ambulance: As Gloria testified, he couldn’t get into or out of a automobile with out help from somebody with particular coaching.
And when he acquired into the ambulance, he had a fever. The subsequent morning, he wound up in one other ambulance — headed to a hospital with meningitis. He misplaced a whole lot of the functioning he’d picked up on the nursing residence.
He died at residence a number of months later. When Gloria testified within the Senate, all of it was nonetheless recent. She informed them that as terrible as Gary’s sickness and decline had been, the fights with insurance coverage have been an added trauma.
Gloria Bent: This shouldn’t be taking place to households and sufferers. It’s merciless. Our household continues to battle with the query that I hear you asking at this time. Why are people who find themselves taking a look at sufferers solely on paper or by way of the lens of an algorithm
making selections that deny the providers judged vital by well being care suppliers who know their sufferers.
Dan: Bob Herman calls Gloria’s story heartbreaking, like so many others he’s seen.
And his consideration goes to 1 a part of Gloria’s story past denial-by-algorithm.
Because: It’s not only one denial. It’s that sequence of denials. You can enchantment, however as Gloria testified, the denials pace up. And it’s important to win each single time. The firm solely has to win as soon as.
I imply, except you’re able to get a lawyer and take your probabilities in court docket– which, along with being a serious enterprise, additionally means racking up nursing residence payments and authorized payments chances are you’ll by no means get reimbursed for, whereas the court docket course of performs out.
Bob Herman: This enchantment system is designed in such a method that individuals will hand over. If you could have a job, you already know, even if you happen to don’t, and also you’re, and also you’re additionally making an attempt to maintain a member of the family, um, it’s a rigorous monotonous course of that can chew folks up and spit them out after which the individuals are inevitably going to surrender. And I feel in some methods insurers know that.
Dan: Going out on a limb to say: I feel so too. So Bob and Casey’s first story on NaviHealth got here out in March of 2023. They have been the characters within the film who go, “HEY, I THINK THERE’S SOMETHING REALLY BAD HAPPENING HERE.”
And folks began paying consideration. Like the U.S. Senate. which held that listening to the place Gloria Bent informed her story.
And just like the federal company that runs Medicare — the Centers for Medicare and Medicaid Services, CMS.
CMS finalized a rule that informed insurers: You can’t deny care to folks simply from utilizing an algorithm.
And one thing else occurred too: Bob and Casey began out of the blue getting quite a bit MORE data.
Bob Herman: We acquired so many responses from folks and it simply opened the floodgates for former workers, simply sufferers and relations, simply everybody throughout the board.
Dan: And not simply former workers. Current workers. And what they realized was: There was completely a technique at work in how this algorithm was getting used. It was technique some folks on the within didn’t be ok with.
And this technique acquired developed after United HealthGroup — and its subsidiary, Optum– purchased NaviHealth in 2020. And right here’s what NaviHealth workers began telling Casey and Bob about that technique.
Bob Herman: For a few of us, it’s creating this ethical disaster. Like we all know that we’re having to take heed to an algorithm to basically kick somebody out of a nursing residence, despite the fact that we all know that they will barely stroll 20 toes.
Dan: What Bob and Casey realized from insiders– and the way it connects to United’s position as a well being care behemoth– that’s subsequent.
This episode of An Arm and a Leg is produced in partnership with KFF Health News. That’s a nonprofit newsroom masking healthcare in America. Their reporters do wonderful work, and I’m honored to work with them. We’ll have slightly extra about KFF Health News on the finish of this episode.
So, NaviHealth — the corporate with the algorithm — acquired began in 2015.. And the thought behind it was to make use of knowledge to get folks residence quicker from nursing properties in the event that they didn’t truly must be there.
Because there was a whole lot of proof that some folks have been being saved longer than they wanted.
Bob Herman: There is a few validity to the concept that there’s, there’s wasteful care in Medicare, like, you already know, there’s been circumstances prior to now proving that individuals keep in a nursing residence for method longer than is important. And clearly there’s monetary incentives for nursing properties to maintain folks so long as doable.
Dan: Traditional Medicare does have limits on nursing residence care — however if you happen to want “post-acute care” — assist getting again in your toes after leaving a hospital conventional Medicare pays in full for 20 days– just about no questions requested. One of the promoting factors of Medicare Advantage — like promoting factors to coverage nerds and politicians — was that it might lower waste, by asking these sorts of questions. NaviHealth and its algorithm have been designed to assist Medicare Advantage plans ask these questions in a wise method.
Bob Herman: There have been… a whole lot of believers inside NaviHealth that have been like, okay, I feel we’re doing the best factor. We’re making an attempt to ensure folks get residence sooner as a result of who doesn’t wish to be at residence.
Dan: And as these workers informed Bob and Casey: Before United and Optum got here in, the algorithm had been there as a information — a sort of first guess — however not the ultimate phrase.
NaviHealth has workers individuals who work together immediately with sufferers. And again within the day, the pre-United day, Bob and Casey realized that these workers might make their very own judgments.
Which made sense, as a result of the algorithm doesn’t know all the pieces about any particular person case. It’s simply making predictions primarily based on the information it has.
Bob Herman: And there was simply, simply this noticeable change after United and OptiMentor that it felt extra inflexible. There’s no extra variation.
Dan: If the algorithm says you go, you might be just about going.
Bob Herman: United has stated, no, that’s not the case, however clearly these paperwork and different communications that we’ve gotten sort of say in any other case.
Dan: Because these workers weren’t simply speaking. They have been sharing. Internal memos. Emails. Training supplies. All making clear: The firm needed folks shipped out on the algorithm’s timetable.
Bob Herman: Documents got here in exhibiting that like this was a reasonably specific technique. You know, UnitedHealth was telling its workers. Listen, we now have this algorithm. We suppose it’s actually good. So when it tells you what number of, what number of days somebody needs to be in a nursing residence, persist with it.
Dan: Stick to it or perhaps be fired. Bob and Casey acquired paperwork — worker efficiency targets– saying: How shut you persist with the algorithm’s suggestions? That’s a part of how we’re evaluating your job efficiency.
Bob Herman: It’s okay. Algorithm stated 17 days, you higher not likely go exterior of that as a result of your job is on the road.
Dan: Here’s how carefully folks have been anticipated to stay to it. In 2022, worker efficiency targets shared with STAT confirmed that staff have been anticipated to maintain precise time in nursing properties to inside three p.c of what the algorithm stated it needs to be. Across the board.
So, say you had 10 sufferers, and the algorithm stated they every ought to get 10 days. That’s 100 days. Your job was to guarantee that the entire precise days for these sufferers didn’t go previous 103 days.
Then, in 2023, the expectations acquired extra stringent: Stay inside one p.c of the algorithm’s predictions. 10 sufferers, the algorithm says 100 days whole? Don’t let it get previous 100 and one.
Bob Herman: Like that’s, virtually nothing. Like what, what, your arms are tied. If you’re that worker, what are you going to do? Are you going to get fired? Are you going to do what you’re informed?
Dan: And one one who ended up speaking, to did get fired.
Bob Herman: Correct. Yes. Uh, Amber Lynch did get fired And what she stated was what we had additionally heard simply extra broadly was it, it created this inside battle, like, Oh my God, what I’m doing doesn’t really feel proper.
Dan: Amber Lynch was a case supervisor. She informed Bob and Casey about onepatient who couldn’t climb the steps in his residence after knee surgical procedure. But the algorithm stated he was prepared. Amber’s supervisor stated, “Have you asked the nursing home staff if they’ve tried to teach him butt bumping?” Amber grit her tooth and made the suggestion to the rehab director.
Amber Lynch: And she checked out me like I had two heads. She’s like, he’s 78 years outdated. He’s not going to do this. He’s not protected to climb the steps but. He’s not doing it. We’re not going to have it butt bump the steps.
Dan: Amber informed Bob and Casey that when she acquired fired, it was partly for failing to hit the one p.c goal and partly for being late with paperwork– which she informed Bob and Casey she fell behind as a result of her caseload was so heavy.
She wasn’t the one one with that criticism.
Bob and Casey’s story exhibits one other NaviHealth case supervisor– not named within the story as a result of they’re nonetheless on the job — of their residence workplace, struggling to maintain up.
That week, they have been presupposed to work with 27 sufferers and their households. Gather paperwork, maintain conferences. Another week, shortly earlier than, they’d had 40 sufferers.
“Do you think I was able to process everything correctly and call everyone correctly the way I was supposed to?” the case supervisor requested. “No. It’s impossible. No one can be that fast and that effective and capture all of the information that’s needed.”
Bob and Casey watched this case supervisor fill out a digital kind, feeding the algorithm the knowledge it requested for on a person in his 80s with coronary heart failure, kidney illness, diabetes and hassle swallowing, who was recovering from a damaged shoulder.
A couple of minutes later, the pc spat out a quantity: 17 days.
The case supervisor didn’t have a whole lot of time or leeway to argue, however they have been skeptical that the algorithm might get that quantity precisely proper primarily based on solely the information it had.
And what knowledge is the algorithm working with? What’s it evaluating the information on any given affected person TO? Bob Herman says that’s an enormous query.
Bob Herman: It’s one thing that for positive, like Casey and I, it’s been bothering us. Like, what, how is that this entire system? Like, what’s it primarily based on? And we have been by no means actually given straight solutions on that. NaviHealth and Optum and United have stated it’s primarily based on hundreds of thousands of affected person information over time. The sources of that, it’s, it’s slightly unclear, the place all that’s coming from.
Dan: Bob and Casey talked with an knowledgeable named Ziad Obermeyer, a professor on the University of California Berkeley School of Public Health, who will not be anti-algorithm. He truly builds algorithmic instruments for choice making in public well being.
AND he’s finished analysis exhibiting that some widely-used algorithms simply scale up and automate issues like racial bias.
He informed Bob and Casey: Using an algorithm primarily based on how lengthy different, earlier sufferers have stayed in a nursing residence — that’s not a terrific thought.
Because folks get pressured out of nursing properties, in his phrases, “because they can’t pay or because their insurance sucks.” He stated, “So the algorightm is basically learning all the inequalities of our current system.”
And leaving apart that sort of bias, it appears unlikely to Bob that any algorithm might predict precisely what each single affected person will want each single time.
No matter how a lot knowledge it’s acquired, it’s predicting from averages.
Bob Herman: It jogs my memory of, like, a basketball recreation the place let’s say somebody averages 27 factors per recreation. They don’t have 27 factors each single, the sport they go on the market. It simply varies every now and then.
Dan: But the NaviHealth algorithm doesn’t must be proper each time for United to earn cash utilizing it.
Using it to make selections can enable United to spice up income coming and going.
Bob Herman: United well being and the opposite insurance coverage firms that use Navi well being. Are utilizing this know-how to kind of kick folks out of nursing properties earlier than they’re prepared. And that’s the claims denial aspect the place it’s like, okay, let’s save as a lot cash as we will as a substitute of getting to pay it to a nursing residence.
Dan: And that’s only one aspect of it. The insurance coverage aspect. Claims denial. But United isn’t simply within the insurance coverage enterprise.
United’s Optum aspect is in each different a part of well being care.
Including — within the years since United took over NaviHealth — residence well being providers. The sort of providers you’re more likely to want if you depart a nursing residence.
In 2022, Optum purchased one high residence well being firm in what one commerce publication known as a “monster, jaw-dropping mega-deal” — greater than 5 billion {dollars}. In 2023, Optum made a deal to purchase a second mega-provider.
Bob and Casey’s story says NaviHealth’s shortening nursing residence stays is integral to United’s technique for these acquisitions. It does appear to open up new alternatives.
Bob Herman: You’re out of the nursing residence as a result of our algorithm stated so. Now we’re going to ship you to a house well being company or we’re going to ship some residence well being aides into your property. And by the way in which, we personal them.
Dan: Oh, proper, as a result of: If you’re in a Medicare Advantage plan, your insurer can inform you which suppliers are coated.
Bob Herman: So the actual query turns into, how a lot is United probably paying itself?
Dan: That is: How a lot would possibly United find yourself taking cash out of 1 pocket — the medical health insurance aspect — and paying itself into one other pocket, Optum’s home-health providers?
We don’t know the reply to how a lot United is paying itself on this method, or hoping to. And United has stated its insurance coverage arm doesn’t favor its in-house companies.
But it looks like an inexpensive query to ask. Actually, it’s a query the feds appear to be asking.
Optum hasn’t wrapped up its buy of that second home-health firm but, and in February 2024, the Wall Street Journal and different shops reported that the U.S. Department of Justice had opened an anti-trust investigation.
And you don’t must be in a Medicare Advantage plan run by United to get kicked out of a nursing residence on an algorithm’s say-so.
Bob Herman says NaviHealth sells its algorithm-driven providers to different massive insurance coverage firms
He says, put collectively, the businesses that use NaviHealth cowl as many as 15 million folks — about half of all people in Medicare Advantage.
Bob Herman: Odds are, if you happen to’re in a Medicare Advantage plan, there’s a, there’s a extremely good shot that your protection insurance policies, if you happen to get actually sick and want nursing residence care, for instance, or any sort of publish acute care, an algorithm could possibly be at play in some unspecified time in the future.
Dan: This is the darkish aspect of Medicare Advantage.
Bob Herman: Everyone loves their Medicare Advantage plan after they first join, proper? Because it’s providing all these bells and whistles. It’s, right here’s a gymnasium membership. It’s acquired dental and imaginative and prescient, which common Medicare doesn’t have. And it’s additionally simply, it’s, it’s cheaper. Like, if it’s simply from a monetary standpoint, if, if you happen to’re a low earnings senior, How do you flip it down? There’s, there’s so many plans that supply like free, there’s no month-to-month premiums along with all of the bells and whistles. But Nobody understands the commerce offs , When you’re signing up for Medicare and Medicare Advantage, you’re on the more healthy aspect of, of being a senior, proper?
Dan: And none of us can rely on staying wholesome without end. When you join Medicare you’re signing up your future self — whether or not that’s ten or twenty or extra years out. That future you, would possibly really want good medical care.
And at that time, as we defined in our final episode, if Medicare Advantage isn’t working for you, chances are you’ll not be capable of get out of it.
Bob Herman: You might probably not absolutely get the care that you simply want. We shouldn’t assume that, that this couldn’t occur to us as a result of it may possibly.
Dan: So, yeah. Kind of a horror story. But: Unlike some horror films, when Bob and Casey began publishing their tales, they began getting folks’s consideration.
We talked about the brand new guidelines from the feds and the senate hearings after Bob and Casey’s first story in March 2023
Later within the 12 months, when Bob and Casey printed their story with paperwork and tales from inside NaviHealth, a class-action lawsuit acquired filed.
Since then, CMS has stated it would step up audits underneath its new guidelines.
Bob Herman: There was a memo that CMS despatched out to Medicare benefit plans that stated, Hey, hear, we’re telling you once more, don’t deny care solely on any AI or algorithms. Like simply don’t do it.
Dan: And in February 2024, the Senate held one other listening to.
Here’s Senator Elizabeth Warren at that listening to, saying these CMS guidelines aren’t sufficient. We want stronger guardrails.
Elizabeth Warren: Until CMS can confirm that AI algorithms reliably adhere to Medicare protection requirements by regulation, then my view on that is CMS ought to prohibit insurance coverage firms from utilizing them of their MA plans for protection selections. They’ve acquired to show they work earlier than they put them in place.
Dan: So folks — folks with at the least some energy– are paying some consideration.
Bob Herman: I don’t suppose that is essentially going to flee. Political scrutiny for some time.
Dan: So, mainly, the story isn’t over.
This isn’t a type of horror films the place the monster’s been safely defeated on the finish, and all people simply begins cleansing up the mess. And it’s not one the place the monster is simply on the free, unleashing the apocalypse.
Because it’s not a film. There’s no ending. There’s simply all of us making an attempt to determine what’s occurring, and what we will perhaps do about it.
One very last thing: I acquired a whole lot of emails after our final episode, the place we laid out a whole lot of details about Medicare Advantage and conventional Medicare. Most of it was alongside the traces of, Thank you! That was actually useful! Which made me really feel actually good.
And we acquired a pair notes about issues we might have finished higher. Especially this: We stated Traditional Medicare leaves you on the hook for 20 p.c of all the pieces, with out an out of pocket restrict.
Which is true — however just for Medicare Part B: Doctor visits, outpatient surgical procedures and exams. Which can add up, for positive.
Medicare Part A — if you happen to’re truly hospitalized — covers most providers at one hundred pc, after you meet the deductible. In 2024 that’s one thousand, 600 thirty-two {dollars}.
Thanks to Clarke Lancina for pointing that out.
There have been a bunch of different, wonderful notes in my inbox not too long ago, and I wish to say: Please maintain them coming.
If you go to arm and a leg present dot com, slash, contact, no matter you sort there goes straight to my inbox. You can connect stuff too: paperwork… voice memos.
Please let me hear from you. That’s arm and a leg present dot com, slash contact.
I’ll catch you in a number of weeks.
Till then, maintain your self.
This episode of an arm and a leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta, and edited by Ellen Weiss.
Adam Raymonda is our audio wizard. Our music is by Dave Weiner and blue dot periods. Extra music on this episode from Epidemic Sound.
Gabrielle Healy is our managing editor for viewers. She edits the primary support equipment publication.
Bea Bosco is our consulting director of operations. Sarah Ballama is our operations supervisor.
And Arm and a Leg is produced in partnership with KFF Health News. That’s a nationwide newsroom producing in depth journalism about healthcare in America and a core program at KFF, an impartial supply of well being coverage analysis, polling and journalism.
Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this present.
And because of the Institute for Nonprofit News for serving as our fiscal sponsor, permitting us to simply accept tax exempt donations. You can study extra about INN at INN. org.
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