♪.

TED: COMING UP NEXT ON "ARIZONA HORIZON," REACTION TO CONGRESS AND DAVID SCHWEIKERT ANNOUNCING HIS CANDIDACY FOR GOVERNOR.

>>> ALSO REACTION TO THE TRUMP ADMINISTRATION'S CLAIMS THAT THE USE OF TYLENOL DURING PREGNANCY COULD LEAD TO AUTISM.

>>> AND ARIZONA IS INVOLVED IN A PILOT PROGRAM THAT REQUIRES PREAPPROVAL FOR SOME MEDICAL PROCEDURES.

THAT STORY AND MORE NEXT ON "ARIZONA HORIZON."

GOOD EVENING AND WELCOME TO "ARIZONA HORIZON."

I'M TED SIMONS.

REPUBLICAN CONGRESSMAN DAVID SCHWEIKERT ANNOUNCED HE'S RUNNING FOR GOVERNOR.

SCHWEIKERT JOINS ANDY BIGGS AND BUSINESSWOMAN KARRIN TAYLOR ROBSON IN A CROWDED REPUBLICAN PRIMARY FIELD AND LEAVES SCHWEIKERT'S NORTHEAST VALLEY CONGRESSIONAL SEAT WIDE OPEN.

FOR ANALYSIS, WE WELCOME POLITICAL CONSULTANT CHUCK COUGHLIN, CEO OF HIGHGROUND.

>> GREAT TO BE IN THE RING.

TED: A CROWDED RING HERE.

WAS THE ANNOUNCEMENT A SURPRISE?

>> I THOUGHT IT WAS JUST JOCKEYING FOR MORE SENIORITY WITH THE SPEAKER FOR WASHINGTON SENIORITY BECAUSE IT'S AN IMPORTANT SEAT FOR THE REPUBLICANS TO HOLD ONTO AND I NEVER REALLY THOUGHT THAT HE WAS SERIOUS ABOUT RUNNING FOR GOVERNOR.

WELL, I WAS WRONG.

HE'S IN THE RACE AND THIS IS FOR REAL.

TED: THERE WAS ALSO THOUGHT HE CONTINUALLY DOES THIS WHEN HE THINKS HE'S NOT DOING WELL AS FAR AS RE-ELECTION IS CONCERNED.

HE'S NOT WORRIED ABOUT RE-ELECTION ANYMORE.

WHY IS HE MAKING THIS MOVE?

>> HE'S BEEN THERE SINCE 2010, HE GOT ELECTED IN 2011 AS A FISCAL CONSERVATIVE AND A BUDGET HAWK.

THAT CONSTITUENCY, LIKE JEFF FLAKE, LEFT THE BUILDING.

IT'S NO LONGER REPRESENTED IN EITHER THE HOUSE OR THE SENATE, AND CERTAINLY NOT THE EXECUTIVE BRANCH.

THESE PEOPLE ARE RUNNING UP THE DEFICIT WILLY-NILLY, AND HE IS A DEFICIT HAWK, AND I THINK THAT BOTHERS HIM.

MY GUESS IS HE IS DISTINCTLY BOTHERED BY THAT AND CAN'T RATIONALLY SUPPORT THOSE SPENDING PRACTICES.

TED: IS HE DISTINCTLY DISTURBED WHAT'S GOING ON IN WASHINGTON, ESPECIALLY WITHIN HIS OWN PARTY, WITH THE PRESIDENT, THIS BEHAVIOR, THESE SORTS OF THINGS?

>> I DON'T KNOW HE'S BROKE WITH TRUMP.

SINCE THE TIME HE RAN, WHEN HE WAS IN THE LEGISLATURE THIS IS WHAT HE TALKED ABOUT.

AT THE COUNTY, THESE ARE THINGS THAT WERE HIS BREAD AND BUTTER ISSUE AND NOT A PASSION OF ANYBODY ELSE'S IN WASHINGTON RIGHT NOW.

TED: AND WE REFERRED TO THIS EARLIER, DOES IT LOOK LIKE CD-1, DOES IT LOOK LIKE HIS SEAT IN THE NORTHEAST VALLEY ESPECIALLY TENUOUS?

IT'S ALWAYS TENUOUS.

IS IT MORE TENUOUS?

>> IT'S A REPUBLICAN LEANING DISTRICT AND REPUBLICAN TURNOUT ADVANTAGE, PARTICULARLY IN A MIDTERM ELECTION.

I DIDN'T THINK THIS WAS A CHALLENGING CYCLE BECAUSE OF THE REPUBLICAN TURNOUT ADVANTAGE.

IN A MIDTERM ELECTION, REPUBLICANS TURN OUT GENERALLY GOES UP.

IT WAS SIGNIFICANTLY PASSED, 9+ TURNOUT IN THE LAST CYCLE SO A DOUBLE-DIGIT TURNOUT IN THIS CYCLE.

SO I DIDN'T THINK IT WAS REALLY THAT SIGNIFICANT.

THIS DOES OPEN UP THE RACE BECAUSE IT REMOVES THE INCUMBENT, SO YOU HAVE A BLOODY REPUBLICAN PRIMARY NOW, AND THE DEMOCRATS ARE CHEERING, AND GOVERNOR HOBBS IS CHEERING.

TED: I WAS GOING TO ASK YOU -- GET TO THAT IN JUST A SECOND AS FAR AS THE CONGRESSIONAL DISTRICT.

BACK TO THE GOVERNOR, DOES HE SEE A LANE BETWEEN ROBSON AND BIGGS?

SEEMS LIKE HE AND ROBSON, I WOULD THINK ANDY BIGGS IS HAPPY RIGHT NOW, DO I HAVE IT RIGHT?

>> YOU HAVE IT RIGHT.

THE BENEFICIARY IS CONGRESSMAN BIGGS, A LOYAL BASE OF SUPPORT AMONG MAGA VOTERS, FREEDOM CAUCUS-GOERS.

TURNING POINT ENDORSED HIM, CHARLIE KIRK ENDORSED HIM.

THAT'S HIS BASE, THAT'S HIS BASE VOTE, AND THAT TURNS UP IN A REPUBLICAN PRIMARY, AND OTHERS DON'T PARTICIPATE IN THOSE TYPES OF -- TO THAT DEGREE.

THERE ARE OTHER TYPES OF REPUBLICANS, BUSINESS REPUBLICANS, MODERATE REPUBLICANS, DAVID WILL COMPETE WITH SOME OF THOSE ON THE BIG SIDE BECAUSE OF SOME OF HIS CONSERVATIVE CREDENTIALS, PARTICULARLY THE FISCAL ONES.

BUT KARRIN IS A VERY STEADY CANDIDATE WITH THE BUSINESS COMMUNITY.

I PERSONALLY DON'T SEE THE LANE.

I MAY BE WRONG, GOD BLESS HIM, HE'S GOT SMART PEOPLE AND CHRIS BAKER WORKS WITH HIM.

I DON'T SEE THE LANE THEY DO.

TED: A BIG HELP TO THE BIGGS CAMPAIGN, SEEMS LIKE A BIG HIT TO THE ROBSON CAMPAIGN?

>> I THINK SO, UNLESS THE NARRATIVE ITSELF BECOMES SIMPLER FOR HER BECAUSE SHE'S GOING TO SAY YOU GOT A CHOICE BETWEEN A BUSINESSWOMAN WHO GOT THINGS DONE WHO ACCOMPLISHED A LOT IN HER CAREER AND LIFE, AND TWO CONGRESSMEN WHO HAVEN'T GOTTEN ANYTHING DONE.

THAT'S AN OVERSIMPLIFICATION, I CAN IMAGINE HER NARRATING THAT LINE.

THESE TWO GUYS OR ME?

TWO MEN OR ME, I'M AN OPTION, AND YOU KNOW, THAT COULD CATCH SOME VOTERS' ATTENTION.

TED: AS FAR AS SCHWEIKERT IS CONCERNED, IS HE MAGA ENOUGH FOR A GOP PRIMARY?

>> NO.

[LAUGHTER] >> NO.

HE'S NOT THE DARLING THAT BIGGS IS.

HE'S NOT -- HE DOESN'T HAVE THE BIGGS CREDENTIAL.

DOESN'T HAVE THE ENDORSEMENT OF THE PRESIDENT, NOT GOING TO GET THE ENDOOR.

THE PRESIDENT, HE DOESN'T HAVE THE ENDORSEMENT OF TURNING POINT.

I THINK THESE ARE THINGS THAT ONLY CONGRESSMAN BIGGS HAS.

TED: OF THE THREE, WHICH WOULD HAVE THE BETTER CHANCE AGAINST GOVERNOR HOBBS?

>> I THINK THEY ALL HAVE A LEGITIMATE SHOT GIVEN THAT TURNOUT CYCLE THIS TIME OF THE THREE, I THINK THE MOST FEARED ONE FROM THEIR PERSPECTIVE WOULD BE KARRIN, WITH HER BUSINESS CREDENTIAL AND HER BACKGROUND, BUT SHE'S ALSO GOT PROBABLY THE MOST DIFFICULT ROAD TO NARRATE IN A REPUBLICAN PRIMARY.

TED: WITH THAT IN MIND, IS THIS A GOOD DAY FOR GOVERNOR HOBBS?

>> NOT BAD.

IT'S NOT BAD.

THE MORE BLOODY THE REPUBLICAN PRIMARY IT IS, THE BETTER IT IS FOR HER BECAUSE IT'S GOING TO FORCE THE CANDIDATES INTO VERBAL COMBAT.

YOU'RE GOING TO GET COMMENTS ON THE RECORD.

WELL, CANDIDATE X SAID THIS ABOUT CANDIDATE Y AND SHE'S A MEMBER YOUR PARTY OR HE'S A MEMBER OF YOUR PARTY, SO YOU GET THAT COMMENTARY GOING, WHICH OTHER CANDIDATES LOVE TO PLAY IN THE GENERAL ELECTION.

TED: SCHWEIKERT IS GONE, REPUBLICAN HOPEFULS, WE DON'T HAVE TIME FOR EVERYONE.

>> WE DON'T.

THE NAMES THAT I HEAR MOST FREQUENTLY ARE REPRESENTATIVE MATT GRESS, A REPRESENTATIVE FROM THE NORTH CENTRAL PART OF THE VALLEY WITH GOVERNOR DUCEY'S BUDGET DIRECTOR AS A TWO-TERM LEGISLATOR NOW, HAS SIDED WITH SOME -- MADE IMPORTANT VOTES WITH THE REPUBLICAN SIDE, WAS ON THE RIGHT SIDE OF THE AXON BILL OPPOSING THE AXON BILL FOR THAT PART OF THE NECK OF THE WOODS UP THERE, SO HE'S NAVIGATED AND GINA SVOBODA, THE CHAIR OF THE REPUBLICAN PARTY.

TED: INTERESTING.

>> EXTENSIVE WORK IN ELECTION MANAGEMENT, WORKED IN THE SECRETARY OF STATE'S OFFICE FOR MANY YEARS AND WELL-REGARDED ELECTION EXPERT AND THE CHAIR OF THE DEMOCRATIC PARTY.

TED: HAS IT IMPACTED THE DEMOCRATIC PRIMARY AT ALL?

>> IT WILL CREATE MORE ENTHUSIASM ON THE FUND-RAISING SIDE.

LET ME FINISH THE REPUBLICAN SIDE.

TED: ONE MORE.

>> I CAN'T IMAGINE IN NORTH SCOTTSDALE THAT SOME RICH BUSINESS PERSON DOESN'T DROP INTO THE RACE AT SOME POINT.

THERE'S PEOPLE WITH A LOT OF WELT IN THE COMMUNITY.

I KNOW SCHWEIKERT HAS A LOT OF SUPPORTERS HE THINKS HE WOULD LIKE TO ENTERTAIN ENDORSING ONE OF THEM, I WOULD THINK.

THAT MAY BE AN OPPORTUNITY.

ON THE DEMOCRATIC SIDE, IT WILL ENHANCE FUND-RAISING PARTICIPATION, BUT THAT'S A REALLY -- THEY HAVE A GIANTLY CROWDED FIELD, AMISH SHAH WON THE LAST PRIMARY, RAN A SUCCESSFUL CAMPAIGN IN THAT CYCLE BUT CAME UP SHORT.

THEY'RE BACK IN THE GAME AGAIN AND OTHER PEOPLE AS WELL.

>> REAL QUICKLY, BEFORE YOU GO, RUNNING OUT OF TIME HERE.

LIEUTENANT GOVERNOR, DOES THE CHOICE FOR LIEUTENANT GOVERNOR, THE FIRST TIME WE'RE GOING TO GO THROUGH WITH THIS, WOULD THE CHOICE FOR LIEUTENANT GOVERNOR AMONG THE THREE REPUBLICAN CANDIDATES FOR GOVERNOR, WOULD THAT MAKE A DIFFERENCE?

>> YES, IT WILL.

WHO KNOWS?

I DON'T KNOW WHAT IS -- THERE'S BEEN ALL KINDS OF COMMENTARY, WELL, KARRIN TAYLOR COULD BE A GOOD LIEUTENANT, I DON'T THINK SHE WANTS THAT.

WOULD DAVID SCHWEIKERT BE A GOOD LIEUTENANT GOVERNOR FOR KARRIN TAYLOR ROBSON?

THEY ARE BOTH RUNNING FOR GOVERNOR.

IT'S GREAT BAR ROOM CONVERSATION, IF YOU WILL, AND WE'LL FIGURE IT OUT.

WE'RE OVER -- LESS THAN A YEAR AWAY FROM THE REPUBLICAN PRIMARY, BUT THOSE KIND OF CONVERSATIONS WILL CONTINUE TO DEVELOP.

TED: CHUCK COUGHLIN, HIGHGROUND, THANK YOU FOR JOINING US, APPRECIATE IT.

>> IT'S A CIRCUS, THANK YOU, TED.

I'M THE MASTER.

[ LAUGHTER ] .

TED: PRESIDENT TRUMP AND THE DEPARTMENT OF HEALTH ANNOUNCED THERE'S A LINK BETWEEN AUTISM AND THE USE OF TYLENOL, DESPITE STUDIES SHOWING SUCH A LINK IS YET AS PROVEN AT BEST.

JOINING US IS PEDIATRICIAN DR.

GARY KIRKILAS.

THANK YOU FOR JOINING US.

>> THANK YOU.

TED: TALKING ABOUT TYLENOL, ACETAMINOPHEN.

WHAT IS ACETAMINOPHEN?

>> A VERY POPULAR PAIN RELIEVER.

WE RECOMMEND IT FOR CHILDREN, ADULTS AND IN PARTICULAR FOR PREGNANT MOTHERS.

>> WHY?

>> IT'S ONE OF THE SAFEST MEDICATION WHEEZE KNOW OF.

THE ALTERNATIVE IS IBUPROFEN OR ASPIRIN, ASPIRIN WOULD CAUSE BAD FETAL KIDNEY ISSUES AND HEART DEFECTS.

WE STEER CLEAR OF THOSE.

ACETAMINOPHEN IS VERY HEALTHY, SAFE FOR A PREGNANT MOTHER TO USE.

TED: FROM MY READING, DOCTORS WARN AGAINST LONG-TERM USE OF TYLENOL.

IF YOU WARN AGAINST LONG-TERM USE, YOU GOT TO WATCH IT, DON'T YOU?

>> USE THE MINIMUM DOSE FOR THE SHORTEST DURATION AND ONLY UNDER THE CARE OF YOUR OB DOCTOR.

ANYTHING MOM TAKES, FETUS TAKES AS WELL.

WE DON'T WANT TO EXPOSE MOM TO UNNECESSARY MEDICATIONS.

TED: WHEN YOU HEARD THE WHITE HOUSE MAKING THE LINK BETWEEN TYLENOL AND AUTISM, WHAT WERE YOUR THOUGHTS?

>> AS A PEDIATRICIAN I WENT TO THE RHETORIC IN THE PAST ABOUT THE MMR VACCINE HAVING A LINK TO AUTISM.

IT WAS TOTALLY DEBUNKED.

WE'RE GRASPING AT THINGS THAT DON'T HAVE A CLEAR LINK TO AUTISM AND ACETAMINOPHEN IS NO DIFFERENT.

STUDIES SHOW A POTENTIAL ASSOCIATION, THERE ARE THOSE THAT SAY THERE IS NO ASSOCIATION.

IT WAS IN THE SAME VEIN FOR ME.

TED: WHY DOES THIS PERSIST?

IF THE TESTS ARE INCONCLUSIVE AT BEST, AND SOUNDS LIKE EVERY PEDIATRICIAN, EVERY ORGANIZATION IS SAYING, PLEASE, IF YOU HAVE A FEVER, NOT FEELING WELL, TAKE TYLENOL, AND THE PRESIDENT OF THE UNITED STATES IS SAYING DON'T TAKE TYLENOL, FIGHT LIKE HELL NOT TO TAKE IT.

WHERE IS THE DISCONNECT COMING FROM?

>> HONESTLY, I THINK IT'S HUMAN NATURE TO POINT TO SOMETHING AND VILLAINIZE IT, IF YOU COULD AVOID THIS ONE THING, IT WOULD BE SMOOTH SAILING, LIKE THE MMR VACCINE, NONE OF THIS PANS OUT.

TED: AS FAR AS AUTISM IS CONCERNED, THERE ARE RISING LEVELS OF AUTISM, IS IT DIAGNOSED DIFFERENT?

THERE ARE MORE PEOPLE AWARE OF AUTISM?

WHY ARE THE NUMBERS AS THEY ARE, WHICH PROMPTS THESE KINDS OF ANNOUNCEMENTS?

>> TWO-FOLD.

ONE WE'RE SCREENING MORE.

EVERY 18 MONTHS AND EVERY 24 MONTHS, WE ARE SCREENING EVERY CHILD THAT COMES IN FOR A WELL CHECK.

ONE EXPLANATION, WE'RE SCREENING MORE CHILDREN.

IN THE PAST, IT WAS VERY LIMITED TO PEOPLE WHO WERE NONVERBAL OR HAD SERIOUS NEURODEVELOPMENTAL DELAYS.

NOW IT'S MORE EXPANDED WHERE MORE PEOPLE FIT INTO THE DIAGNOSTIC CRITERIA.

IS THERE POTENTIAL THERE IS A ENVIRONMENTAL EXPOSURE THAT IS ALSO AT PLAY?

THAT REMAINS TO BE SEEN.

TED: THE PHRASE ON THE SPECTRUM, I NEVER HEARD THAT UNTIL RECENT YEARS, SEEMS LIKE THAT BY ITSELF EXPANDS THE DIAGNOSIS?

>> RIGHT.

TED: THE WHITE HOUSE DURING THIS ANNOUNCEMENT RECOMMENDED LUCOVAREN AS A POSSIBLE TREATMENT?

MAKE SENSE?

>> FOLIC ACID IS IMPORTANT IN NEURODEVELOPMENT.

OB-GYN AND PEDIATRICIANS RECOMMEND EXPECTANT MOTHERS TO TAKE PRENATAL VITAMINS THROUGHOUT PREGNANCY.

CERTAIN PEOPLE THAT HAVE AUTISM HAVE AN AUTOANTIBODY THAT ATTACHES ITSELF TO THE FOREFRONT RECEPTOR.

TO GIVE A BROAD RECOMMENDATION THAT IT'S A TREATMENT FOR ALL PEOPLE WITH AUTISM OR A CURE, THERE IS NO RESEARCH THAT BACKS THAT.

TED: IS THERE RESEARCH THAT BACKS UP THE STATEMENT FROM THE PRESIDENT THAT WOMEN WITH PAIN SHOULD TOUGH IT OUT?

>> NO, NO.

IN FACT, PAIN, FEVER, IF SEVERE ENOUGH WILL CAUSE PRETERM LABOR.

IF YOU HAVE A MOM EXPERIENCING THE FLU, HIGH FEVERS, YOU WOULDN'T WANT THE FEVER TO RIDE OUT.

THAT WOMAN WILL LIKELY HAVE PRETERM LABOR, WHICH YOU DON'T WANT, YOU WANT BABY IN AS LONG AS POSSIBLE, NINE MONTHS.

TED: THE IDEA OF SAYING DON'T TAKE SOMETHING, TOUGH IT OUT, WHEN A FEVER FOR A PREGNANT WOMAN, THAT IS SERIOUS BUSINESS?

>> IT IS.

AN OB WOULD ADVISE TAKING TYLENOL IF YOU HAVE HIGH FEVER OR ARE IN EXTREME PAIN.

TED: WHAT DO PEDIATRICIANS MAKE OF IT, WHAT DO PATIENTS THINK THEY'RE SCARED, I DON'T WANT TO TAKE TYLENOL.

DO YOU BRING CHILDREN WITH AUTISM THAT COME IN AND THE POOR MOM IS THINKING DID I TAKE TYLENOL AND THAT'S WHY PERHAPS MY MOM IS ON THE SPECTRUM IN SOME WAY, SHAPE, OR FORM?

THAT'S DIFFICULT.

>> YEAH, WHEN THAT COMES UP, I REASSURE MOMS, THERE IS NOTHING THAT DID YOU THAT WAS WRONG.

IF THEY WANT, I CAN EXPLAIN THE RESEARCH THAT SAYS SOME CASES THERE IS ASSOCIATION, SOME CASES THERE IS NO ASSOCIATION.

THERE IS RESEARCH THAT SHOWS NEGATIVE ASSOCIATION I.E., TAKING TYLENOL WOULD BE BENEFICIAL TO PREVENT AUTISM.

IF THE THOUGHT IS THE FEVER OR INFECTION THAT CAUSED THE FEVER, TAKING THE TYLENOL WOULD PREVENT THE ASSOCIATION.

TED: LAST QUESTION HERE, IS THERE ANYTHING IN THE WHITE HOUSE ANNOUNCEMENT THAT WAS SOUND MEDICAL ADVICE?

>> TO ANSWER YOU BLUNTLY, NO.

A LOT OF INFORMATION WAS GIVEN WITH A LOT OF CERTITUDE, AND WE DON'T HAVE THAT FROM THE RESEARCH, AND SOME OF THAT WAS -- IF YOU FACT CHECK IT, IT DOESN'T LINE UP.

TED: ARE YOU CONCERNED ABOUT THIS ANNOUNCEMENT?

>> I AM.

IF WE LEARNED ANYTHING FROM THE MMR SCARE WHERE PEOPLE WERE TOLD MMR HAD A CAUSE WITH AUTISM, WE SAW VACCINE RATES PLUMMET.

WHEN VACCINE RATES PLUMMET, WE HAVE MEASLES OUTBREAKS LIKE CALIFORNIA OR TEXAS.

I CAN IMAGINE A MOM NOT TAKING TYLENOL, HAVING A HIGH FEVER AND CAUSING PRETERM LABOR OR TAKING IBUPROFEN OR ASPIRIN AND HAVING WORSE DEFECTS.

TED: DR.

KIRKILAS.

THANK YOU FOR JOINING US.

>> THANKS FOR HAVING ME.

.

TED: A CONTROVERSIAL NEW WAY TO ADMINISTER MEDICARE IS COMING TO ARIZONA BY WAY OF A PILOT PROGRAM THAT LOOKS TO REDUCE WASTEFUL AND INAPPROPRIATE SERVICES.

IT'S CONTROVERSIAL BECAUSE IT CALLS FOR PREAPPROVAL FOR SELECT MEDICAL TREATMENTS.

WE SPOKE TO DR.

SWAPNA REDDY FROM ASU'S COLLEGE OF HEALTH SOLUTIONS.

GOOD TO SEE YOU.

>> GOOD TO SEE YOU.

>> PILOT PROGRAMS ARE LIKE, YOU WANT TO BE INVOLVED?

LET'S BE INVOLVED.

THAT'S NOT INVOLVED HERE, IS IT?

>> LESS SO.

SIX STATES HAVE BEEN CHOSEN BY THE CENTERS OF MEDICARE AND MEDICAID SERVICES AND THE SIX STATES HAVE BEEN CHOSEN ARE ARIZONA FOR A SIX YEAR PILOT PROGRAM.

IT WILL ENTAIL TRADITIONAL MEDICARE, FEE FOR SERVICE MEDICARE, TRADITIONALLY NOT SUBJECT TO PRIOR AUTHORIZATION.

ABOUT 16 SERVICES AND THAT COULD EXPAND, WILL BE SUBJECT TO PRIOR AUTHORIZATION, PRIOR APPROVAL BY THE INSURER BEFORE YOUR HEALTH CARE PROVIDER OR THE HEALTH SYSTEM CAN PROVIDE CERTAIN SERVICES OR FILL CERTAIN PRESCRIPTIONS.

TED: GIVE US AN EXAMPLE OF PRIOR AUTHORIZATION?

>> IF YOU ARE IN THE HEALTH CARE FIELD YOU KNOW IT WELL, IF YOU ARE A PATIENT, YOU MAY OR MAY NOT HAVE INTERACTED WITH IT.

WHAT IT BASICALLY STATES IS YOUR INSURANCE COMPANY, YOUR PAYOR, HAS TO APPROVE CERTAIN TREATMENT, CERTAIN MEDICATION, CERTAIN PROCESSES, NOT EMERGENCY PROCESSES, BUT MOST HEALTH CARE IS NOT AN EMERGENCY SETTING, RIGHT, BEFORE YOUR PROVIDER CAN KNOW THAT THEY WILL GET PAID OR REIMBURSED FOR THAT TREATMENT, AND OFTEN WHAT THE INSURANCE COMPANY IS ASKING IS, IS THIS BASICALLY THE LEAST EXPENSIVE WAY TO PROVIDE THIS TREATMENT?

IS THERE A LESS EXPENSIVE, LESS ARDUOUS, LESS EXTENSIVE WAY TO PROVIDE THE TREATMENT OR GET THE MEDICATION ON BOARD.

TED: I WANT TO GET BACK TO THE QUESTIONS IN A SECOND, SOUNDS LIKE IT COULD BOG DOWN A MEDICAL PROGRAM.

IF YOU'RE A DOCTOR DEALING WITH THIS, THIS CAN'T BE GREAT NEWS?

>> YOU MIGHT NOT BE SURPRISED THE CONCEPT OF PRIOR AUTHORIZATION IS NOT POPULAR AMONG PHYSICIANS, CLINICIANS, HEALTH CARE SYSTEMS.

QUICK STATS, YOUR AVERAGE DOCTOR'S OFFICE AROUND THE COUNTRY, THEY SUBMIT ABOUT 40 PRIOR AUTHORIZATION REQUESTS A WEEK.

THEY SPEND ABOUT 10 TO 12 HOURS JUST ON PRIOR AUTHORIZATION, THAT'S NOT JUST SUBMITTING, THAT'S HAVING CONVERSATIONS WITH THE INSURANCE COMPANY, CONVERSATIONS ABOUT APPEALS, ET CETERA, AND ABOUT 25% OF ALL PRIOR AUTHORIZATION REQUESTS ARE DENIED ON THE FIRST RUN.

TED: WOW.

AND THE PRIOR AUTHORIZATION METHOD, THIS IS USED WITH PRIVATE MEDICARE SITUATIONS.

FIRST OF ALL, WHAT ARE THE -- WE HEAR MEDICARE ADVANTAGE, ALL SORTS OF OTHER THINGS.

EXPLAIN THE PROCESS, EXPLAIN THE FORMULA HERE?

>> REALLY QUICKLY, MEDICARE ADVANTAGE IS AN OPTION FOR MEDICARE RECIPIENTS WHERE THEY CAN SUPPLEMENT OR ADD ON SERVICES BY PURCHASING INTO THE PRIVATE HEALTH INSURANCE SYSTEM, SO PRIOR AUTHORIZATION IS QUITE COMMON IN THE MEDICARE ADVANTAGE SYSTEM.

IT IS REALLY, REALLY RARE IN THE TRADITIONAL MEDICARE FEE FOR SERVICE SYSTEM, AND THIS PARTICULAR PILOT PROGRAM IS GOING TO AFFECT THE TRADITIONAL MEDICARE SYSTEM.

TED: UNDERSTAND A.I., MACHINE LEARNING WILL BE USED ALONGSIDE CLINICAL TREATMENTS AND CLINICAL ASSESSMENTS AND THESE SORTS OF THINGS.

HOW DOES THAT WORK?

>> WE'RE LEARNING THIS EVERY DAY, LEARNING THE PLANS EVERY DAY.

AS HAS BEEN STATED.

BASICALLY IF THERE IS A REQUEST FOR PARTICULAR AUTHORIZATION FOR ONE OF THE 16 TYPES OF TREATMENTS, THERE WILL BE SOME A.I.

ALGORITHM THAT WILL BE APPLIED, AND BASED ON THE ALGORITHM, THE INSURER WILL DECIDE OR THE PRIVATE CONTRACTOR THAT THE INSURER IS WORKING WITH WILL DECIDE IF THE TREATMENT IS APPROVED OR NOT.

WHAT THE INSURERS HAVE TOLD US IS THE ULTIMATE DECISION WILL NOT COME FROM THE A.I.

FORMULA BUT A CLINICIAN WHO WILL REVIEW WHAT THE A.I.

RECOMMENDS.

TED: THE 16 CONDITIONS, WHAT ARE SOME OF THEM, A. B, WHERE WERE THESE CHOSEN?

>> SO A COMMON CONDITION IS SKIN REPLACEMENTS OR KIND OF TREATMENTS THAT HAVE TO DO WITH WOUND MANAGEMENT, WHICH TEND TO BE FAIRLY EXPENSIVE.

THERE IS SOME EVIDENCE THAT THERE'S WASTE ASSOCIATED WITH THE COST ASSOCIATED WITH WOUND MANAGEMENT, WHICH IS VERY COMMON FOR MEDICARE PATIENTS.

ALSO THINGS LIKE INCONTINENCE.

NERVE MANAGEMENT.

PAIN MANAGEMENT, ET CETERA.

THESE ARE THE TYPES OF TREATMENTS THAT ARE COMMONLY LISTED IN THE LIST OF 16.

TED: WHY WOULD NERVE AND PAIN MANAGEMENT -- IS THAT STOCK AND BOND WHAT WE'VE SEEN IN THE PAST?

WASTE AND FRAUD AND SUCH?

>> WELL, ACCORDING TO THE EXPERTS AT THE CMS AND THOSE THAT HAVE DESIGNED THIS PROGRAM, THEY'RE STATING SOME OF THESE PROCESSES AND THE TREATMENTS, THERE IS EVIDENCE THAT THERE'S HIGH WASTE FOR SOME OF THESE PROCEDURES, AND IT'S INTERESTING BECAUSE THEY HAVEN'T NECESSARILY LISTED ALL OF THE PROCEDURES WHERE THERE IS HIGH EVIDENCE FOR WASTE.

WE'RE GOING TO SEE WHAT IT'S LIKE FOR THESE 16.

IT'S GOING TO START IN JANUARY, AND RIGHT NOW IT'S SCHEDULED FOR ABOUT SIX MONTHS.

TED: SIX MONTHS OR SIX YEARS?

>> SORRY, SIX YEARS.

TED: CALLED THE WASTEFUL AND INAPPROPRIATE SERVICE REDUCTION MODEL, WISER, I THINK.

>> YES.

TED: HAS THERE BEEN WASTEFUL AND INAPPROPRIATE SERVICE?

IS THIS A GOOD THING?

>> IT REALLY DEPENDS WHO YOU'RE TALKING TO, RIGHT?

IF YOU ASK THE HEALTH INSURANCE INDUSTRY, THE ANSWER WILL OFTEN BE, LOOK, THERE'S A HISTORY OF SOME WASTE, THERE'S A HISTORY OF SOME ABUSE, THERE'S A HISTORY OF SOME FRAUD IN THE HEALTH CARE SYSTEM, AND I THINK THAT THAT'S SOMEWHAT UNDENIABLE.

THIS IS AN ATTEMPT AT SOLVING THAT PROBLEM.

EVIDENCE KIND OF SHOWS ABOUT FIVE TO SEVEN PER CENT COST SAVINGS BASED ON PRIOR AUTHORIZATION.

IF YOU ASK PROVIDERS AND HEALTH CARE SYSTEMS WHAT THE ANSWER WILL BE, WELL, BUT WE'RE SPENDING BILLIONS OF DOLLARS IN JUST THE ADMINISTRATIVE REQUIREMENT, AROUND 40% OF ALL DOCTOR'S OFFICES HAVE SOMEONE HIRED JUST TO HANDLE PRIOR AUTHORIZATION.

SO THIS IS A HUGE ADMINISTRATIVE CHALLENGE, HUGE ADMINISTRATIVE COST THAT OFTEN GETS PASSED ONTO THE PATIENT.

TED: AND WE'VE ALSO HEARD FROM CRITICS OF THIS PARTICULAR IDEA AND THIS PILOT PROGRAM, THIS IS A BACKDOOR WAY TO PRIVATIZING MEDICARE?

IS THERE ANY POINT IN THAT?

>> WELL, WE'LL HAVE TO SEE BECAUSE AGAIN, THIS IS SOMEWHAT UNPRECEDENTED.

WE GENERALLY HAVE NOT HAD A SYSTEM LIKE THIS, OR APPROACH LIKE THIS ESPECIALLY WITH TRADITIONAL MEDICARE.

WE DON'T TOUCH TRADITIONAL MEDICARE.

SOMETHING ELSE THAT'S REALLY INTERESTING IS THAT THE COMPANIES THAT WILL BE CONTRACTED FOR THE A.I.

REVIEW, THERE IS A PROFIT SHARING ARRANGEMENT AS WELL, SO AT THE MOMENT THERE'S A PROFIT SHARING ARRANGEMENT SO THE COMPANIES WILL RECEIVE SOME KIND OF PROFIT FOR THE WASTE THAT THEY'VE SAVED THE FEDERAL GOVERNMENT.

TED: MY GOODNESS, A LITTLE COMMISSION GOING ON, HUH?

>> AS STATED RIGHT NOW.

TED: INTERESTING.

IS THERE ANY OPTING OUT FOR ANYONE IN ANY WAY, SHAPE, OR FORM WITH THIS?

>> AS IT'S STATED, PROVIDERS, CLINICIANS, HEALTH SYSTEMS, NEED TO OPT INTO THE SYSTEM, BUT WHAT'S TRICKY HERE IS IF YOU HAVE NOT OPTED INTO THE PRIOR AUTHORIZATION PROCESS FOR THE 16 PROCESSES, THERE CAN BE A POST REVIEW OF HOW YOU TREATED SAID ONE OF THE 16 ISSUES, RIGHT?

AND YOU CAN STILL BE DENIED REIMBURSEMENT IF THE A.I.

GENERATION AND IF THE REVIEW DETERMINED THAT YOU DID NOT PROVIDE THE CORRECT TREATMENT OR THE LEAST EXPENSIVE TREATMENT.

TED: I WOULD IMAGINE A POST REVIEW WOULD BE MORE ADMINISTRATIVE WORK, WOULD IT NOT?

>> WELL, IT WOULD.

AND REMEMBER, WHEN WE'RE TALKING ABOUT THE REVIEWS IN GENERAL, WE'RE NOT AS FAMILIAR WITH THE A.I.

REVIEWS BUT WE HAVE INDEPENDENT CLINICIANS THAT WORK FOR THE INSURER, THE CONTRACTOR THAT REVIEWING THE TREATMENT, THE PRESCRIPTION, THERE ARE CONVERSATIONS BETWEEN THE PRESCRIBING PHYSICIAN AND THE REVIEWING PHYSICIAN, SOMETIMES NOT THE MOST PLEASANT AND ALSO THE ADMINISTRATOR AT THE PHYSICIAN'S OFFICE OR WITH THE HEALTH CARE SYSTEM, IT'S A PROCESS, AND CAN YOU APPEAL BUT LOTS OF PATIENTS DON'T APPEAL, AND SO THERE'S A NAVIGATION TO THE PROCESS.

TED: LAST QUESTION BECAUSE WE'RE RUNNING OUT OF TIME, SEEMS LIKE THIS IS FLYING AWFULLY LOW UNDER THE RADAR.

WHEN THIS KICKS IN IN JANUARY ARE WE GOING TO SEE A HUE AND CRY, WAIT A MINUTE, WHAT'S GOING ON HERE?

>> WE'LL SEE WHAT THE ACTUAL AFFECTS ARE.

WHAT'S INTERESTING IS THE TRUMP ADMINISTRATION HAS BEEN PROUD OF THE FACT THEY'VE LESSENED AND STREAM LINED SOME OF THE PRIOR AUTHORIZATION REQUIREMENTS AROUND MEDICARE ADVANTAGE.

IT WAS A FASCINATING DECISION TO INSTITUTE THIS NEW APPROACH A FEW MONTHS LATER.

WE'LL HAVE TO SEE HOW THIS AFFECTS PATIENTS IN THE HEALTH CARE SYSTEM.

TED: DR.

SWAPNA REDDY, ALWAYS A PLEASURE, THANK YOU.

>> THANKS FOR HAVING ME.

TED: THAT IS IT FOR NOW.

I'M TED SIMONS.

THANK YOU SO MUCH FOR JOINING US.

YOU HAVE A GREAT EVENING.