Becker’s Payer Issues Podcast: Recent Episodes
Becker's Healthcare
The Becker's Payer Issues Podcast is the must-listen podcast exclusively created for health insurance executives. Two new 15-minute episodes are released weekly with the leaders who shape health insurance in America and the cost of care, policy and regula
In this episode, Jessica Lopez-Liggett, Commercial State Plan President for Anthem Blue Cross and Blue Shield in Indiana, discusses rising healthcare costs, simplifying the member and provider experience through technology, and expanding high-quality, lower-cost care through provider partnerships. She also shares why addressing social determinants of health and bringing employers, providers and community organizations together is critical to improving healthcare.
In this episode, Dr. Stanley Crittenden, Chief Medical Officer at Cigna Healthcare, discusses how AI-powered analytics and personalized care management are helping identify health risks earlier, improve outcomes and simplify healthcare navigation. He shares how Cigna is using technology to support clinicians, expand access to care and drive affordability while keeping human connection at the center.
In this episode, Katie Catlender, Chief Operating Officer at Point32Health, discusses the organization’s push to consolidate legacy digital platforms, reduce administrative costs and create a simpler experience for members and providers. She also shares how Point32Health is using AI responsibly to personalize care, reduce friction and build trust while keeping members at the center.
In this episode, Sarah Adkins, director of public policy with the Elevance Health Public Policy Institute, discusses research showing lower telehealth utilization among rural populations and the barriers driving the gap. She shares strategies for payers and healthcare leaders to expand digital infrastructure, tailor telehealth programs and improve access for underserved members.
In this episode, David Debono, MD, Oncology Medical Director at Carelon Health, shares how technology, clinical pathways, and data-driven insights are helping improve cancer care while supporting physicians, expanding access, and delivering more personalized treatment for patients.
In this episode, Dan LaVallee, Associate Vice President of Community Engagement at UPMC Health Plan, and Dr. Brandy Hershberger, Chief Nursing Officer and Vice President of Academic Affairs at UPMC, discuss how innovative apprenticeship programs, workforce partnerships, and community engagement are creating sustainable healthcare career pathways and strengthening the future workforce.
In this episode, Susan Mullaney, Chief Operating Officer at Blue Shield of California, discusses how stronger payer-provider partnerships, AI, value-based care, and pharmacy innovation can improve health outcomes, lower costs, and reshape care delivery for the future.
In this episode, Dr. Ben Kornitzer, Senior Vice President, Chief Medical Officer at Aetna, discusses how AI, real-time data exchange, and prior authorization reform can strengthen payer-provider partnerships and improve patient outcomes.
In this episode, Dr. Daniel Knecht, Chief Medical Officer, EmblemHealth, discusses how the organization's AI-powered Environmental Resilience Program helps identify and support members at risk during extreme heat events. He also shares how predictive outreach, clinical oversight, and addressing social determinants of health are shaping the future of population health management.
In this episode, Angel Ballew, Head of Pharmacy Clinical Programs and Services at Centene, discusses how the organization approaches GLP-1 coverage across Medicaid, Medicare, and marketplace plans while balancing clinical evidence, affordability, and member access. She also shares insights on utilization management, adherence strategies, and preparing for the next wave of indications for these rapidly evolving therapies.
In this episode, Dr. Ken Cohen, Chief Medical Officer at Optum Health, discusses new research on Medicare Advantage, social vulnerability, and how full-risk care models can improve quality, efficiency, and patient outcomes. He also shares insights on the infrastructure, technology, and strategies needed to advance value-based care.
In this episode, Margaret Anderson, President of Health Alliance Plan by Henry Ford Health, discusses the organization's rebrand, its strategy for deeper integration with Henry Ford Health, and how it's driving growth while improving affordability. She also shares insights on provider sponsored health plans, administrative efficiency, and the growing impact of gene therapies on the healthcare system.
In this episode, Karla Mills, Vice President of Product Innovation, Surescripts, discusses how health plans can use medication data as an early signal to identify risk, prioritize new members, and improve care management. She shares practical strategies for preparing ahead of enrollment surges and leveraging existing programs to drive better outcomes and operational performance. For more information, please check out our website: https://surescripts.com/who-we-serve/health-plans
In this episode, Kelly Munson, President and CEO of Independence Health Group, discusses the evolving Medicaid and ACA landscape, the impact of policy changes on coverage and affordability, and the role of managed care in improving health outcomes. She also shares insights on food as medicine, healthcare innovation, and leadership lessons from becoming the organization's first female CEO.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Liz Signorella, Senior Director of Payor Contracting, Clover Health. She discusses reducing administrative burdens for providers, leveraging AI and real-time data to support proactive care, and improving patient outcomes through stronger care coordination and earlier intervention.
In collaboration with Hippocratic AI.
In this episode, Morgan Kendrick, EVP and President, Commercial Health Benefits, Elevance Health, discusses the rising cost pressures facing employers and explores how balanced funding, self-funding, and multiple employer welfare arrangements can help improve affordability while simplifying healthcare benefits for businesses and their employees.
In this episode, Rhonda Randall, DO, Executive Vice President and Chief Medical Officer, UnitedHealthcare, Commercial Business, Board member of the United Health Foundation, discusses findings from the America’s Health Rankings 2026 Senior Report, highlighting encouraging gains in preventive care and physical activity alongside rising concerns around drug deaths, suicide, and food insecurity among older adults.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Sharon Williams, Chief Executive Officer, and Management Consultant, University of Michigan Health Plan. Sharon shares insights on balancing rising utilization costs with member experience, the role of technology and data integration in improving care coordination, and why expanding access to healthcare coverage is critical to building a healthier America.
In collaboration with Hippocratic AI.
In this episode, Carey Ketelsen, President of Virtix Health, joins the podcast to discuss how healthcare organizations are transforming risk adjustment through prospective outreach, AI-enabled workflows, and stronger payer-provider collaboration. She shares insights on improving documentation integrity, aligning incentives, and building patient-centered risk adjustment programs that support long-term success in value-based care.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Adam Park, Director of Network Development, Curative Health Plan, who discusses how Curative is redesigning employer-sponsored healthcare by removing financial barriers to care and investing in prevention. He also shares how AI is improving credentialing, prior authorization, and member support while helping create faster, more personalized healthcare experiences.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Cara Wahmann, Executive Director Clinical Oversight & Ops Support, HCSC, who discusses how health plans are navigating rising complexity across regulation, digital transformation, and member expectations. She also shares insights on using interoperability and AI to reduce administrative friction, digitize clinical policies, and improve consistency, personalization, and outcomes across payer operations.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Patrick Stevenson, Vice President, Data and Technology, McLaren Health Plan. Patrick discusses how McLaren Health Plan is leveraging predictive analytics, AI, and proactive care strategies to improve member outcomes, streamline prior authorization, and better manage risk in today’s evolving payer landscape.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Garfield Collins, Co-Founder and Chief Administrative and Partnership Officer, Zing Health. Garfield shares how Zing Health is balancing affordability with high-touch member engagement, leveraging technology and AI to support chronically ill populations, simplify care navigation, and build long-term trust with members.
In collaboration with Hippocratic AI.
In this episode, Dave DeHommel, Senior Vice President and General Manager of Payer Solutions at Reveleer, discusses how Medicare Advantage plans can reduce RADV audit exposure through stronger clinical data infrastructure, prospective risk adjustment strategies, and year-round documentation readiness. Visit https://www.reveleer.com/solutions/radv-audit?utm_source=beckers&utm_medium=podcast&utm_campaign=260402--radv-b2g1 to learn more.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Patrick Stevenson, Vice President, Data and Technology, McLaren Health Plan. Patrick discusses how McLaren Health Plan is leveraging predictive analytics, AI, and proactive care strategies to improve member outcomes, streamline prior authorization, and better manage risk in today’s evolving payer landscape.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Rob Hitchcock, President and Chief Executive Officer, Select Health. Rob discusses the operational pressures facing payers today, including Medicare Advantage challenges and rising pharmaceutical costs, while sharing how Select Health is leveraging AI and end-to-end member insights to improve care coordination, trust, and the overall member experience.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Andy Higgins, Vice President, Product And Member Engagement, Clever Care Health Plan. Andy shares how Clever Care is building trust through culturally competent care, community-based member engagement, and AI-enabled support tools that enhance human interaction while improving quality outcomes and member experience.
In collaboration with Hippocratic AI.
In this episode, Rakesh Mathew, MS, MBA, CPHIMS, Interoperability Leader at Jefferson Health Plans, joins the podcast to discuss the financial pressures facing payers and how sustained losses can reduce competition and lead to market consolidation. He shares perspectives on improving affordability and access, and outlines how organizations can prepare for success in 2027 through stronger interoperability and strategic planning.
In this episode, Ilan Shapiro, MD, MBA, FAAP, FACHE, Chief Health Correspondent and Medical Affairs Officer and Senior Vice President at AltaMed Health Services, joins the podcast to discuss breaking language barriers in healthcare and closing gaps between patients and providers. He shares how improving communication and cultural understanding can lead to better access, stronger relationships, and improved health outcomes.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Michael Roan, Market Lead, South Atlantic Markets, Oscar Health. He discusses innovative plan design, proactive care strategies, and how Oscar Health is leveraging AI and personalized member experiences to improve outcomes, reduce barriers to care, and support long-term health engagement.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Damanjeet Chaubey, Vice President, Clinical Affairs, Clover Health. She discusses how Clover Health is using AI, clinical decision support, and home-based care models to improve member outcomes, reduce costs through proactive interventions, and support care teams without adding administrative burden.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Chris Gay, Chief Executive Officer, Evry Health and Pendral. He discusses rebuilding trust between payers and members, using AI voice technology to improve engagement and care coordination, and how innovative plan design and digital tools can help lower costs while enhancing the member experience.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Betsy Williamson, RN, BS, MHA, Vice President, Quality Performance and Population Health, Medical Mutual of Ohio. She shares how an AI healthcare voice agent is expanding member engagement, improving satisfaction, and enabling care teams to focus on higher impact work while maintaining a human-centered approach to care.
This episode is sponsored by Hippocratic AI.
In this episode, Steve Moorehead, Vice President of Product, Strategic Planning and Performance Management at Blue Cross Blue Shield of Massachusett, and Marc Pierce, Principal at ECG Management Consultants, discuss why client retention has become a growing challenge for health plans and how organizations can use data-driven insights to identify risk earlier.
This episode is sponsored by ECG Management Consultants.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Brandy Thompson, CEO, Benefitbay. She discusses how ICHRA models are shifting healthcare decision-making to employees, the operational challenges payers face with legacy systems, and how AI is improving member engagement, plan selection, and care navigation while maintaining trust and quality.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Ceci Connolly, President And Chief Executive Officer, ACHP, reflects on the growing financial and operational pressures facing health plans across all lines of business, and how nonprofit, community-based payers are navigating affordability while strengthening local relationships and care coordination.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Siva Balu, Senior Vice President, Chief Information and Digital Officer, Quartz. He discusses the operational challenges facing payers today, how AI and automation are improving affordability and member experience, and the importance of interoperability and data-driven engagement across healthcare.
In collaboration with Hippocratic AI.
In this episode, Lisa Baird, Chief Executive Officer of Aetna Better Health of Missouri, joins the podcast to discuss keeping community needs at the center of healthcare strategy. She shares how her organization is reaching members in rural areas, improving access to care, and navigating evolving Medicaid eligibility requirements while continuing to support vulnerable populations.
In this episode, Kelli Tice, MD, Vice President of Medical Affairs and Chief Health Improvement Officer at GuideWell and Florida Blue, joins the podcast to discuss navigating healthcare with limited resources while continuing to improve outcomes. She shares insights on advancing maternal health, the importance of thoughtful decision-making, and how leadership choices can create meaningful impact across populations and communities.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Jennifer St Thomas, Senior Vice President, Commercial and Medicare Markets, Mass General Brigham Health Plan. She discusses the growing focus on affordability, improving access to lower cost sites of care, and how digital tools and AI are helping simplify member communications and strengthen care coordination.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Dr. Krystal Revai, Chief Medical Officer, Atrio Health. She shares how her team is tackling data challenges, using targeted care management to improve outcomes for high risk members, and thoughtfully integrating AI to support rather than replace human driven care.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Nora Leibowitz, Chief Medicaid Program Officer, CareOregon. She discusses rising utilization and funding pressures, how CareOregon is streamlining operations to improve member and provider experience, and the role of data and AI in reducing friction and strengthening outcomes.
In collaboration with Hippocratic AI.
In this episode, Dr. Tunde Sotunde, President and CEO of Blue Cross and Blue Shield of North Carolina & CuraCor Solutions, discusses the drivers of rising healthcare costs, the importance of value-based care and whole-person health, and how innovative programs and partnerships are improving access, affordability, and outcomes across the state.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Ellen Sexton, Executive Vice President and Chief Growth Officer, Blue Shield of California. She discusses tackling healthcare affordability, scaling virtual care and digital tools like Virtual Blue, and using AI and data-driven strategies to improve access, reduce ER utilization, and enhance member experience while maintaining trust and quality.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Dr. Saria Saccocio, Chief Medical Officer, Essence Healthcare discusses how clinicians are overwhelmed and how payer-provider collaboration, simplified care navigation, and AI-enabled workflows are helping improve quality, reduce costs, and strengthen member experience in Medicare Advantage.
In collaboration with Hippocratic AI.
In this episode, Hasan Shanawani, Associate Chief Medical Officer at Horizon Blue Cross Blue Shield of New Jersey, joins the podcast to discuss rising healthcare costs and the growing role of AI in payer decision-making. He shares how AI can enable organizations to “say yes” more often, while maintaining trust, transparency, and quality as these tools increasingly face consumers.
In this episode, Brendan Harris, President, UPMC for You and State Programs & Patti Jackson-Gehris, President, UPMC North Central and Williamsport markets, discuss UPMC’s strategies to improve rural healthcare access through workforce development, telehealth expansion, and innovative care models that address geographic and socioeconomic barriers.
In this episode, Tim Lieb, Senior Vice President of Commercial Markets at Blue Shield of California, discusses the three-year impact of Virtual Blue, including lower costs, reduced ER utilization, improved access to care, and how virtual first models are reshaping employer and individual health plans.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Alan Silver, President, ICHRA, Ambetter Health Solutions, discussing how payers are addressing consumer expectations and affordability pressures, leveraging digital tools to scale ICHRA, and driving a more personalized, choice-based future for employer-sponsored healthcare.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Howard Weiss, Vice President, Government Relations, EmblemHealth, discussing how payers are addressing trust in healthcare, balancing cost with member experience, and using AI to enhance care management, outreach, and workforce support without replacing human roles.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Trey Sutten, CEO and Co-Founder of Siftwell, Director of Clinical Solutions. Here, he explores how health plans can prepare for HR1 by identifying at risk members, leveraging data and community partnerships, and building proactive strategies to maintain coverage amid regulatory change.
This episode is sponsored by Siftwell.
In this episode, Dr. Lisa Shah, Executive Vice President and Chief Medical Officer of Twin Health, discusses how AI-powered digital twin technology is transforming care for chronic conditions and enabling personalized, real-time interventions. She also shares insights on payer trends, outcomes-based models, and new approaches to reducing reliance on medications while improving long-term health outcomes.
This episode is sponsored by Twin Health.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Dirk Soenksen, Chief Executive Officer of Ceresti Health, discussing why dementia is a major yet underrecognized cost driver and how it reshapes population health strategy. He highlights the critical role of family caregivers, the limitations of traditional care management, and how payer-focused models can improve outcomes while reducing costs.
This episode is sponsored by Ceresti Health.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Megan Zakrewsky, VP of Product Strategy, Veradigm, Director of Clinical Solutions. Here, she explores how prospective gap closure, interoperable data exchange, and EHR integrated workflows are helping independent providers act on payer insights in real time, reduce administrative burden, and improve outcomes across underserved and rural populations.
This episode is sponsored by Veradigm.
In this episode, Rob Andrews, Chief Executive Officer of the Health Transformation Alliance, joins the podcast to discuss the ongoing pressures and competition within Medicare Advantage. He shares insights on chronic care initiatives and the importance of collaboration and compromise between carriers and providers to improve outcomes and control costs.
In this episode, Brandy Thompson, Chief Executive Officer, Benefitbay, discusses the rapid growth of ICHRA models and why large employers are increasingly embracing choice driven benefits. She also shares how education, broker alignment, and evolving payer strategies are shaping the future of employer sponsored healthcare.
In this episode, Harlon Pickett, President of Eagle Care Health Solutions, joins the podcast to discuss the impact of direct primary care models on patient outcomes and cost. He shares how designing more effective networks and leveraging data can help create a more personalized and efficient healthcare experience.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Joseph Leach, Market President, Oscar Health. He discusses the growing trust gap in healthcare, how empowering consumers through tools like ICHRA and AI can improve outcomes, and why meeting members where they are is key to balancing cost and experience.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Dr. Benjamin Kornitzer, Chief Medical Officer, Aetna, discussing efforts to reduce administrative friction, streamline prior authorization, and improve care navigation for members and providers. He also shares how Aetna is leveraging AI, interoperability, and digital tools to enhance real time decision making, build trust, and deliver more personalized, efficient healthcare experiences.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Christina Ott, Chief Strategy Officer, Quartz, discussing how her organization is tackling rising costs by rethinking the payer role, improving care navigation, and reducing friction for members. She also shares insights on aligning digital investments and using AI to streamline workflows, enhance communication, and create a more seamless healthcare experience.
In collaboration with Hippocratic AI.
This episode recorded live at the Becker’s Spring 2026 Payer Issues Roundtable features Robert Holzer, Strategy and Innovation Leader, Next Horizon Innovations, Martin Luethi, Chief Technology Officer, Quest Analytics, & Bob Tavernier, Solution Executive, Quest Analytics. The conversation explores how provider data has evolved from a compliance requirement into a strategic driver of AI readiness, network performance, regulatory alignment, and member trust, emphasizing the need for clean data, strong governance, and scalable infrastructure.
This episode is sponsored by Quest Analytics.
This episode recorded live at the Becker’s 16th Annual Meeting features Jennifer Jones, Director of Clinical Solutions, Noom. Here, she explores how GLP-1s should be viewed as part of chronic disease management rather than a pharmacy-only cost issue, and how payer strategies that combine medication access with behavior change programs can improve long-term clinical outcomes and deliver more sustainable ROI.
This episode is sponsored by Noom Health.
In this episode, Sundar Srinivasan, President – Health Plan & Life Sciences, NTT DATA, discusses how payer organizations are moving from AI pilots to scaled deployments, focusing on high impact use cases, operational transformation, and the importance of trust, governance, and measurable ROI.
This episode is sponsored by NTT DATA.
In this episode, Mike Stuart, President and CEO of Blue Shield of California, shares how his finance and provider background shapes a systems approach to improving health outcomes, strengthening provider partnerships, and addressing rising healthcare costs. He also discusses the growing impact of chronic disease and why collaboration across the healthcare ecosystem is critical to making care more affordable and accessible.
In this episode, Steve Yurjevich, Chief Executive Officer of Optum Insight’s Payer Market and a member of the American Heart Association Executive Leadership Team, joins the podcast to discuss rising healthcare costs and the growing adoption of AI across the payer landscape. He shares how the industry is shifting from pre-pay models to true avoidance strategies, focusing on preventing unnecessary care and improving overall system efficiency.
In this episode, Jeff Bak, President and Chief Executive Officer of Imagine360, joins the podcast to discuss improving health literacy for seniors and the role it plays in driving better outcomes. He shares how proactive care strategies and smarter use of utilization data can help create a more effective, patient-centered healthcare system.
In this episode, Rob Duffy, Chief Technology Officer at HealthEdge, explores how modern cloud infrastructure and deeply integrated AI can help health plans manage rising complexity, reduce administrative costs, and scale operations. He shares why platform consolidation and embedded AI are critical to staying competitive and sustaining performance in a rapidly evolving healthcare landscape.
This episode is sponsored by HealthEdge.
In this episode, Alexandra Anderson, Head of Health Plan Sales & Partnerships at Color, explores how proactive, personalized screening and integrated care pathways can improve early cancer detection and reduce total cost of care for cancer. She shares insights on Color's approach to identifying risk & closing screening gaps, increasing member engagement, and the importance of timely, proactive interventions along the cancer care continuum.
This episode is sponsored by Color.
In this episode, Pankhuri Sharma, Strategy and Operations Leader at Humana, joins the podcast to discuss gaps between population health strategy and real-world outcomes. She shares key priorities for effective population health programs and offers practical advice for emerging leaders navigating the evolving healthcare landscape.
In this episode, Charles Fan, President of Headspace, and Charlie Andres, Lead Actuary at Headspace, explore the drivers behind rising behavioral health costs and the growing impact of outpatient therapy. They discuss how integrated, prevention-focused care models and improved care pathways can help health plans manage costs while delivering better outcomes.
This episode is sponsored by Headspace.
In this episode, Marc Jeffreys, General Manager of Health at Gradient AI, discusses how insurers are moving from experimental AI to practical tools that support underwriting, pricing, and population health decisions. He also explains why connected intelligence across the risk lifecycle can improve pricing stability, strengthen employer relationships, and unlock clearer insights from complex data.
This episode is sponsored by Gradient AI.
In this episode, Kevin Knight, Chief Marketing Officer at Sidecar Health, joins the podcast to discuss making healthcare more intuitive and consumer-friendly. He shares how giving money back to consumers through tools like HSAs can improve engagement, and explains why competition and technology are key drivers of meaningful system-wide improvement.
In this episode, Jhana Spence, Senior Vice President of Strategy at CERIS, discusses the shift toward proactive payment integrity and what it means to “move left” in the claims lifecycle. She explores how health plans are leveraging data, analytics, and automation to reduce financial leakage, improve provider relationships, and build accuracy before payment goes out the door.
This episode is sponsored by CERIS.
In this podcast, Steve Province, former CEO of a major MCO, joins Kendall Lockhart, Founder & CEO of Me+U Care, to unpack why “meeting people where they are” remains so hard in practice for many health plans, and what it will take to rebuild trust under growing HR1 pressures. A grounded, real world conversation about the human side of member retention.
This episode is sponsored by Me+U Care.
In this episode, Dr. Faisal Tai, board-certified psychiatrist and founder of PsychPlus, discusses how fragmented systems, limited connectivity, and misaligned incentives are driving gaps in behavioral health access and rising costs. He shares how vertically integrated care models, unified platforms, and better care coordination can improve outcomes, reduce ED utilization, and lower total cost of care at scale.
This episode is sponsored by PsychPlus.
In this episode, Gene German, Chief Technology Officer at Lyric, explores how small, domain-specific language models (SLMs) are driving measurable improvements in claims and payment integrity. He outlines how combining AI with human judgment can increase efficiency, reduce variability, and enhance accuracy across complex healthcare workflows. Gene also shares a practical roadmap for scaling AI, from identifying the right use cases to building the data, governance, and feedback systems needed for sustained impact.
This episode is sponsored by Lyric.ai.
In this episode, Gretchen Wagner, Associate Vice President - Risk Management, Humana, discusses how health plans are navigating cost pressures, workforce challenges, and rapid change by strengthening value-based partnerships and operational efficiency. She highlights the critical role of data interoperability, digital innovation, and analytics in improving member experience and long-term sustainability.
In this episode, Dr. Sameer Amin of L.A. Care Health Plan discusses how building durable community infrastructure, rather than short-term programs, supports continuity of care amid Medicaid enrollment shifts. He explains how investments in housing, food access, and care coordination can deliver measurable ROI while improving outcomes and reducing administrative burden.
In this episode, Brian Cheney, Division SVP of Sales Operations and Commercial Markets Growth at Health Care Service Corporation, discusses the launch of Unity Health Hub and how it helps employers navigate the growing number of digital health solutions. He explains how the platform integrates vetted vendors, improves member engagement, and delivers clearer data on outcomes and impact.
In this episode, Rhonda Randall, DO, Chief Medical Officer for UnitedHealthcare’s employer and individual business, discusses the company’s expansion of doula coverage to millions of members and the evidence behind its impact on maternal and infant health. She also explains how doulas support care teams and why employers are increasingly prioritizing better maternity care outcomes.
In this episode, Daniel J. Elliott, MD, MSCE, FACP, FAAP, Chief Medical Officer of Provider Experience at Centene Corporation, discusses how payers and providers can work together to address cost pressures, workforce challenges, and care coordination. He also shares perspectives on using AI, improving data sharing, and reducing friction in processes like prior authorization to strengthen the healthcare ecosystem.
In this episode, Krista Nelson, CEO of Optum Health, shares her vision for strengthening value based care through a more focused care delivery model, stronger clinician support, and expanded technology capabilities. She also discusses Medicare Advantage policy stability, the role of AI in reducing administrative burden, and how partnerships across the healthcare ecosystem can improve outcomes and patient experience.
In this episode, Dr. Kara Odom Walker, Chief Medical Officer for Aetna Medicaid, discusses a new collaboration with National Association of Community Health Centers to improve hypertension control in underserved communities. She shares how data, community partnerships, and addressing social drivers of health can help reduce disparities, prevent chronic disease complications, and improve outcomes for Medicaid members.
In this episode, Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan, joins the podcast to discuss how payer–provider relationships are evolving amid cost pressures and workforce shortages. She explores common gaps between strategy and execution, the importance of disciplined operational follow-through, and why healthy competition remains essential to driving innovation, value, and improved outcomes across the healthcare landscape.
In this episode, Jennifer L. Kowalski, Vice President of the Public Policy Institute at Elevance Health, discusses how rigorous research and data shape Medicare Advantage strategy, from supplemental benefits to dual eligible integration. She shares insights on affordability, care navigation, and how evidence based policy can strengthen value, access, and long term sustainability in the program.
In this episode, Karen Walker Johnson, Chief Executive Officer of Clever Care Health Plan, discusses how culturally competent, value based care is reshaping Medicare Advantage. She shares insights on strengthening provider trust, investing in community based engagement, and advocating for quality metrics that recognize cultural competence to improve outcomes and affordability.
In this episode, Jeff Bak, President and Chief Executive Officer of Imagine360, shares how alternative health plan models and reference based pricing can lower employer costs while improving the member experience. He discusses narrowing networks, building provider trust, correcting broker misconceptions, and delivering guaranteed savings in a high pressure cost environment.
In this episode, Emily Durfee, Partner of Corporate Venture Capital at Healthworx, discusses strengthening payer provider collaboration, accelerating responsible AI adoption, and using strategic investment to address regulatory uncertainty and the rising cost of care.
In this episode, Saria Saccocio, MD, MHA, Chief Medical Officer of Essence Healthcare, discusses the growing collaboration between payers and providers, the push for site neutral care and pharmacy cost reform, and the need for stronger investment in cardiometabolic and population health. She also shares how quality performance, member experience, and social determinants of health are shaping health plan strategy and margins heading into 2026.
In this episode, Michael Hunn, CEO, and Yunkyung Kim, COO, of CalOptima Health discuss preparing for Medicaid eligibility changes, preventing coverage losses, and supporting providers amid rising uncompensated care risks. They also share plans for a 2027 Covered California marketplace launch and reflect on building community trust through collaboration and mission driven leadership.
In this episode, Jennifer Schirmer, VP of Growth and Community Engagement and interim VP of Duals Program Integration at Blue Shield of California Promise Health Plan, breaks down the sweeping Medicaid changes under HR1 and their impact on California’s Medi-Cal members. She shares how her team is investing in high touch outreach, community partnerships, and duals integration to help vulnerable populations maintain coverage and access to care amid rising administrative complexity.
In this episode, Elizabeth Crawley, Vice President for Clinical and Care Management Solutions at EXL, explores how AI driven workflows and agentic automation are transforming prior authorization. She discusses balancing efficiency with clinical oversight, scaling decision support across the enterprise, and why data readiness and change management are critical to success.
This episode is sponsored by EXL.
In this episode, Sheri Johnson, former Vice President of Member Enrollment and Billing at UCare, shares insights on how payer and provider relationships are evolving under cost and workforce pressure, where strategy and operations often misalign, and why AI is poised to reshape health plan performance in the years ahead.
In this episode, Ty Wang, Co-Founder and Chief Executive Officer at Angle Health, shares how his team is rethinking health plan infrastructure to move beyond transactional payer provider relationships. He discusses modernizing operations with AI, improving transparency for employers and brokers, and aligning incentives around outcomes, affordability, and member experience.
In this episode, Eric C. Hunter, President and CEO of CareOregon, discusses how the organization is aligning with providers to improve quality and performance while managing cost pressures. He shares insights on leveraging AI, navigating regulatory challenges, and creating sustainable solutions for Medicaid and community health.
In this episode, Brandy Thompson, Chief Executive Officer of Benefitbay, shares where payer strategy continues to fall short in execution, what investments could reshape health plans, and how reducing administrative complexity can improve margins and access to care.
In this episode, Rob Andrews, Chief Executive Officer of the Health Transformation Alliance, discusses how employers and providers can work more closely to improve value, reduce middleman costs, and drive better outcomes. He shares perspectives on payer competition, transparency, GLP 1 cost pressures, and how technology and personalized medicine may reshape health plans in the years ahead.
In this episode, Melanie Fernando, President and CEO of Aetna Better Health of Illinois, discusses launching a virtual menopause partnership to close gaps in Medicaid women’s health, improve member engagement, and drive better outcomes through tailored, community based solutions.
In this episode, Alex Ding, MD, Enterprise Deputy Chief Medical Officer at Humana, discusses the findings from Humana’s latest Value-Based Care Report, including lower hospital admissions and emergency department visits among Medicare Advantage members in value based arrangements. He shares how deeper primary care continuity, stronger payer provider alignment, and reduced administrative burden are key to scaling sustainable, outcomes driven care. Learn more here: https://humana.com/vbc
In this episode, Steve Sutherland, Senior Vice President of Information Systems at CERIS, shares how AI and machine learning are reshaping payment integrity across the full claims lifecycle. He discusses the shift toward prepayment solutions, the importance of governance and data quality, and how leaders can balance automation with accuracy, fairness, and trust.
This episode is spon sponsored by CERIS.
In this episode, Patrick Gilligan, President and CEO of Point32Health, shares how the New England based nonprofit is confronting rising medical and pharmacy costs while staying focused on members and employers as its true shareholders. He discusses the affordability crisis, aligning incentives with providers, and why redesigning care around the patient experience is essential to lowering costs and improving outcomes.
In this episode, Paul Markovich, President and CEO of Ascendiun, discusses his testimony before Congress, the push to eliminate PBM spread pricing and rebates, and why he believes the healthcare industry must confront its cost problem head on. He also shares how Ascendiun’s new structure, digital health record ambitions, and unbundled PBM model aim to build a system that is sustainably affordable and worthy of patients and families.
In this episode, Thomas Graf, MD, Chief Medical Officer for Florida Blue, part of GuideWell, shares how the health plan is improving cancer care through a high-touch, tech-enabled navigation program for Medicare Advantage members. He discusses reducing variation, closing gaps between diagnosis and treatment, and achieving better outcomes, higher satisfaction, and lower costs by centering care around the patient experience.
In this episode, Lila Benayoun, Chief Operating Officer at MetroPlusHealth, shares how the organization is translating member affordability data into simpler plan design, predictable costs, and high-touch community support across New York City. She discusses addressing disparities through multilingual outreach, culturally competent services, and operational strategies that help members better understand and use their coverage.
In this episode, Tilak Mandadi, Executive Vice President of Ventures and Chief Experience and Technology Officer at CVS Health, shares how the company is investing in and building technology to simplify healthcare and drive better consumer engagement. He discusses CVS Health Ventures, interoperability, AI strategy, and the vision behind creating an open, consumer-centric platform that connects payers, providers, pharmacies, and patients.
In this episode, Dr. Damanjeet Chaubey, Vice President of Clinical Affairs at Clover Health, shares how payer provider relationships are evolving under cost and workforce pressures and where plans often fall short in operational execution. She discusses technology enabled, PCP centric, and home based care models as critical levers for managing utilization, improving outcomes, and sustaining Medicare Advantage performance.
In this episode, Craig Kurtzweil, Chief Data and Analytics Officer for UnitedHealthcare’s commercial business, shares insights from UnitedHealthcare’s latest employer health trends report, including rising costs among younger workers, more frequent catastrophic claims, and growing metabolic risks. He discusses how data driven strategies can help employers better target engagement, prevention, and affordability.
In this episode, Brett Bingham, Chief Network Development Officer at Banner Plans and Networks, discusses how payers and providers are shifting toward collaboration amid cost pressures and workforce shortages. He shares where strategy is outpacing execution, why data and payment models matter for value based care, and how Banner is staying disciplined in its long term investments.
In this episode, Kristie Spencer, Vice President of Provider Partnerships at Elevance Health, shares how the company is aligning incentives, leveraging digital tools, and using AI to simplify workflows. She explains how effective partnerships and actionable data are driving better outcomes, affordability, and sustainability in value-based care.
In this episode, Howard Brill, Senior Vice President of Population Health and Quality at Monroe Plan for Medical Care, shares insights on value based contracting, rising cost pressures, and the persistent gap between strategy and execution in population health. He also discusses the role of data integration, AI, and regulatory practices in shaping affordability, access, and health plan performance in 2026.
In this episode, Rob Hitchcock, President and Chief Executive Officer of Select Health, discusses how payer provider collaboration, cultural change, and proactive care models are reshaping health plan strategy amid rising cost pressures. He shares perspectives on regulatory headwinds, Medicaid and Medicare reform, and more.
In this episode, Dr. Sachin Jain, President and CEO of SCAN Group, discusses his Forbes op-ed outlining 10 leadership resolutions and argues that healthcare’s biggest challenge is a lack of resolve, not innovation. He shares why speaking plainly, rejecting performative change, and focusing on real patient impact are essential to rebuilding trust in the industry.
In this episode, Erin Henderson Moore, President and CEO of Fidelis Care of New Jersey, shares how the plan is navigating Medicaid uncertainty through integration, member engagement, and upstream investment in behavioral health, housing, and LTSS. She discusses why data sharing, outcome based accountability, and enabling people to age at home will shape the next decade of government sponsored care.
In this episode, Linda Hines, Virginia’s Medicaid Market President at Humana, shares how school based partnerships are improving access to youth behavioral health services, especially in rural communities. She discusses workforce development, measurable outcomes, and why listening to families, providers, and youth is critical to long term success.
In this episode, Jack Hooper, CEO and Co-founder of Take Command, explains how individual coverage HRAs are reshaping employer sponsored benefits and why adoption is accelerating. He discusses cost control, employee choice, and what early success stories signal for the future of health insurance.
In this episode, Bethanie Stein, PharmD, Segment President of Pharmacy at Humana, discusses how employers are approaching GLP-1 coverage and why partnerships with manufacturers like Eli Lilly and Novo Nordisk matter now. She shares how CenterWell Pharmacy is using transparency, clinical oversight, and adherence focused models to expand access while managing costs.
In this episode, Dr. Alice Hm Chen, Executive Vice President and Chief Health Officer at Centene, discusses how the organization is improving maternal and child health outcomes across Medicaid, Medicare, and Marketplace populations. She shares insights on rural care challenges, evidence based interventions like midwifery and doulas, and how data and partnerships drive population health impact.
In this episode, Nick Gates, president of Priority Health, shares his leadership journey, the values shaping his approach, and how trust and community guide decision making. He also discusses digital transformation, multi state expansion, and priorities around affordability, access, and member experience.
In this episode, Heather Tamborino, Chief Financial Officer at EmblemHealth, discusses how payer provider collaboration, thoughtful use of AI, and data integration can improve outcomes while easing administrative burden. She also shares how rising pharmacy costs, PBM strategy, and transparency initiatives are shaping financial priorities for 2026.
In this episode, Jay Nakashima, President of eHealth Exchange, discusses how modern data standards and trusted networks are transforming payer provider information sharing, reducing reliance on fax and manual processes. He also shares where inefficiencies persist, how interoperability can lower administrative costs, and what policy changes could improve affordability and access.
In this episode, Howard Weiss, Vice President of Government Affairs at EmblemHealth, discusses how payer provider collaboration, community based programs, and value focused partnerships can improve affordability and outcomes. He also shares how consumer pressure, regulatory scrutiny, and responsible use of AI are shaping health plan strategy and margins in 2026.
In this episode, Chris Gay, CEO and Co-Founder of Evry Health, joins Jakob Emerson to discuss how technology, scale, and business model alignment can dramatically reduce prior authorization friction. He shares why Evry Health’s approach delivers faster decisions, lower denial rates, and a better patient and provider experience, and what the industry needs to change next.
In this episode, Ellen Sexton, Executive Vice President and Chief Growth Officer at Blue Shield of California, discusses the impact of major policy changes on Medicaid and commercial markets, how her team is preparing for uncertainty, and the strategies needed to support members, stabilize employer coverage, and advance innovation across California's health care landscape.
In this episode, Dr. Cynthia Brown, Medical Director and Clinical Lead for Women’s Health at Elevance Health, discusses Elevance Health’s expansion of doula services into select employer health plans, highlighting how doula support improves outcomes, reduces disparities, strengthens the care experience, and creates long-term value for mothers and babies.
In this episode, Steve Levin, CEO of Quest Analytics®, shares how health plans can prepare for 2026 as regulations evolve and market expectations shift. He unpacks what current network trends are signaling for plan strategy, why provider data accuracy and operational efficiency are becoming key competitive differentiators, and how leaders can adopt technology and AI in practical ways that drive real, measurable value.
This episodeis sponsored by Quest Analytics®.
In this episode, Dr. Saria Saccocio, Chief Medical Officer at Essence Healthcare, explains how strong provider partnerships, real time data, and a member centered approach drive the plan’s four and a half star performance. She also shares how addressing social needs and listening closely to members shapes future benefit design and care delivery.
In this episode, Steve Tringale, President of Mass General Brigham Health Plan, shares how the organization is expanding its product portfolio, entering the dual eligible market, and investing in integrated digital care management to better support members across all stages of life.
In this episode, Kevin Adams, CEO of HealthEdge, discusses how health plans can overcome legacy technology challenges through modernization, business process as a service (BPaaS), and AI-driven efficiency. He shares insights on building stronger operational foundations and how next-generation automation is reshaping payer operations.
This episide is sponsored by HealthEdge.
In this episode, Rick Harbit of Blue Cross Blue Shield of North Carolina and Bob Tavernier of Quest Analytics discuss how payers are navigating financial pressures, advancing network adequacy 2.0, and using data and network intelligence to drive long-term success.
This episode is sponsored by Quest Analytics.
Dr. Meera Atkins, Chief Medical Officer at Lyric.ai, shares how clinically informed AI can transform payment accuracy from a reactive process to a proactive, transparent partnership. She discusses the importance of trust, clinical validation, and equity in advancing value-based care and reducing administrative friction across the healthcare ecosystem.
This episode is sponsored by Lyric.ai.
In this episode, Marcy Tatsch, Executive Vice President and General Manager of Truven by Merative, shares insights into how employers and health plans can use data analytics to lower costs, improve outcomes, and design smarter benefit strategies in a challenging healthcare landscape.
This episode is sponsored by Merative.
In this episode, Shana Hoffman, President and CEO of Lucet, shares why behavioral health is the key to transforming patient outcomes and reducing costs. She discusses how Lucet is breaking down fragmentation, scaling integrated care, and achieving measurable results for patients and health plans.
This episode is sponsored by Lucet.
In this episode, Vinay Kulkarni, Chief Information Officer at SCAN Group, discusses how AI, automation, and digital tools are transforming Medicare Advantage. He explains how these technologies improve care coordination, reduce administrative burden, and personalize care for seniors while maintaining high-quality, empathetic member experiences.
In this episode of Payer Issues, Rachel French, Chief Strategy and Partnerships Officer at MD Live by Evernorth, discusses the impact of point solution fatigue on the member experience, and how MD Live is redefining access with care that's connected, personalized, and provider-guided.
This episode is sponsored by MD Live by Evernorth.
This episode features Dave Raccagni, Vice President of Innovation, Market Insights, and Communications at Cigna Healthcare. He discusses Cigna’s partnership with Paytient to expand flexible, no-interest dental payment options for 13 million members, how the program improves preventive and critical care access, and its potential to drive long-term health and cost savings across broader areas of care.
On this episode, Mark Grippi, AmeriHealth Caritas Ohio Market President joins the podcast to discuss opening dialogue with members to improve care, the role of health risk assessments, and overcoming digital fatigue in healthcare.
This episode features Dr. Richard Celko, Chief Dental Officer at UPMC Health Plan who discusses challenges with access to dental care in rural areas, strategies for addressing community needs, and insights on current events shaping the dental industry.
This episode features Heather Tamborino, CFO at EmblemHealth, who discusses the company’s $2 million investment in food security across New York City. She shares how EmblemHealth’s neighborhood care centers are addressing food insecurity, connecting social and medical care, and redefining health equity as both a mission and a strategic imperative.
This episode features Richard Greene, President of Clever Care Health Plan, discussing how the organization is growing through a unique model that combines Eastern and Western medicine, invests in culturally tailored community centers, and builds sustainable relationships with providers and members across California.
This episode features Colleen Briggs, President of the Blue Cross NC Foundation and Vice President of Corporate Responsibility at Blue Cross NC. She discusses the Feed Your Health initiative, how food-based interventions are improving outcomes for members with diabetes, and what it takes to move these programs from pilot to sustainable, systemwide solutions.
In this episode, Michael Carson, President and CEO of Wellcare, a Centene company, shares how his diverse career and mission-driven approach shape Wellcare’s Medicare strategy. He highlights the unique needs of dual eligible members, the importance of integrated care, and the push to improve consumer experience across healthcare.
In this episode, Dan Kueter, CEO of UnitedHealthcare's Employer & Individual business, talks about new tools like the UHC Store, the impact of AI on healthcare navigation, and how employers and members are adapting to rising costs and evolving therapies.
In this episode, Steven Berkow, Senior Advisor for Value-based Care at InterSystems, and Robert Tennant, Executive Director of the Workgroup for Electronic Data Interchange, discuss the evolving landscape of ePrior authorization. They share insights on regulatory changes, industry collaboration, and what healthcare leaders should know as the 2027 compliance date approaches.
This episode is sponsored by InterSystems.
In this episode, Zack Myers, National General Manager at SCAN Health Plan, discusses the organization’s expansion into new markets, its nonprofit approach to provider partnerships, and how innovative models like iSNPs are improving care and independence for seniors.
In this episode, Brendan Harris, president of UPMC for You and state programs, shares how initiatives like the Pathways to Work program and Neighborhood Centers are addressing social determinants of health, supporting Medicaid members, and strengthening local communities.
In this episode, Mack McGee, Chief Marketing Officer at CareFirst BlueCross BlueShield, shares how the organization earned top marks for customer experience in Forrester’s 2025 rankings and discusses the importance of trust, personalization, and simplifying healthcare interactions for members.
In this episode, Scott Burton, Market President at Providence Health Plan, shares insights on the growing interest in ICRAs, strategies to manage rising employer health costs, and how Providence is balancing innovation with long-term sustainability in a shifting insurance landscape.
In this episode, Jay Deady, President of Price Optimization at Zelis, discusses why fragmented pricing operations create inefficiencies for health plans and how integrated solutions, advanced technology, and personalization are paving the way for a more connected financial experience across healthcare.
This episode is sponsored by Zelis.
This episode features Cereasa Horner, Director of Policy and Payment Integrity at CERIS, who shares insights on the evolving payer oversight landscape. She discusses the challenges of maintaining consistency across state and federal guidelines, the role of AI and predictive compliance modeling, and strategies for payers to stay proactive in a dynamic regulatory environment.
This episode is sponsored by CERIS.
In this episode, Bill Harlan, Vice President of Behavioral Health at Point32Health, shares how his team is addressing access challenges, supporting members through navigation services, and building innovative partnerships to improve mental health care delivery.
In this episode, Dan LaVallee and Dr. Brandy Hershberger of UPMC share how the health system is creating innovative apprenticeship programs to support Medicaid members and employees in pursuing meaningful careers. They discuss workforce development, grant funding, and how these programs are shaping the future of healthcare talent pipelines.
In this episode, Alan Cohen, Co-founder and Chief Product Officer at Centivo, joins the podcast to share his perspective on escalating healthcare costs, premium increases, and the risks facing the ACA market. He also explains how Centivo partners with high-performing providers to deliver cost-effective, sustainable coverage for employers and their employees.
In this episode, Dr. Nathan Crock of Premera Blue Cross shares how the AI-powered chatbot “Alice” is helping hundreds of customer service representatives quickly find accurate information, reducing call times, improving member satisfaction, and enhancing internal knowledge management.
In this episode, John Byrnes, Chief Operating Officer at Banner|Aetna, discusses how the organization is advancing value-based care through integrated technology, strong payer-provider collaboration, and personalized member support. He highlights key strategies driving improved health outcomes and sustainable cost management in Arizona.
In this episode, Karen Ignagni, Executive Chair, and Dr. Dan Knecht, Chief Medical Officer at EmblemHealth, discuss the launch of the first health plan covered lifestyle medicine program for early-stage Alzheimer’s. They explore how evidence-based interventions, community support, and integrated care are reshaping brain health and advancing equity in underserved populations.
In this episode, Jeff Yuan, Co-founder of Mending, discusses how his company is building an AI-native health insurer focused on reducing provider burden and improving patient access through direct primary care partnerships. He also shares insights on rebranding, early success in Maine and Oklahoma, and plans for thoughtful national expansion.
In this episode, Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan, shares her experience testifying before Congress on the future of Medicare Advantage and highlights key policy changes needed to protect access, expand rural care, and ensure member choice in a rapidly evolving healthcare landscape.
In this episode, Michael Hunn, CEO of CalOptima Health, joins Jakob Emerson to discuss how the organization is preparing for sweeping changes under the Federal Reconciliation Bill. He shares insights on preserving access to care, the importance of managed care partnerships, and how collaboration, communication, and innovation will be essential to maintaining Medicaid’s long-term sustainability.
This episode features Anthony J. Colistra, President of MD Live by Evernorth, discussing how virtual care has evolved, where consumer demand is headed, and how MD Live is using AI to personalize the patient experience, improve patient-provider communication, and streamline provider administrative tasks to give them more time to spend with patients.
This episode is sponsored by Evernorth.
In this episode, Alan Murray, President and CEO of MediDrive, shares how innovative, tech-enabled approaches to non-emergency medical transportation are closing care gaps, reducing no-show rates, and supporting more coordinated, patient-centered care—while also improving administrative efficiency and helping to lower system-wide costs.
This episode is sponsored by MediDrive.
In this episode, Dr. Joe Kimura, Chief Medical Officer at SCAN Health Plan, discusses how SCAN is leading innovation in Medicare Advantage through personalized care, data analytics, and strategic partnerships. He also explores the critical role of technology and member engagement in improving outcomes for a growing senior population.
This episode features Amy Jordan, Vice President of Consumer Digital Engagement at UnitedHealthcare, discussing the launch of Smart Choice, a data-driven provider search tool designed to simplify healthcare navigation. Amy shares how the platform uses personalization and quality metrics to improve member experience and how it fits into UnitedHealthcare’s broader digital transformation strategy.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dr. Tom Allen, Executive Medical Director, Behavioral Health, Blue Cross and Blue Shield. Dr. Allen shares how his team is advancing behavioral health outcomes through telehealth, data-driven insights, and deeper integration with primary care while addressing rising rates of mental health conditions with a focus on member experience and whole-person care.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Chris Wasel, President, Strategic Partnerships, Vantage Healthcare. He shares how Vantage is aligning value-based care, patient satisfaction, and care accessibility through innovative on-site services in skilled nursing and assisted living facilities across New England.
In this episode, Michelle Fullerton of Blue Cross Blue Shield of Michigan and Connie S. Ducaine of MyndYou, explore how AI is streamlining workflows, improving patient engagement, and helping care teams operate at the top of their licensure. They share real-world use cases, tips for integration, and insights on measuring value across efficiency, quality, and outcomes.
This episode is sponsored by MyndYou.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Saria Saccocio, Chief Medical Officer, Essence Health. Saria shares how Essence Health is enhancing outcomes through physician-led value-based care, leveraging technology like AI and wearable health devices, and advancing health equity through deep community partnerships.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Shawn Shuman, Director, Medical Management, Peak Health. Shawn discusses how Peak Health is tackling healthcare access barriers, boosting member satisfaction, and addressing health equity through innovative care management strategies.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Harlon Pickett, President, Eagle Care Health Solutions. He shares how his organization is improving healthcare access, affordability, and quality through customized, membership-based models, while expanding care equity in rural and underserved communities.
In this episode, Kevin Barron, Deputy VP of Payer Relations at University Health, shares how his team is navigating increasingly aggressive payer tactics, implementing smarter contract oversight, and championing a mission-first approach to revenue cycle operations. He also explains why aligning contracting within RevCycle has delivered measurable results for patient care and financial performance.
In this episode, Carey Ketelsen, President of Virtix Health, joins Becker’s Healthcare to discuss how payers are navigating and accelerating value-based care (VBC) strategies in 2025. From increasing revenue projections to the role of AI and data analytics, Carey shares insights into the opportunities and challenges shaping payer-provider collaboration. Tune in to explore how health plans can align technology, readiness, and long-term strategy to thrive in a shifting care landscape.
This episode is sponsored by Virtix Health.
Chris Gay, CEO of Evry Health, joins the podcast to discuss how his organization is enhancing the patient experience and advancing population health. He explores how innovative technology is being used to address persistent challenges in the payer space and improve health outcomes. Gay also shares insights into building a more efficient, patient-centered healthcare system through digital transformation.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Doug Henry, Enterprise Medical Director of Behavioral Health, Highmark Health. Dr. Henry shares how Highmark is improving access, outcomes, and satisfaction through strategic partnerships, data-driven innovation, and value-based care models that prioritize mental health as a pillar of total health.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Illan Shapiro Strygler, Chief Health Correspondent and Medical Affairs Officer and Senior Vice President, AltaMed Health Services. Dr. Shapiro shares how AltaMed leverages data, cultural understanding, and community connection to improve care quality, reduce costs, and advance health equity.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Kourtney Witten, Area Vice President Network Managing Partner Wisconsin, Advocate Health. Witten discusses how her organization is leveraging data, technology, and relationship-based care to reduce costs, close care gaps, and deliver high-quality, patient-centered outcomes across diverse populations.
In this episode, Becker's Healthcare speaks with Jim Blondin, Senior Director of Digital Product Strategy at Accredo Specialty Pharmacy, about the strategic benefits of integrating specialty pharmacy into EHR workflows. The discussion explores how this integration can reduce workflow friction, improve care coordination, and enhance both patient and provider experiences. Tune in for insights relevant to pharmacy leaders, CIOs, and healthcare executives navigating digital transformation.
This episode is sponsored by Accredo Specialty Pharmacy.
In this episode, Joey Seliski of Allegheny Health Network and Pritee Subramany of Highmark Health discuss how consistent, accurate provider data is essential for improving care coordination, patient trust, and enabling AI-driven tools like virtual assistants and personalized provider recommendations.
This episode is sponsored by Kyruus Health.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dr. Brian Smolich, Vice President, Health Alliance Quality and Managed Care Operations, Carle Health. Dr. Smolich shares how his organization is balancing cost and quality, leveraging biosimilars, digital engagement tools, and provider collaboration to improve member outcomes and transform the care experience.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Brad Riley, Vice President, Analytics and Reporting, Longevity Health. Brad discusses how Longevity Health is leveraging predictive analytics, machine learning, and innovative provider partnerships to balance cost containment with high-quality care, while empowering staff with AI literacy for the future of managed care.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Paul Christopher Hiltz, President and CEO, NCH Healthcare System. Paul shares how a metrics-driven culture, strategic partnerships, and clinical excellence are guiding NCH’s efforts to improve care quality, reduce costs, and expand access through major initiatives like a new orthopedic hospital and heart institute.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Louis DeStefano, Senior Vice President of Growth at Oscar Health. He shares how Oscar is leveraging personalized plan designs, technology-driven engagement, and the growing potential of ICHRAs to improve affordability, satisfaction, and outcomes in the individual insurance market.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dr. Alex Ding, Deputy Chief Medical Officer, Humana. Dr. Ding shares how Humana is bridging its payer and provider roles to advance health equity, enable clinicians, and drive value-based care transformation at scale, all while putting whole-person care and patient experience at the center.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Sufian Chowdhury, Chief Executive Officer of Kinetik. Sufian discusses how Kinetik is transforming non-emergency medical transportation (NEMT) through real-time data, interoperability, and plan-owned infrastructure to improve compliance, reduce fraud, and enhance member experience.
This episode is sponsored by Kinetik.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Lila Benayoun, Chief Operating Officer, MetroPlusHealth. She shares how the organization is combining predictive analytics, personalized outreach, and community-based services to proactively manage care, improve member satisfaction, and address social determinants of health across New York City.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Mark Rich, Former President and current Board Member of Steward Health Care System LLC. Mark shares insights from the provider and ACO perspective on accelerating value-based care, aligning payer-provider collaboration, and leveraging actionable data to drive both affordability and improved outcomes.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Lawrence Hamilton, Executive Vice President, The Permanente Medical Group. Lawrence discusses the power of payer-provider alignment in delivering population health, advancing health equity across service lines, and using real-time patient feedback to enhance care experience and outcomes.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Dr. Aisha Rahim, Medical Director and Co-Lead, AI Governance Council, Johns Hopkins Health Plans (JHHP). Dr. Rahim discusses how JHHP is leveraging artificial intelligence to manage costs, close care gaps, advance health equity, and enhance member engagement across a diverse population.
In this episode, Dr. Jennifer Nuovo, Chief Medical Officer of Blue Shield of California’s Promise Health Plan, joins Jakob Emerson to discuss how her team is increasing access to preventive care, addressing health disparities, and building community trust through targeted outreach, innovative programs, and a focus on whole person care.
Stacy Edgar, Co-Founder and CEO at Venteur, joins the podcast to discuss how her organization is working to strike the right balance between affordability and quality in healthcare. She highlights initiatives that support new mothers in navigating their healthcare journey and emphasizes the importance of understanding and aligning with partners to drive meaningful outcomes.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dawn Maroney, Chief Executive Officer of Alignment Health Plan and President of Alignment Health. She shares how Alignment uses AI-assisted care, culturally aware outreach, and a deep commitment to equity to deliver affordable, personalized care for seniors while preserving the human touch at every step.
This episode, recorded live at the Becker’s Hospital Review 15th Annual Meeting, features Nirnay Patel, EVP and GM of Benefits1™ and Chief Digital Officer at Simplify Healthcare. He shares how integrated benefits data, AI, and platform thinking are transforming payer operations and personalizing the member journey across Medicare, Medicaid, and commercial markets.
This episode is sponsored by Simplify Healthcare.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dawn Maroney, Chief Executive Officer of Alignment Health Plan and President of Alignment Health. She shares how Alignment uses AI-assisted care, culturally aware outreach, and a deep commitment to equity to deliver affordable, personalized care for seniors while preserving the human touch at every step.
In this episode of the Becker’s Healthcare Podcast, Lukas Voss is joined by Chad Kersting, Business Development Director, and Dr. Eric Gratias, National Physician Executive of Medical Benefit Services, both from EviCore by Evernorth. Together, they explore the evolving landscape of utilization management (UM) beyond prior authorization—highlighting common misconceptions, the challenge of underutilization, and the growing push toward preventive, personalized care. Tune in for real-world examples, emerging strategies, and a future-focused look at how UM can better serve both clinicians and patients.
This episode is sponsored by Evernorth.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Samuel Wollner, Vice President, Strategy and Partnerships, EmblemHealth. He shares how EmblemHealth is advancing health equity, leveraging Net Promoter Score for improvement, and focusing on deep community engagement to transform care delivery across New York.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dr. Rebekah Hughey, Medical Director at Highmark Wholecare. She shares how Highmark’s Living Health model streamlines care delivery, tackles health equity through maternal health and food access programs, and enhances member satisfaction through a patient-centered, tech-enabled approach.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Crissy Turino, Chief Plan Officer & Chief Operating Officer, CountyCare. Crissy shares how CountyCare is advancing health equity through housing and food access programs, while boosting member satisfaction and outcomes through value-based care and community engagement.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Catherine Tabaka, Chief Executive Officer, and Dr. Michael Cantor, Chief Medical Officer. They discuss how Matrix Medical Network’s in-home care model addresses gaps in the healthcare system by enabling whole-person care, improving coordination, and supporting better health outcomes at lower costs.
This episode is sponsored by Matrix Medical Network.
In this episode of the Becker’s Payer Issues Podcast, Jakob Emerson speaks with Dr. Tracy Gayeski, Chief Health Officer at Catalight, a nonprofit organization dedicated to transforming care for individuals with autism and intellectual and developmental disabilities (I/DD). Dr. Gayeski discusses how Catalight is addressing affordability, individualized care at scale, and social determinants of health—all while preparing for the transformative role AI will play in the next two years. Tune in for a thoughtful exploration of what meaningful, sustainable, and person-centered care really looks like.
This episode is sponsored by Catalight.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Raj Ronanki, Chief Executive Officer, Lyric. Here, he discusses the company's evolution, its focus on real-time, AI-powered payment integrity, the strategic acquisition of ClaimShark, and Lyric’s vision for enabling autonomous healthcare operations and greater transparency across the system.
This episode is sponsored by Lyric.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Dr. Sachin Jain, President and Chief Executive Officer, SCAN Group. Dr. Jain discusses how SCAN is redefining member experience through human-centered care and highlights the urgent need for deeper payer-provider partnerships to drive true innovation and better outcomes in healthcare.
In this episode, Erfan Karim, Chief Clinical Operations Officer at NYC Health + Hospitals/Bellevue, discusses the critical role of Medicaid in public health, the impact of recent policy shifts, and how innovation in care delivery can help safeguard vulnerable communities. He also shares how personal experience drives his commitment to equitable access for all.
In this episode, Alan Silver, President of Centene’s ICHRA-focused Ambetter Health Solutions, joins the Jakob Emerson to discuss the rapid evolution of individual coverage HRAs, why large and small employers are embracing the model, and what it takes for insurers to succeed in this growing space.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Sheri Johnson, Vice President, Member Enrollment and Billing, UCare. Sheri discusses how member feedback led to meaningful changes in payment options—including credit card and pay-by-phone solutions—and how these innovations have significantly improved member satisfaction and engagement.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Sheri Johnson, Vice President, Member Enrollment and Billing, UCare. Sheri discusses how member feedback led to meaningful changes in payment options—including credit card and pay-by-phone solutions—and how these innovations have significantly improved member satisfaction and engagement.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Jarrod McNaughton, CEO of Inland Empire Health Plan. Jarrod shares how IEHP is aligning mission, culture, and bold innovation to drive health equity, improve quality through performance-based partnerships, and enhance member satisfaction with community-centered programs.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Dr. Eric Weil, Chief Medical Officer at MD Live by Evernorth. Dr. Weil discusses how MD Live is innovating virtual care through a focus on efficiency, prevention, and access—while emphasizing the critical role of quality and safety in transforming healthcare delivery.
This episode is sponsored by Evernorth.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Peter Kuipers, CFO of Clover Health. Peter shares how Clover’s technology-first approach is enabling earlier chronic disease diagnosis, improving care quality, and driving down costs—while expanding access through a premium-free PPO model and partnerships with other payers.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Stuart Langley, SVP, Client Services, Everise & Sadie Rizzuto, Vice President, Enterprise Technology Solution Implementation, Humana. They discuss the power of predictive models, AI, and automation in improving member engagement, reducing friction in claims, and advancing proactive care and provider collaboration.
This episode is sponsored by Everise.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Angie Kalousek, Senior Director, Clinical Strategy and Programs at Blue Shield of California. Angie shares how her organization is innovating in value-based care, virtual delivery, and health equity initiatives to balance affordability, quality, and access for diverse member populations.
In this episode of the Becker’s Healthcare Podcast, Erika Spicer Mason speaks with Brian Workinger and Lauree Handlon of The Craneware Group about how AI and data-driven insights are helping providers navigate increasingly complex payer contracting and reimbursement environments. The conversation covers predictive modeling, payer transparency, and preparing for shifts in Medicare Advantage participation, all within the broader context of value-based care. Tune in to hear how hospitals can leverage advanced analytics to drive smarter financial strategies and improve long-term sustainability.
This episode is sponsored by Craneware.
In this episode, Jake Biscoglio, President of Commercial Business at Harvard Pilgrim Health Care, discusses the organization's expanded partnership with Progeny Health to support families for a full year after NICU discharge. He shares personal insights and industry strategies to improve outcomes through comprehensive, family-centered care.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Dr. Damanjeet Chaubey, Vice President of Clinical Affairs at Clover Health. Dr. Chaubey shares how Clover is leveraging AI-powered technology, proactive care models, and home-based strategies to improve outcomes, reduce costs, and redefine Medicare Advantage.
In this special episode recorded at Becker’s Annual Meeting 2025, leaders from Noom Health share how their platform is advancing whole-person care through behavior change and digital innovation. The conversation highlights how Noom leverages data, coaching, and psychology to support better health outcomes—particularly in chronic disease management and preventative care. Tune in to hear how scalable digital solutions are reshaping engagement and impact across the healthcare ecosystem.
This episode is sponsored by Noom Health.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Ty Wang, Co-Founder and Chief Executive Officer of Angle Health. Ty shares how Angle Health is using AI and human-centered advocacy to improve member experience, lower costs, and drive innovation in health plan delivery.
In this episode, Dorothy Seleski, President of Medi-Cal at Health Net, discusses the organization's $9 million investment in strengthening California’s physician workforce, with a focus on underserved communities, cultural representation, and long-term collaboration across sectors.
Bob Tavernier of Quest Analytics® and Karen Tachian of Health Care Service Corporation discuss network performance in health plans including key survey insights, challenges with data quality, and how payers can use network data to drive strategic goals. The conversation highlights the importance of competitive intelligence, compliance, and member access in building high-performing networks.
This episode is sponsored by Quest Analytics.
This episode recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable features Eric Cannon, Chief Pharmacy Benefits Officer at SelectHealth. Eric shares how transparency, evidence-based care, and a personalized approach to member experience are key to driving better outcomes and reducing healthcare costs.
This episode, recorded live at the Becker's 3rd Annual Spring Payer Issues Roundtable, features Karina Lupercio, VP of Market Integration & Data, and Ann Marie Gomez, Sr. Director of Marketing at Healthcare Highways. They discuss how curated networks, culturally competent communication, and emerging technologies like AI are helping redefine healthcare access, affordability, and trust for members.
In this episode, we’re joined by Courtney Yeakel, Chief Product Officer, and Michael Moore, Chief Revenue Officer at Veradigm, to explore how technology is driving deeper collaboration between payers and providers. They share strategies for reducing administrative complexity, integrating risk adjustment and quality initiatives, and harnessing AI to improve patient outcomes. Tune in to hear how trusted partnerships, data transparency, and forward-thinking governance are shaping the future of value-based care.
This episode is sponsored by Veradigm.
In this episode of the Becker’s Payer Issues Podcast, Erika Spicer Mason speaks with Dr. Jenna Glover, Chief Clinical Officer at Headspace, about how health plans can better address mental health challenges by moving away from one-size-fits-all models. Jenna shares how smart triage, proactive care, and precision-based strategies can lead to better outcomes, reduced costs, and more equitable access to support. Tune in to hear how health plans can take a leading role in reshaping mental healthcare delivery for the future.
This is episode is sponsored by Headspace.
In this episode, Jeff Bak, President and CEO of Imagine360, discusses how his organization is innovating to make healthcare more affordable, equitable, and member-friendly. He shares insights on direct contracting, price protection, health equity efforts, and how better member engagement is driving improved outcomes.
In honor of Mental Health Awareness Month, Dr. Matthew Hurford, President and CEO of Community Care Behavioral Health at UPMC, discusses how UPMC is advancing mental health support across staff, providers, and communities. He highlights practical steps to move from awareness to action and addresses pressing challenges like youth mental health and social isolation.
In this episode of the Becker’s Payer Issues Podcast, Lukas Voss speaks with Whitney Eubanks, VP of Product Management at PointClickCare, about the sharp decline in Star Ratings across major health plans and what it means for the future of value-based care. Whitney unpacks the financial, operational, and patient care implications of slipping scores—and shares how real-time data and smarter care coordination can help plans close gaps, meet critical benchmarks, and regain their edge. Tune in for a candid conversation on what it really takes to reverse the trend and boost plan performance in a competitive landscape.
Sponsored by PointClickCare.
In this episode, Dr. Romilla Batra, SVP and Chief Medical Officer at Premera Blue Cross, discusses how she’s rethinking clinical strategy to align with the quintuple aim, reduce healthcare costs, and enhance equity. She also shares insights on empowering providers, removing barriers to care, and partnering with communities for better health outcomes.
In this episode, we explore how data analytics and clinical expertise can transform kidney health management for health plans. Joining the conversation is Joe Vattamattam, Founder and President of Healthmap Solutions, who shares insights on why tackling chronic kidney disease (CKD) and end-stage renal disease (ESRD) is crucial. Tune in to learn how Healthmap leverages technology, clinical support, and innovative strategies to improve outcomes for patients and providers.
This episode is sponsored by Healthmap Solutions.
In this episode of the Becker’s Healthcare Podcast, Lukas Voss sits down with Mark Johnson, Senior Vice President at CERIS, to explore how payment integrity can significantly reduce billing errors and financial waste in healthcare. With up to 80% of medical bills estimated to contain mistakes, Mark shares how technology, process modernization, and strategic payer initiatives are making a meaningful impact. Tune in for insights on how payers can improve accuracy, streamline operations, and drive value across the payment lifecycle.
This episode is sponsored by CERIS.
In this episode, Melissa Skottegaard, Chief Communications Officer and Chair of The Cigna Group Foundation, shares how the organization is tackling youth mental health, veteran housing insecurity, and health equity through a data-driven, employee-powered community engagement strategy designed for deeper, more focused impact.
In this episode of the Becker’s Healthcare Podcast, Brook and Jocelyne from Verifiable dive into the critical connection between provider network growth, payer collaboration, and the modernization of credentialing systems. They explore how outdated legacy systems hinder patient access and provider onboarding, and share actionable strategies for healthcare leaders to improve compliance, reduce delays, and prepare for upcoming NCQA changes. With real-world examples — including Midi Health's rapid nationwide expansion — this discussion offers a forward-looking roadmap for building more efficient, scalable, and patient-centered networks.
This episode is sponsored by Verifiable.
In this episode, Dr. Ruchi Talwar, Medical Director of Episodes of Care Population Health at Vanderbilt Health, joins Jakob Emerson to discuss how provider-led bundled payment programs are improving outcomes, reducing costs, and delivering value for both employers and patients. She shares insights into Vanderbilt’s innovative “My Health Bundles” and their real-world success in reshaping specialty care.
In this episode, Steve Tringale, President of Mass General Brigham Health Plan, discusses the evolving landscape of healthcare, the challenges and opportunities brought by change, and how the organization is leveraging AI and integrated care to improve member outcomes and experiences. He also shares insights into leadership in a time of rapid industry transformation.
In this episode of the Becker's Healthcare Podcast, Erika Spicer Mason speaks with Neetu Rajpal, CEO of Lilac Software, about the evolving role of AI—specifically agentic AI—in the healthcare payer space. Neetu shares how this emerging technology is being applied to streamline claims grievances, close care gaps, and support Medicare Advantage programs, all while emphasizing the importance of ethics, patient-centered design, and regulatory compliance.
This episode is sponsored by Lilac Software.
In this episode, Senthu Arumugam, Chief Commercial Officer at SCAN Health Plan, discusses the evolving Medicare Advantage landscape, the impact of market disruptions, and how technology and stability-driven strategies can improve member experiences.
In this episode, Dr. Ravi Kavasery, Chief Medical Officer at Blue Shield of California, joins Jakob Emerson to discuss the company’s ambitious goal of shifting 90% of eligible healthcare spending to pay-for-value models. Dr. Kavasery shares insights on the challenges of transitioning from fee-for-service, the importance of aligning incentives, and the innovative models shaping the future of healthcare affordability and quality.
In this episode, Dr. Steve Friedhoff, Senior VP of Healthcare Services at Blue Cross Blue Shield of North Carolina, discusses innovative initiatives addressing healthcare workforce shortages and expanding access to care. From supporting veterans transitioning into medical careers to investing in youth mental health programs, Dr. Friedhoff highlights how Blue Cross NC is shaping the future of healthcare in the state.
In this episode, Jane Brown, Vice President of Medicaid Strategic Support and Oversight at Aetna, discusses the evolving Medicaid landscape. She shares insights on improving connectivity, driving value-based care, and empowering both providers and beneficiaries through data and technology.
In this episode, Dr. Dirk Slaker, Chief Medical Officer at Sonder Health Plans, discusses the evolving Medicare Advantage landscape. He shares insights on addressing rising healthcare costs, improving care coordination, supporting caregivers, and how Sonder’s partnership with Cleo aims to enhance patient outcomes.
In this episode of the Becker’s Payer Issues Podcast, Dr. Pooja Mittal, Vice President and Chief Health Equity Officer at Health Net, discusses key challenges and opportunities in healthcare today. She explores the impact of Medicaid funding, the role of telehealth in underserved communities, and how AI can drive better health outcomes.
In this episode of the Becker's Healthcare Podcast, Jakob Emerson is joined by Rob Duffy, CTO at HealthEdge, to discuss the evolving role of platform-based technology in healthcare. They explore how interoperability, regulatory changes, and change management strategies are shaping the future of health plans. Tune in for expert insights on overcoming technological silos, preparing for innovation, and navigating the complexities of the healthcare ecosystem.
This episode is sponsored by HealthEdge.
In this episode, Dr. Shantanu Agrawal, Chief Health Officer at Elevance Health, discusses the company’s innovative approach to addressing social determinants of health. He highlights the Elevance Health Foundation’s new impact investing program, its focus on behavioral health, and how insurers can drive meaningful change in communities.
In this episode, Sam Melamed, CEO of NCD, and Bret Voith, Chief Strategy Officer, discuss major regulatory shifts affecting ACA and Medicare Advantage. They explore how new policies may impact health plans, enrollment trends, and the growing demand for supplemental benefits like dental and vision coverage.
In this episode, Dr. Ken Cohen, Executive Director of Translational Research at Optum Health, discusses the impact of value-based care models on patient outcomes. He shares key findings from his recent research, including how Medicare Advantage patients in value-based arrangements receive superior care and how these benefits extend to traditional Medicare patients.
In this episode of the Becker’s Healthcare Podcast, host Lukas Voss is joined by Aarti Karamchandani, Chief Growth Officer at MacroHealth, to discuss how payers can drive continuous improvement in the healthcare ecosystem. They explore the role of price transparency data, interoperability, and robust data analysis in optimizing workflows, improving patient outcomes, and reducing costs. Tune in for key insights on overcoming challenges and implementing effective strategies for data-driven healthcare transformation.
This episode is sponsored by MacroHealth.
In this episode of the Becker’s Healthcare Podcast, host Erika Spicer Mason explores how payer organizations can leverage compliance as a strategic advantage in their digital marketing efforts. David Chai, Senior Manager of Product Marketing at Freshpaint, shares insights on key industry trends, evolving consumer expectations around data privacy, and emerging tools that can help payers stay competitive.
This episode is sponsored by Freshpaint.
Katherine Barresi, Chief Health Services Officer at Partnership HealthPlan of California, shares insights on the current sphere of healthcare and highlights efforts to improve access to care. She also discusses how rapid advancements in technology are bringing innovative solutions to healthcare.
Brian Janssen, Chief Information Officer for Medicare at WPS Health Insurance, discusses the responsible use of AI in healthcare to improve patient outcomes and reduce costs. He highlights the opportunity to enhance healthcare literacy in response to events from 2024 and shares valuable advice for emerging healthcare leaders.
In this episode, Troy Shaffer, VP of Contact Center Operations at SCAN Health Plan, discusses the evolving healthcare landscape. He shares insights on leveraging technology for member engagement, balancing investments, and maintaining a personalized service approach while driving operational efficiency.
In this episode, Emily Porter, VP of External Affairs at Sidecar Health, discusses the latest executive order on price transparency, its impact on insurers and hospitals, and how Sidecar Health is using transparent pricing to empower consumers.
In this episode, Chris Wasel, President of Marketing & Strategic Partnerships at Vantage Healthcare, discusses Vantage’s 2025 initiatives, including ACO expansion, new CMS programs, and the challenges of collaboration in value-based care. Chris also shares insights on the impact of AI in healthcare and the need for long-term stability in payment models.
In this episode, Jakob Emerson sits down with Rona Li, SCAN Group's Chief Development Officer, and Rob Scruggs, Chief Digital Officer, to discuss SCAN’s latest digital initiatives. They explore how investments in technology, including the upcoming SCAN member portal and mobile app, are revolutionizing member engagement, improving access to care, and enhancing personalized health experiences.
In this episode of the Becker’s Healthcare Podcast, host Erika Spicer Mason speaks with Visar Tasimi, Senior Vice President of Provider Success at Lucet, about the critical communication challenges in behavioral health. They discuss the growing demand for services, the role of primary care in care coordination, and key strategies for improving provider engagement. Tune in for expert insights on how health plans can better support behavioral health providers and enhance patient care.
This episode is sponsored by Lucet Health.
In this episode, Rick Abbott, Senior Vice President of Employer Solutions and Innovation at Priority Health, discusses the evolving landscape of employer-sponsored healthcare. From tackling affordability challenges to leveraging digital health and virtual care, Rick shares insights on how Priority Health is driving innovation to improve access, quality, and cost efficiency for employers and members alike.
In this episode, Paul Penzone, Vice President and Chief Community Relations Officer at Blue Cross Blue Shield of Arizona, joins the podcast to discuss AZBlue’s mission to support community healthcare needs. He shares insights on the company's initiative to erase medical debt, expand access to preventive care, and foster long-term health equity across Arizona.
In this episode, Matt Gibbs, Senior Vice President and Chief Pharmacy Officer at Blue Shield of California, joins Becker’s to discuss how the company is dismantling the traditional PBM model to bring cost transparency and flexibility to pharmacy care. He shares insights on specialty drug pricing, the role of biosimilars, and why health plans must take back control of their pharmacy management.
In this episode, Jakob Emerson sits down with Dr. Todd May, Vice President and Medical Director at Health Net, to discuss an innovative multi-payer value-based payment model in California. Dr. May shares insights on how major insurers are working together to improve primary care quality, advance health equity, and reshape provider reimbursement.
In this episode of the Becker's Payer Issues Podcast, Dr. Kate Goodrich, Chief Medical Officer at Humana, joins Jakob Emerson to discuss the challenges of the primary care shortage, the impact of value-based care, and Humana’s commitment to improving health outcomes through innovative care models.
In this episode, Jakob Emerson sits down with Michael Hunn, CEO of CalOptima, to discuss the organization's plans to offer coverage on California’s ACA exchange by 2027. They explore how this move aims to improve continuity of care for individuals transitioning in and out of Medi-Cal, the challenges faced by low-income residents in Orange County, and the key steps ahead in the regulatory approval process.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Paige Brogan, Principal CalAIM at Blue Shield of California. Paige discusses Medi-Cal transformation through the CalAIM initiative, emphasizing value-based care, health equity, and innovative member engagement strategies to address whole-person needs.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Dr. Adrienne Moore, SVP of Finance at Banner Health. Dr. Moore discusses her top priorities, including the shift toward value-based care, addressing industry-wide cost pressures, and leveraging innovation to create a sustainable healthcare future.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Eric Witte, Chief Operating Officer of Genesis Orthopedics & Sports Medicine. Here, he shares insights on advancing value-based care strategies and the organization's commitment to improving access to care for patients from all backgrounds. Witte also discusses the challenges of recruiting staff and providers in today’s competitive healthcare landscape.
In this episode, Pleasant Radford Jr., MBA, CHIE, Health Equity Officer at UCare, discusses initiatives to improve inclusivity in healthcare, including staff training on data usage and addressing members with correct pronouns. Learn about innovative steps toward building a more equitable healthcare environment.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Dennis Hillen, Senior Vice President at Oscar Health. Here, he discusses Oscar Health's low-cost, tech-first strategy and how the organization is tailoring its services to accommodate Spanish-speaking and Latino members. Hillen also highlights strategies for driving engagement and retention, ensuring members stay connected and supported in their healthcare journey.
In this episode, Jakob Emerson speaks with Patrick Quigley, CEO of Sidecar Health. Patrick shares insights about his unconventional journey into healthcare and how Sidecar Health is revolutionizing the health insurance industry with a consumer-first approach.
Health plans face crucial decisions when it comes to managing payment accuracy. This episode dives into the pros and cons of insourcing Payment Integrity solutions. We explore how control over operations translates to flexibility and cost management in a constantly evolving healthcare landscape. Industry expert Jhana Spence, Vice President of Strategy at CERIS, offers insights for health plan leaders to optimize their insourcing strategy.
This episode is sponsored by CERIS.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Anne Groves, Market President at Arkos Health. Here, she emphasizes the importance of member engagement, ensuring individuals follow through with creating and adhering to their necessary health plans. Groves also encourages healthcare workers to stay focused on their mission, maintaining a patient-centered approach even amidst operational challenges.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Jordan Taggart, SVP of Payer & PBM Growth at Vida Health. Here, he discusses the importance of partnering with organizations that share Vida’s clinical philosophy to drive meaningful growth. Taggart also explores how Vida Health supports individuals from diverse backgrounds in achieving their weight loss goals, emphasizing personalized and inclusive care strategies.
In this episode of the Becker's Healthcare Podcast, Lukas Voss welcomes Dr. Katherine Hobbs, CEO of Author Health, to explore the evolving dynamics of payer-provider collaboration in healthcare. Dr. Hobbs shares insights on the impact of value-based care models, strategies for integrating mental health services, and overcoming barriers to data collection in behavioral health. Tune in for a forward-looking discussion on how healthcare leaders can drive greater collaboration, improve patient outcomes, and reduce costs.
This episode is sponsored by Author Health.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Pankhuri Sharma, Strategy & Operations Leader at Humana. Here, she discusses efforts to deliver more holistic population health services, with a focus on supporting vulnerable populations. Sharma also highlights the ongoing need to build patient trust as a critical area for improvement in advancing healthcare equity and access.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Brad Riley, VP of Clinical Delivery at Longevity Health Plan. Here, he discusses how leveraging robust data sets can drive operational efficiency and improve decision-making. Riley also explores the challenges and limitations of generative AI technology in healthcare, emphasizing the need for cautious and informed adoption.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Krischa Winright, President of Medicare Advantage at Blue Cross Blue Shield of Michigan. Here, she discusses sustainable solutions for seniors on Medicare, focusing on providing seamless access to healthcare. Winright also examines market shifts in the post-COVID era and highlights the importance of strengthening partnerships with providers to enhance care delivery and outcomes.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Mihir Kamdar, Chief Medical Officer at Tuesday Health. Here, he addresses the challenges of member experience that contribute to high healthcare costs and shares how his team is working to intervene earlier, reducing the need for costly end-of-life care. Kamdar also highlights strategies for improving patient engagement to create more proactive and supportive care solutions.
In this episode, Dr. Edward Juhn, Chief Quality Officer at Inland Empire Health Plan, shares how IEHP is tackling challenges within the Medicaid system through innovative technology, AI-driven solutions, and community-focused initiatives. Discover how IEHP is addressing provider shortages, advancing care quality, and fostering future healthcare leaders to better serve their vulnerable populations.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Scott D. Schweiger, VP of The Clinic by Cleveland Clinic. Here, he explores strategies for enhancing member engagement, encouraging patients to seek necessary care, and connecting them with programs tailored to their needs. Schweiger also discusses cost-reduction strategies aimed at making healthcare more accessible and affordable for patients.
In this episode, Dr. Yolanda Lawson, Executive Medical Director for Maternal and Infant Health at Health Care Service Corporation, discusses innovative strategies to improve maternal and infant outcomes across diverse communities. From predictive data models to community-driven initiatives like Special Beginnings, Dr. Lawson highlights how HCSE is addressing disparities, leveraging technology, and fostering partnerships to create impactful change.
In this episode of the Becker's Healthcare Podcast, host Jakob Emerson is joined by Gianni Aiello, VP of Product at Verifiable, to explore the evolving landscape of network compliance in healthcare. They discuss the core components of successful compliance programs, barriers to effective implementation, and the role of digital transformation in addressing regulatory challenges.
This episode is sponsored by Verifiable.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Abdou Bah, SVP of Medical Management and Chief Health Equity Officer at Emblem Health. Here, he discusses strategies for controlling and managing ongoing healthcare costs while addressing the invisible barriers that prevent patients from accessing the care they need. Bah highlights the importance of equity-focused solutions to improve patient outcomes and reduce disparities in healthcare.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Mitchell Gorodokin, VP of Business Development at Certify. Here, he shares strategies for enhancing workflow efficiency and offers advice for leaders on growing their businesses by improving existing systems and processes. Gorodokin also addresses the challenges of navigating changing compliance regulations across jurisdictions and explains how Certify effectively manages these complexities.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Dr. Daniel Beckles, Surgeon at Ochsner Health. Here, he discusses the importance of understanding patients' lifestyle choices and explores innovative ways to incentivize healthier behaviors, aiming to improve overall health outcomes and reduce long-term healthcare costs.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Wayne Pan, Medical Doctor at San Francisco Health Plan. Here, he discusses the transformative impact of improving patient experience and how it streamlines both internal and external processes. Pan emphasizes the value of maintaining a patient-centric focus to drive meaningful change and enhance healthcare delivery.
Join us on the Becker’s Healthcare Podcast as we delve into the future of consumer-centric healthcare with Russell Van Gorp from Publicis Sapient. Discover how digital solutions, AI, and data interoperability are reshaping the payer space and learn valuable insights from other industries that can enhance healthcare delivery.
This episode is sponsored by Publicis Sapient.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Edward Juhn, Chief Quality Officer at Inland Empire Health Plan. Edward shares strategies for improving member outcomes, addressing provider shortages, and leveraging technologies like AI and machine learning, all while emphasizing the importance of ethical data stewardship and member-centered care.
In this episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, Aric Sharp, CEO of Value-Based Care at Clover Health, discusses how technology is revolutionizing value-based care, improving clinical outcomes, and streamlining workflows for physicians, particularly through the use of AI and data integration. He also shares insights on how Clover’s tech stack is setting new industry standards for care delivery.
Explore how Evernorth Health Services leverages technology and innovative models to meet 2024 healthcare goals with insights from Brendan Kerrigan.
This episode is sponsored by Evernorth Health Services.
In this episode, Mike Jasperson, Senior Vice President of Provider Network and Health Plan Operations at Priority Health, shares insights into the organization's long-standing success in value-based care. He discusses Priority Health's innovative strategies, provider collaborations, and use of advanced technologies to improve patient outcomes, lower costs, and address social determinants of health across their growing markets.
In this episode recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, Harlon Pickett, President of Eagle Care Health Solutions, discusses his innovative approach to health plans that focus on zero-cost healthcare and improving member access. He shares insights on overcoming barriers to member engagement, the future of healthcare consumerism, and the importance of behavioral health in a digital age.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Erin Henderson Moore, President and CEO of Fidelis Care. Here, she discusses her five key priorities for Fidelis Care, focusing on a growth-centric approach to leadership. Erin also shares how she is driving innovation within the organization by leveraging AI to enhance services and streamline care.
In this episode, Jennifer Shermo, Chief Growth Officer at Security Health Plan, shares her insights on tackling healthcare challenges in rural communities, navigating Medicare Advantage trends, and leveraging innovation and collaboration to enhance care. Jennifer also discusses the future of healthcare leadership and the importance of adaptability in an evolving landscape.
Discover Evernorth Home-Based Care's mission and strategies to overcome industry challenges with John Young, Chief Strategy and Development Officer.
This episode is sponsored by Evernorth.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Angela Perri, President, Medicare Products. Here, she discusses the significant barriers created by lack of access to care and emphasizes the center's commitment to people-first values. Angela also shares how their benefit design supports not only healthcare needs but also the behavioral, social, and community aspects that impact overall well-being.
Join us on Becker’s Healthcare Podcast as we speak with Yvette LeFebvre, Chief Medical Officer at Evernorth Health Services – Home-Based Care. Discover the biggest challenges and opportunities in engaging healthcare members, the strategies for improving quality while maintaining compliance. Tune in for an insightful conversation on transforming home-based healthcare.
This episode is sponsored by Evernorth Health Services.
In this episode, Chris Wasel, President, Marketing & Strategic Partnerships at Vantage Healthcare shares insights into his background & scope of his current role, Vantage Healthcare’s growth strategy, what traits the most effective healthcare leaders will need to be successful in the coming years, and more.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Gary Rosenfield, Director, Medicaid Product & Strategy, United Concordia Dental. Here, he discusses strategies for overcoming community access barriers to connect people with essential services and providers. Gary also emphasizes initiatives for enhancing quality and clinical outcomes in home-based care.
In this episode, Dr. Crystal Clark, the CMO for the Community Health Choices Program at UPMC Health Plan, discusses the vital role of addressing food insecurity and other social determinants of health. Dr. Clark shares insights on UPMC’s programs, including meal delivery, healthy food allowances, and community partnerships that are transforming healthcare access and promoting holistic well-being.
In this episode, Karen Downes, Senior Director or HR Technology and HR Operations at Prime Therapeutics, discusses the company's transformation, including the pivotal Magellan acquisition and how Workday technology has supported Prime’s talent and organizational changes.They explore commitment to transparency, avoiding conflicts of interest, and the role of modern technology and AI in driving strategic objectives and business growth.
This episode is sponsored by Workday
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Eric Cannon, Chief Pharmacy Officer and General Manager of Select Health/Scripius. Here, he discusses how transparency can help drive down costs and improve the member experience. Eric also explores innovative approaches to helping members choose the best care through an e-commerce experience tailored to their needs.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Ty Wang, Co-Founder and CEO of Angle Health. Here, he discusses strategies for improving the member experience and shares insights on growing the business while keeping patient experience as the top priority. Ty also explores how Angle Health is leveraging AI and new technology to enhance service and care.
In this episode, Valerie Martinez, chief health equity officer, Blue Shield of California's Promise Health Plan, shares her journey in healthcare and her role in bridging clinical and managed care to promote health equity. Valerie discusses the critical initiatives she leads, including the integration of health equity across services, community resource centers, and mobile mammography clinics, to improve access and outcomes for California’s Medi-Cal population.
This episode, recorded live at the Becker’s Healthcare 2024 Fall Payer Issues Roundtable, features Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross. Here, he shares his approach to improving member experience by addressing overutilization, enhancing health literacy, and integrating whole-person care. He highlights the role of technology in growth strategies and discusses Capital Blue Cross's move towards a fully integrated care model to foster better health outcomes.
This episode explores how payers can navigate the challenges and opportunities of alternative payment models in healthcare. Jakob Emerson speaks with Angie Adams, VP of Product Management at i3 Healthcare Solutions, about agility and technology for contract management, as well as key objectives for payers and the future of healthcare payer operations.
This episode is sponsored by i3Healthcare Solutions.
In this episode, Margaux Currie, Senior Director of Commercial Medical Clinical Solutions and Strategy at Cigna Healthcare, shares her personal breast cancer journey and discusses Cigna's proactive approaches to early detection and personalized support for breast cancer patients. From awareness campaigns to individualized oncology nurse advocacy, Margaux outlines how Cigna is advancing care for those impacted by breast cancer.
In this episode, Dr. Manu Chaudhry, President of Capitol Dental Care, shares his unique perspectives on transforming dental care through integrated systems and a community-focused model. Dr. Chaudhry delves into the importance of AI in bridging humanistic care, the shift toward value-based care, and the role of collaborative teams in addressing the rising complexity of oral health.
Join Jakob Emerson from the Becker's Healthcare Podcast as he sits down with Catherine Tabaka, CEO of Matrix Medical Network, to explore the rising trend of in-home health assessments. Discover how technology and in-home care are reshaping patient services and what opportunities lie ahead for payer organizations.
This episode is sponsored by Matrix Medical Network.
Join Erika Spicer Mason as she engages in a conversation with Trina Histon, PhD, VP of Clinical Product Strategy at Woebot Health, about the innovative integration of digital mental health solutions in healthcare systems like Virtua Health. Discover how Woebot is transforming mental health support and the challenges of implementing such technology in existing healthcare frameworks.
This episode is sponsored by Woebot Health.
Infermedica's Chief Commercial Officer, Amanda Bury, joins Becker's Healthcare to discuss how AI is revolutionizing healthcare. We explore how AI is influencing member experience, its impact on health systems, and the importance of responsible innovation in an era of rapid technological advancement. We also delve into maximizing ROI in digital health and ensuring patients benefit from this transformative technology.
This episode is sponsored by Infermedica.
In this episode, Chris Palmieri, President and CEO of Commonwealth Care Alliance, discusses key insights from the healthcare landscape, including lessons from the Steward Health System crisis, areas ripe for innovation, and the critical alignment between nonprofit missions and private capital.
In this episode, Kristen Cerf, President and CEO of Blue Shield of California Promise Health Plan, discusses the plan's recent four-star NCQA rating and the innovative approaches that led to this achievement. She shares insights on the importance of preventative care, data-driven strategies, and impactful community partnerships aimed at improving healthcare access for Medicaid members across California.
In this episode, Kimberly Funderburk, President of Government, Education & Health Systems at Cigna Health Benefits, discusses her career journey and how Cigna is addressing the unique health challenges of public sector employees. She highlights strategies such as mental health first aid training, wellness centers for transit workers, and the integration of behavioral health services to support long-term engagement and well-being.
This episode of the Becker's Healthcare Podcast dives into the critical issue of payment integrity with Debra Hamer, Director of Product at CERIS. We discuss why proactive strategies are essential in the fight against fraud, explore new innovations, and look towards the future of this evolving landscape.
This episode is sponsored by CERIS.
In this episode, Dr. Wyatt Decker, Executive Vice president and Chief Physician for Value-Based Care and Innovation at UnitedHealth Group, shares insights on the transition to value-based care, its impact on patient outcomes, and the challenges facing healthcare providers. Tune in for a deep dive into how UnitedHealth Group is leading efforts to reshape the U.S. healthcare system.
In this episode, Piyush Khanna, Vice President of Clinical Services at CareFirst BlueCross BlueShield, joins the podcast to discuss the importance of timely data from provider networks. He shares insights on quality reporting requirements, operational challenges, and how advancements in data exchange are shaping the future of healthcare delivery.
In this episode, Rushil Desai, President and CEO of Aetna Better Health of Illinois, discusses key trends in Medicaid managed care, including the integration of behavioral health and social needs, the impact of digital health solutions, and the future of value-based care. He also shares insights into the innovative programs improving access and equity for Illinois' most vulnerable populations.
In this episode, George Halvorson, Chair and CEO of the Institute for InterGroup Understanding and former CEO of Kaiser Permanente, shares insights on the evolution of Medicare Advantage, its success in delivering quality care, and its role in shaping the future of healthcare. Halvorson delves into key topics like capitation, healthcare cost management, and the ongoing challenges facing the Medicare system.
In this episode, Chronis Manolis, Senior Vice President, Pharmacy and Chief Pharmacy Officer at UPMC Health Plan, shares his perspective on the evolving pharmacy and drug access landscape. He discusses the challenges surrounding rising drug costs, GLP-1 medications, and the future of pharmacy benefit management in a complex healthcare environment.
In this episode, Laura Dyrda speaks with Joanne McFall, Market President of Keystone First and AmeriHealth Caritas Pennsylvania. Joanne shares her insights on post-pandemic Medicaid unwinding, rising healthcare costs, and the role of managed care in addressing social factors like housing and food insecurity to improve health outcomes.
In this episode, Joe Glinka, Director of PA HealthChoices at Highmark Whole Care, delves into the complexities of managing Medicaid in Pennsylvania, addressing issues like rising healthcare costs, the impact of social determinants on health, and the innovative community initiatives Highmark is undertaking to support vulnerable populations.
In this episode, Dr. Lisa Saul, UnitedHealthcare’s National Medical Director of Maternal Child Health, discusses the key findings from the 2024 Maternal and Infant Health Disparities Data Brief. Dr. Saul highlights persistent disparities in health outcomes and shares how UnitedHealthcare is working to improve maternal and infant care through community engagement and collaborative efforts.
In this episode, Karen Walker Johnson, interim CEO at Clever Care, discusses her career journey in healthcare, Clever Care's mission to serve vulnerable populations, and the company’s culturally tailored approach to Medicare Advantage.
In this episode, Fred Turner, CEO of Curative, shares the journey of scaling the company from a COVID-19 testing powerhouse to a disruptive force in the commercial health plan space. He discusses Curative's unique no-deductible model, the importance of early patient engagement, and the challenges of entering a highly regulated industry dominated by a few major players.
In this episode, Dr. John Kim, Chief Medical Officer for Alignment Health's West Coast Markets, discusses the significant social barriers affecting senior healthcare, including transportation, economic insecurity, and loneliness. He shares how Alignment Health is tailoring benefits and programs to meet the evolving needs of seniors, emphasizing the importance of holistic care and support.
In this episode, Ananya Banerjee, Chief Commercial Officer at Aledade, Inc., discusses the challenges of healthcare access, cost management, and physician independence, while highlighting Aledade's impact on rural communities and the future of value-based care.
In this episode, Dr. Robert Groves, Executive Vice President & Chief Medical Officer of Banner/Aetna, discusses the evolving healthcare landscape, the impact of cost pressures, and the innovative approaches Banner/Aetna is taking to improve care delivery. Discover how community-driven programs and advancements in AI are shaping the future of patient care.
In this episode, Boyd Faust, Chief Strategy Officer at GoHealth Urgent Care and newly elected member of the Urgent Care Association Board of Directors, discusses the critical role of value-based care, strategic payer partnerships, and patient engagement in the evolving urgent care landscape.
This episode of the Becker's Healthcare Podcast dives into the future of in-home care with Joseph Buchanan, SVP of Clinical Network at Matrix Medical Network, about how they prioritize high-quality care delivery in patients' homes. They discuss the importance of a clinician-led approach to in-home assessments and how it improves access, patient experience, and health equity for payers.
This episode is sponsored by Matrix Medical Network.
In this episode, Dr. Tommy Ibrahim, President and CEO of Sanford Health Plan, discusses his journey from clinical practice to leading a health plan, the challenges and opportunities in rural healthcare, and his strategies for driving growth and innovation in a rapidly evolving industry.
In this episode, Dr. Johanna Vidal-Phelan, Chief Medical Officer of Quality and Pediatrics, and Rebecca Nagle, Director of Medicaid and CHIP Quality Programs at UPMC Health Plan, discuss strategies to address vaccine hesitancy. They share insights on effective communication, community partnerships, and initiatives to increase vaccination rates and improve public health.
Join Erika Spicer Mason on Becker's Healthcare podcast as she discusses the evolution of healthcare data with Dr. Karl Serrao from Driscoll Health Plan and Dr. Katherine Schneider from Medecision. They explore the significance of real-time data, the integration of technological advancements, and the impact on community health outcomes.
This episode is sponsored by Medecision.
Steve Sutherland, Senior Vice President at CERIS, dives into how AI and machine learning are transforming payment integrity in healthcare. He explores the benefits payers can experience, challenges to widespread adoption, and best practices for leaders implementing these powerful tools.
This episode is sponsored by CERIS.
In this episode, Jakob Emerson speaks with Guy A. Medaglia, President & CEO of Saint Anthony Hospital in Chicago, and Michael Shakman, Partner at Miller Shakman Levine and Feldman, about St. Anthony's transformative role in community healthcare and their ongoing lawsuit against the state of Illinois over Medicaid payment issues. Guy shares his unconventional journey into healthcare and personal motivation rooted in his upbringing, while Mike explains the complexities and current status of their legal fight for fair and transparent Medicaid reimbursements.
In this episode, Jakob Emerson interviews Krischa Winright, President of Medicare Advantage at Blue Cross Blue Shield of Michigan. They discuss Krischa's extensive background in healthcare, the unique needs of seniors in the Medicare Advantage market, and how BCBS Michigan is addressing these needs through innovative partnerships and strategies. Krischa also shares insights on the recent changes in Medicare Advantage star ratings and how her team is navigating industry headwinds to continue providing high-quality, affordable care to their members.
In this thrilling episode, Stephen Anderson, VP of Provider Contracting & Network Administration at Blue Cross Blue Shield of Michigan, discusses the significance of GLP-1 medications and the importance of making them affordable and accessible for those in need. He also explores the future growth prospects for Blue Cross, highlighting factors driving up costs in the healthcare system and the strategies being implemented to manage these challenges.
In this episode of the Becker's Healthcare Podcast, Mariah Muhammad interviews Drew Thompson, Head of Sales and Growth at Northwell Direct. Drew discusses the challenges employers face with rising healthcare costs, the benefits of direct-to-employer healthcare models, and the importance of exploring alternative solutions like self-insurance and captive models to manage expenses and improve coverage.
In this episode of the Becker's Healthcare Podcast, Laura Dyrda interviews Joanne Mizell, COO of Banner | Aetna, to discuss the joint venture's innovative efforts to transform healthcare and enhance patient experiences. They explore current trends and challenges in the industry, Banner | Aetna's focus on transparency and technology, and successful initiatives to improve member engagement and satisfaction.
Chris Carmody, CTO and Senior Vice President at UPMC, joins Laura in a discussion on the need for caution when implementing new technologies into our healthcare system. He discusses the increasing cybersecurity threats facing healthcare institutions and the importance of safeguarding patient data. Chris also highlights strategies for optimizing care for both patients and hospital workers, ensuring that technological advancements contribute positively to healthcare delivery and safety.
In this thrilling episode, Stephen Anderson, VP of Provider Contracting & Network Administration at Blue Cross Blue Shield of Michigan, discusses the significance of GLP-1 medications and the importance of making them affordable and accessible for those in need. He also explores the future growth prospects for Blue Cross, highlighting factors driving up costs in the healthcare system and the strategies being implemented to manage these challenges.
In this episode of the Becker's Healthcare Podcast, Laura Dyrda speaks with Dr. Tenbit Emiru, Chief Medical Officer at UCare. Dr. Emiru discusses her role and insights into current healthcare trends, including the challenges of increased medical utilization, advancements in therapeutics, and the critical need for mental health services, while also sharing UCare's strategies for growth and innovative partnerships.
Join Laura Dyrda on the Becker's Healthcare Podcast as she interviews Troy W. Williams, MBA, Vice President of Health Systems Partnerships at First Choice Health. Troy shares his extensive experience in healthcare, the importance of transparency, and how First Choice Health is expanding its geographic footprint and enhancing health plan incubation to improve efficiencies and patient care.
In this episode of the Becker's Healthcare Podcast, Laura Dyrda is joined by Sonny Goyal, Senior Vice President and Head of Diversified Businesses at Blue Cross North Carolina. Sonny discusses innovative strategies to improve access to quality, affordable care, focusing on trends such as telehealth, AI advancements, and value-based care models, while also addressing significant headwinds like rising healthcare costs and provider shortages.
In today's podcast, we explore how optimizing provider data management (PDM) is key to boosting operational efficiency for health plans. Parvathy Sashidhar, Senior Director of Product Management for HealthEdge, dives into the common challenges plans face with outdated provider information and how these issues can be mitigated. Learn how advanced PDM solutions can streamline data integration and ensure accurate provider details, ultimately improving care delivery and strategic growth.
This episode is sponsored by HealthEdge.
This Becker's Healthcare podcast episode dives into whole-person care with Catherine Tabaka, CEO of Matrix Medical Network. Matrix delivers whole-person care by assessing patients’ health in all its dimensions, including physical, emotional, spiritual and social, which can improve outcomes and health equity. Matrix home-based services uncover factors such as social determinants of health and empower patients to manage their health. Leaders can prepare for the future of healthcare by focusing on care coordination and ensuring patients don't fall through the cracks.
This episode is sponsored by Matrix Medical Network
In this episode, Erin Drinkwater, Chief of Government Relations and Strategic Partnerships at MetroPlusHealth discusses her background, the initiatives at MetroPlusHealth focused on enhancing healthcare access and equity for New Yorkers, and the organization’s strategic priorities, including their integrated behavioral health services and the Food as Medicine program.
Edward Juhn, Chief Quality Officer of Administration at Inland Empire Health Plan, shares his strategies for ensuring top-tier care in clinical services, data innovation, and public health in this fascinating episode. Emphasizing the importance of partnerships, Edward discusses the continuous efforts to enhance all aspects of healthcare delivery. He also sheds light on the groundbreaking “pay for performance program,” which has led to remarkable improvements and outcomes.
In this episode of the Becker's Healthcare Podcast, host Laura Dyrda sits down with Hilary Marden-Resnik, President & CEO of UCare. Over the course of their conversation, they delve into the current trends and challenges in the healthcare industry. Hilary shares insights on UCare's innovative strategies for enhancing patient care and managing the complexities of the healthcare system.
In this episode of the Becker's Healthcare Podcast, host Laura Dyrda interviews Pankhuri Sharma, Strategy & Operations Leader at Humana. Pankhuri discusses her role at Humana, the strategic initiatives she's leading, and the operational challenges in the healthcare industry. Tune in for an insightful conversation on driving innovation and efficiency in healthcare.
In this episode, we explore the latest trends in AI-powered automation with Paul Torrey, Senior Industry Practice Director, UiPath. We discuss how businesses are leveraging automation to improve scalability, efficiency, and integrate cutting-edge technologies like ML and NLP. We'll also get insights on how to navigate the ever-evolving landscape of automation and implement successful AI-driven solutions within your organization.
This episode is sponsored by UiPath.
In this episode of the Becker's Healthcare Podcast, host Laura Dyrda talks with Dr. Darren Wethers, the Chief Medical Officer of ATRIO Health Plans. Dr. Wethers shares his experiences and insights on the current healthcare landscape, the challenges faced, and the opportunities available. Tune in to hear an engaging discussion on healthcare management and delivering quality patient care.
Join us for an insightful conversation with Alessa Quane, Executive Vice President and Chief Insurance Officer at Oscar Health. Alessa discusses key healthcare trends, including consumer expectations, ACA growth, and disruptive technology, while highlighting Oscar Health's innovative HolaOscar program for the Hispanic and Latin communities.
Health plans rely on complex networks of providers to deliver care to their members. But how do they measure success? This episode dives into health plan network performance benchmarking with Subhash Seelam, SVP of Applied Network Analytics at Quest Analytics®, and Bob Tavernier, Solutions Executive at Quest Analytics. They discuss key metrics, the challenges of benchmarking, and how it can be used to better differentiate and optimize networks thereby improving member satisfaction and retention.
This episode is sponsored by Quest Analytics.
In this episode of Becker's Healthcare Podcast, host Laura Dyrda sits down with Rebecca D'Amico, Chief of Staff to the CEO and Vice President of Strategy at Blue Cross Blue Shield Association. Rebecca provides an in-depth look at the strategic initiatives shaping the future of healthcare insurance. She discusses her role in steering the organization through industry challenges, the importance of innovation in healthcare, and the strategies Blue Cross Blue Shield is implementing to enhance member experiences and outcomes. Tune in for a compelling conversation on the evolving landscape of healthcare insurance and leadership.
In this episode of the Becker's Healthcare Podcast, host Laura Dyrda interviews Angela Jenkins, Vice President of Accountable Communities and Community Health at Prisma Health. Angela discusses her work in expanding access to care, addressing social determinants of health, and partnering with local organizations to improve community health. Tune in for insights on creating sustainable improvements in community health.
This episode features Dr. Leonardo Seoane, Executive Vice President and Chief Academic Officer at Ochsner Health. Tune in as Dr. Seoane shares his background, insights into the biggest issues he is following in healthcare this year, essential qualities for effective healthcare leadership in the coming years, and more.
In this episode of the Becker's Healthcare Podcast, host Laura Dyrda talks with Barry Streit, Senior Vice President of Growth at Essence Healthcare. Barry shares insights on Essence Healthcare's focus on coordinated and preventive care, their growth strategies, and the future of Medicare Advantage. He also offers advice for newcomers to the healthcare industry, emphasizing patient understanding and adaptability. Tune in for an expert discussion on the evolving Medicare Advantage landscape.
In this episode, Dr. Kelli Tice, Chief Health Equity Officer and Vice President of Medical Affairs at GuideWell shares insights into her background & what led her to become GuideWell’s first Chief Equity Officer, what trends & issues in healthcare she is following today, what health insurers need to focus on to insure health equity can be sustained for the long term, and more.
In this episode of the Becker's Healthcare Podcast, host Jakob Emerson sits down with Dr. Shantanu Agrawal, Chief Health Officer at Elevance Health. Dr. Agrawal discusses his journey in healthcare, the innovative strategies Elevance Health is implementing to improve patient outcomes, and the critical role of technology in transforming healthcare delivery. Tune in to gain insights into the future of healthcare from one of the industry's leading voices.
Abdou Bah, Senior Vice President, Medical Management & Chief Health Equity Officer at EmblemHealth joins the podcast to share insights into his background, the healthcare trends he is closely monitoring today, current initiatives his organization is implementing to improve quality of care, and more.
In this episode, Dr. Matthew Hurford, President and CEO at Community Care Behavioral Health (UPMC Insurance Services) shares his diverse background, insights into the biggest issues facing behavioral health today, the role that social media plays in raising behavioral health awareness, and more.
Adam Kustin, Senior Vice President, Sales and Marketing at Health Network One joins the podcast to share insights into his background & organization, his focus on the challenges and opportunities facing artificial intelligence in healthcare, what traits the most effective healthcare leaders will need to be successful in the coming years, and more.
Mark Friedberg, MD, SVP of Performance Measurement & Improvement at Blue Cross Blue Shield of Massachusetts joins the podcast to discuss key insights into his healthcare career journey, his organization’s ‘pay for equity’ financial model, advice for healthplan leaders looking to achieve better health equity outcomes for their members, and more.
Join us for an insightful conversation with Carolyn Tandy, Chief Diversity and Inclusion Officer at Humana, as we explore the vital role of diversity, equity, and inclusion in healthcare. Carolyn shares her background, insights into the impact of DEI on the healthcare industry, Tune in for valuable perspectives on fostering inclusivity and equity in healthcare leadership.
In this episode, Jakob Emerson has a discussion with Catherine Anderson, UnitedHealth Group’s Senior Vice President of Health Equity Strategy, about UnitedHealth Group surpassing $1 billion in affordable housing investments.
Becker's Healthcare Podcast host Jakob Emerson dives into the world of member voice data with Amy Brown, Founder & CEO of Authenticx. They discuss how to utilize conversational AI to analyze healthcare interactions.
This episode is sponsored by Authenticx.
In this episode, Dr. Sachin Jain, CEO of SCAN Group, shares insights into his organization, SCAN Groups’s first report showcasing their impact on seniors and the unhoused population, the health plan side of the business, and much more.
Tune in as Raven Ryan Solon, Chief Compliance & Regulatory Officer at MetroPlusHealth, shares insights on her background, key healthcare issues in 2024, excitement, concerns, and the essential traits for effective healthcare leadership in the coming years.
Tune in as Mamata Majmundar, Chief Medical Officer of Evry Health, discusses her background, key healthcare issues of 2024, and her outlook on the future. Gain insights into what excites her about the evolving landscape and the challenges ahead.
This podcast explores the evolving landscape of payor coverage for diabetes and continuous glucose monitoring (CGM) with Mike Steelman, VP Managed Markets at Dexcom. We delve into key trends and developments in the payor space for diabetes management, how CGM coverage and utilization management have changed, and the recipe for successful partnerships in optimizing diabetes care through CGM.
This episode is sponsored by Dexcom.
Join Dr. Alex Li, Chief Health Equity Officer at L.A. Care Health Plan, as he discusses key questions on health equity. From why addressing disparities is gaining momentum to L.A. Care's journey towards NCQA accreditation, explore the challenges and solutions in advancing equitable healthcare, with insights on the role of AI.
Hosted by Bill Paschall (Senior Vice President of Growth and Strategic Accounts for Clear Arch Health), with subject matter expert Josh Hoover, (National Business Development Manager with Clear Arch Health) this podcast episode delivers pertinent insights into Medicare Advantage plans, detailing the importance of expanding supplemental benefits in telehealth to plan members as a way to not only increase CMS star ratings, grow membership and address Social Determinants of Health, but to also enhance member satisfaction, improve care coordination, and expand health equity with remote patient monitoring and personal emergency response systems.
This episode is sponsored by Clear Arch Health.
Dr. Yan Chow, Global Healthcare Leader at Automation Anywhere, dives into the growing role of AI and automation in healthcare. He discusses the current state of the field, how health insurers are leveraging this technology, and the challenges and opportunities that lie ahead.
This episode is sponsored by Automation Anywhere.
Join Jakob Emerson at Becker’s April Annual Meeting as he sits down with Trent Iden, Chief Growth Officer for Catalight, to explore the challenges and innovations in autism and IDD care. Gain insights into the future of behavioral health and Catalight's unique approach to supporting individuals with developmental disabilities.
Sponsored by Catalight.
Join us as we sit down with Bryan Holgerson, President of U.S. Commercial at Cigna Healthcare, for an insightful conversation about the company's new podcast with Holly Robinson Peete and the intersection of job satisfaction and health. Bryan discusses his role at Cigna, the importance of the podcast in supporting employers and their workforces, and the impact of invisible challenges on organizational culture. Tune in for valuable insights and advice on promoting employee well-being in the workplace.
Join Erika Spicer Mason as she discusses Excellus BCBS's experience during the transparency in coverage mandate with Nicole Columbare and Kim Valenti. Delve into their strategies for member engagement and learn about the future of healthcare transparency.
This episode is sponsored by Kyruus Health.
Join us as we delve into the realm of healthcare innovation with Michael Moore and Courtney Yeakel, experts from Veradigm, discussing the integration of advanced technologies to enhance outcomes and quality for payers, providers, and patients. From navigating regulatory changes to leveraging AI's potential, discover how technical automation is revolutionizing the healthcare landscape.
This episode is sponsored by Veradigm.
Tune in as Praveen Thadani, CEO of Priority Health, shares insights into the organization's involvement in expanding patient navigation services through the Biden Cancer Moonshot initiative. Learn about the unique opportunity to discuss the initiative with First Lady Jill Biden and gain valuable insights into the support provided to cancer patients through patient navigation services. Gain a deeper understanding of Priority Health's role in enhancing healthcare access and support for those battling cancer.
Join Jay Meyers, Chief Commercial Officer of Rula, as he discusses how Rula is tackling the mental health crisis, particularly for adolescents and young adults. Gain insights into the challenges of accessing quality mental healthcare with insurance and learn how Rula collaborates with the current ecosystem to facilitate easier access to high-quality mental health services.
Join us as we sit down with Dr. Joel Nelson, President of UPMC International, for a captivating discussion on the current landscape of healthcare. Dr. Nelson shares his insights on the biggest issues shaping healthcare in 2024, his excitement for upcoming developments, and the essential qualities for effective healthcare leadership in the years ahead. Tune in for valuable perspectives from a prominent leader in the healthcare industry.
Join Dr. Linda Anegawa, Chief Medical Officer at Noom, as she delves into why the success of GLP-1 therapy hinges on lifestyle changes. Discover insights into Noom's clinical support for payers in treating obesity, including managing GLP-1 medications, and learn about the integration of medication management with lifestyle modification techniques for optimal health outcomes.
This episode is sponsored by Noom.
Join us as Dr. Adam Myers, former Chief Clinical Transformation Officer at Blue Cross Blue Shield Association, shares his expertise and insights. Discover the pressing healthcare issues of 2024, Dr. Myers' excitement and concerns, and the key attributes essential for healthcare leaders to thrive in the coming years.
In this episode Dr. Senan Ebrahim, Founder and CEO of Delfina, dives into the critical landscape of women's health, particularly maternal care. We explore the challenges of maternity service closures and evolving regulations, alongside the opportunities presented by personalized healthcare.
This episode is sponsored by Delfina.
Payer executives are increasingly focusing on claims management to cut costs. Prepayment review offers a proactive approach compared to traditional post-payment methods, allowing payers to identify and address potential issues before claims are processed.
This episode is sponsored by CERIS.
This podcast discusses the upcoming Health Equity Index (HEI) replacing the Reward Factor in Medicare Advantage Star Ratings with Dr. Ashwin Patel, the Chief Medical Officer at Pyx Health. Learn how this impacts plans in 2024-2025 and what steps they can take to prepare for the HEI shift. We'll also explore how Pyx Health helps identify and address member needs related to social risk factors and the HEI.
This episode is sponsored by Pyx Health.
Tune into this episode featuring Rehan Mirza , Chief Growth Officer at Verifiable, and Dara McDaniel, Associate Director of Credentialing at Humana. Dara and Rehan share insights on credentialing outside of patient safety and compliance, new approaches to leverage technology and much more.
This episode is sponsored by Verifiable.
In this episode, we explore how member engagement and care navigation are crucial for value-based care, population health, and member satisfaction. We discuss the challenges health plans face and the opportunities presented by AI technology. Our guest, Amanda L. Bury, MS Chief Commercial Officer at Infermedica, shares how AI tools can drive member engagement and improve care journeys. She also dives into real-world examples and the positive outcomes health plans can achieve through this approach.
This episode is sponsored by Infermedica.
In this episode, Dr. Bloom returns to discuss the specific challenges and opportunities in supporting preventive care for patients with complex diabetes. We explore how value-based care models can align with best practices in this area, and what future shifts we can expect as chronic disease prevalence rises. Dr. Bloom also shares his insights on exciting developments in caring for this population.
This episode is sponsored by Podimetrics.
The rising tide of chronic diseases threatens healthcare costs. In this episode, we are joined by Dr. Sam Toney, CEO of Toney Healthcare, as we explore how payers can leverage care management programs to address this challenge. We discuss the opportunities technology presents to enhance patient care, the importance of psychosocial determinants of health and looking at each patient uniquely, and offer insights into the future of care management for payers.
This episode is sponsored by Toney Healthcare.
Payers are on a mission: boost growth and improve member experiences. But navigating new technologies and reducing costs can be tricky. This episode dives into the top challenges and opportunities payers face, plus expert advice on how to streamline operations, leverage exciting tech advancements, and ultimately, empower members.
This episode is sponsored by EXL.
Join Nate Maslak, CEO of Ribbon Health, as he hosts health plan leaders Will Shrank and Jill Hummel for a discussion on strategies to improve Medicare Star Ratings using provider data. Delve into the significance of Star Ratings for health plans, the impact on revenue, enrollment, and retention, and the crucial role of accurate provider data in improving ratings. Tune in for valuable insights from two health plan executives on how to prioritize Star Ratings and optimize for more positive member experiences and healthcare outcomes.
This episode is sponsored by Ribbon Health.
Join Erika Spicer Mason on the Becker’s Healthcare Podcast as she sits down with Anshul Rathi, Founder, and CEO of CertifyOS, to discuss improving healthcare by addressing critical issues like administrative burdens on providers, inefficiencies in provider data management and the impact on patient care. Learn how improving provider data accuracy will improve access to quality care, enhance provider satisfaction, and ultimately transform the healthcare industry's operational framework for facilitating better care matching.
This episode is sponsored by CertifyOS.
Join us in this episode as we speak with Shana Hoffman, President & CEO of Lucet, as she dives deep into how provider shortages are impacting everyone, the importance of timely access and the innovative technology solutions payers are using to bridge the gap. We'll also explore how payers and providers can work together to address the social determinants of health and ensure equitable access to behavioral health care for all.
This episode is sponsored by Lucet, The Behavioral Health Optimization Company.
Tune in as Jakob Emerson from Becker's Healthcare interviews Dr. John Bulger, Chief Medical Officer of Geisinger Health Plan, exploring the factors driving member satisfaction, integration with Geisinger Health System, and Medicare Advantage strategies for 2024. Gain insights into recent developments in the healthcare landscape and valuable advice for insurance executives in this engaging conversation.
Join us for an insightful conversation with Caroline Carney, President of Behavioral Health and Chief Medical Officer at Magellan Health, as she shares her background and perspectives on current healthcare challenges. Caroline delves into the major issues of 2024, revealing her excitement and concerns, while also discussing the evolving traits necessary for effective healthcare leadership in the near future.
Paula Blomquist, Chief Experience Officer at GoHealth joins the podcast to share insights into her background in retail & journey into healthcare, trends in urgent care she is keeping an eye on, what healthcare leaders need to be successful in the next 2-3 years, and more.
Join Dr. Don Berwick, former CMS Administrator and esteemed health policy lecturer at Harvard Medical School, as he engages in a dynamic conversation with moderator Jakob Emerson of Becker's Healthcare. Together, they delve into the intricacies of Medicare Advantage in 2024, exploring the ongoing challenges within the industry. Gain valuable insights and expert analysis from this insightful discussion on the current state and future trajectory of Medicare Advantage plans, offering a comprehensive understanding of its implications for patients and providers alike. Tune in to this enlightening podcast for a nuanced perspective on vital healthcare policy issues.
Join Laura Dyrda from Becker's Healthcare as she interviews James Holland, President & CEO of Johns Hopkins Health Plans, discussing key healthcare issues, growth strategies, and exciting projects for the future. Gain insights into Holland's background, his perspective on industry trends in 2024, and the factors driving growth at Johns Hopkins Health Plans along with current challenges and future initiatives.
Join Jakob Emerson from Becker's Healthcare as he speaks with Brian Pieninck, President and CEO of CareFirst BlueCross BlueShield, exploring strategies for addressing social determinants of health and promoting health equity. Gain insights into regional initiatives and the broader national landscape, as Pieninck shares perspectives on healthcare trends and strategies for ensuring affordability, accessibility, and equity for all Americans.
Dive into the post-No Surprises Act landscape with Martin Cody, Senior Vice President of Sales for Madaket Health! This podcast tackles key challenges for payers, providers, and patients: inaccurate directories, compliance complexities, and optimizing operations. Discover Madaket Health's platform and how they're helping navigate the new normal. Learn what healthcare leaders should prioritize for smooth sailing in the age of surprise billing protection. Don't miss out on insider insights and valuable resources!
This episode is sponsored by Madaket Health. To learn more visit, madakethealth.com/roi.
Susan Beaton, Vice President of Health Plan Strategy at Wellframe joins the podcast to share insights into her organization, how she sees the role of digital health management evolving this year, the importance for health leaders to keep cyber security top of mind, and more.
In this episode, join Damanjeet Chaubey, Senior Medical Director and Vice President of Clinical Affairs at Clover Health, as she provides insights into her background and expertise in healthcare leadership. Damanjeet discusses the prominent issues shaping healthcare in 2024, expressing her excitement and concerns, and offers valuable perspectives on the essential qualities for effective healthcare leadership in the next 2-3 years.
Tune in to the Becker's Payer Issues Podcast as Erica Carbajal engages in an insightful conversation with Greg Dorn, President of CERIS. Explore the complexities of healthcare M&A, payment integrity challenges, and CERIS' unique strategies for sustaining business success in an ever-evolving industry. Gain valuable insights on key drivers for payment integrity success in 2024 and the imperative role of transparency, innovation, and collaboration. Sponsored by CERIS, this episode offers a deep dive into the future of healthcare financial strategies.
Half of the US population lives with a musculoskeletal (MSK) condition, which includes joint, back and muscle pain or immobility; tune into this episode on transforming the patient and provider experience around MSK care. Becker's talks with Rachel Winokur, Co-Founder and CEO of TailorCare about her personal experiences and much more.
This episode is sponsored by TailorCare
Join us in this episode of the podcast featuring Tom Grote, CEO of Banner | Aetna, as he provides insights into his background and the organization's growth strategy for the upcoming year. Gain valuable perspectives on the significant challenges and opportunities facing health plans from his vantage point. Additionally, explore the technologies Banner | Aetna employs to enhance the member experience in this engaging conversation.
In this 9-minute conversation, the CTO at Free Market Health, Mark Conklin, dives into the evolving specialty pharmacy landscape and its impact on payers. The discussion focuses on the complexities of the ecosystem, why the status quo is no longer working, and what payers can expect in the new year. Tune in to gain valuable insights on the changing world of specialty pharmacy, how technology is driving innovation, and more.
This episode is sponsored by Free Market Health.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Dr. Adam Wolk, Regional Chief Medical Officer, Alignment Health. Here, he discusses his background, headwinds health plans are facing, specific technologies his organization is utilizing to enhance the senior care experience, and more!
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Dr. Arta Bakshandeh, Chief Medical Informatics Officer at Alignment Health. Here, he discusses his background, Alignment’s focus on serving seniors, the challenges and opportunities regarding AI, and more.
Henriette Coetzer, MD, Chief Medical Officer at Blue Health Intelligence joins the podcast to discuss her healthcare career, her role as BHI's CMO, and data trends in the payer landscape. Looking ahead to 2024, Dr. Coetzer outlines strategic priorities, initiatives, and advice to payer leaders seeking to harness the power of data analytics.
In this episode of the Becker’s Healthcare Podcast series, Brian Zimmerman, AVP of Client Content + Strategy, engages in a thought-provoking conversation with Matt Cook, Chief Commercial Officer at Firefly Health, exploring the dynamic landscape of healthcare through the lens of virtual-first health plans. Together, they delve into the fundamentals of virtual-first plans, the motivations behind their increasing adoption, and the multifaceted benefits they offer to both employers and members. Matt Cook shares insights on the growing traction of virtual-first plans in the marketplace and speculates on whether they might become the norm rather than the exception. The discussion also delves into the crucial aspects of affordability, benefit design, and reorienting healthcare consumers around primary care. As they wrap up, Matt offers valuable considerations for employers evaluating the integration of virtual-first health plans. Tune in for a comprehensive exploration of the future of healthcare in this rapidly evolving landscape.
This episode is sponsored by Firefly Health.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Kimberly Reich, Interim Executive Director & Compliance & Privacy Officer, Lake County Physicians' Association (LCPA). Here, she discusses her role, Lake County Physicians expanding more into the Medicare & Medicaid space, the importance of health equity in order to achieve quality, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Ashish Shah, CEO of Dina. Here, he discusses key insights into Dina, how he plans to grow Dina’s reach in the next year, the importance of transparency, and more.
This episode features Bob Darin, CEO of Blue Health Intelligence (BHI). Here he discusses healthcare analytics, his career journey, healthcare trends he is currently watching, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Dr. Mamata Majmundar, Chief Medical Officer at Evry Health. Here, she discusses key insights into her background & Evry Health, the challenges & opportunities specific to being a 100% cloud-based insurance plan, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Eric Witte. Here, he discusses his background, generative and degenerative AI, headwinds health plans are currently facing, and more!
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Don Antonucci, President & CEO at Providence Health Plan. Here he discusses his organization moving more toward value-based care, the biggest challenges facing health plans today, technologies he is utilizing to enhance member experience, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Dr. Darren Wethers, Chief Medical Officer at Atrio Health Plans. Here, he discusses his background, the strategy behind how Atrio Health Plans is growing its reach, the biggest opportunities & challenges facing health plans today, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Mac Davis, VP of Digital Product & Data at Belong Health. Here, he discusses key insights into his background & Belong Health, growth strategy going into the next year, specific technology he is utilizing to improve member experience, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Howard Weiss, VP of Public Policy & Government Engagement at EmblemHealth. Here, he discusses his background & what led him to his current position, the expansion of EmblemHealth’s “Neighborhood Care” facilities, challenges facing health plans today, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Mike Hill, Founder of Total Control Health Plans. Here, he discusses key insights into his organization, the biggest challenges & opportunities facing health plans, technology he is utilizing in his role to enhance the member experience, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Krista Hoglund, CEO of Security Health Plan. Here, she discusses key insights into Security Health Plan, headwinds health plans are currently facing, technology her organization is utilizing to enhance the member experience, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Will Johnson, Vice President & General Manager at +Oscar. Here, he discusses his background, where he sees +Oscar growing its reach in the next year, the biggest opportunities & challenges facing health plans today, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Beejadi Mukunda, VP & CMO at CareSource. Here, he discusses key insights into his organization, the biggest challenges & opportunities facing health plans, technology he is utilizing in his role to enhance the member experience, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Lisa Davis, EVP & CIO at Blue Shield of California. Here, she discusses her background, where she sees her organization growing its reach, challenges & opportunities health plans are facing today, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Matt Fox, Senior Director at UPMC Health Plan. Here, he discusses key insights into his background, challenges & opportunities facing health plans today, UPMC’s Anywhere Care program, and more!
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Ally Thomas, AVP of Quality Improvement, UPMC Health Plan. Here, she discusses her background & journey into the healthcare space, how UPMC Health Plan is growing its reach, what technologies she is utilizing in order to improve member experience, and more.
This episode recorded live at the 2023 Becker’s Payer Issues Roundtable in Chicago features Dr. Catherine Brisland, Senior Medical Director, Utilization Management, UPMC Health Plan. Here, she discusses her background & insights into her current role, the growth strategy of UPMC Health Plan, the biggest challenges facing health plans today, and more.
Allison Hofmann, Vice President, Hospital and Health System Industry Vertical at Cigna Healthcare joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Megan Reid, Senior Vice President of Medicare Growth and Strategy at Humana joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Ceci Connolly, President and CEO at Alliance of Community Health Plans joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
In this episode we are joined by Stephanie Ngo, Managing Director, Payer + Provider Integrated Solutions at Tegria to discuss how current interoperability climate influencing payers and the impact on their technology-related decisions. Tune in to hear examples of an effective payer-provider collaboration where both parties worked together to more effectively help patients and reduce costs.
This episode is sponsored by Tegria.
In this 22 minute conversation Carrie Douglas, Partner at Bracewell, gives us insights on the developments under the NSA (No Surprises Act). Tune in to hear concerns with the NSA arbitration process from a provider perspective and initial thoughts on the Feds proposed changes to the NSA process.
This episode is sponsored by Bracewell.
Dr. Bruce Rogen, Chief Medical Officer at Cleveland Clinic Employee Health Plan joins the podcast to discuss key insights into his background & organization, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Jack Shoemaker, Business Operations Delivery Lead at Medical Home Network joins the podcast to discuss his background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
This episode features Thomas Grote, CEO at Banner|Aetna. Here, he discusses key insights into his background & organization, his focus on pre-authorizations & member engagement, programs and initiatives that have been needle-moving, and more!
Dr. Anil Singh, Senior Vice President, Executive Medical Director - Population and Curated Health for Highmark Health joins the podcast to discuss his background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Dr. Krystal Revai Sodaitis, Associate Chief Medical Officer at Health Alliance joins the podcast to discuss key insights into her background & Health Alliance, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
In this episode we are joined by Jon Bloom, M.D., Co-Founder and CEO at Podimetrics to discuss how health plans and at-risk providers drive improved outcomes of member populations with complex diabetes. Tune in to learn cost effective ways to support at-risk populations.
This episode is sponsored by Podimetrics.
In this episode, we are joined by two guests from HealthEdge, Steve Krupa, CEO, and Ryan Mooney, Executive Vice President and General Manager of Payment Integrity, to discuss the gaps in payment integrity, the difference between prospective payment integrity and traditional payment integrity, and a lot more.
This episode is sponsored by HealthEdge.
In this episode, we are joined by Geeta Wilson, Chief Technology Officer of Whole Health, Advocacy and Provider Platforms at Elevance Health, and Christopher Patterson, VP of Product Strategy Customer Service & Sales at Pegasystems, to discuss Elevance Health's mission and strategy, how they center care around the individual, how they use technology for a competitive advantage and more.
This episode is sponsored by Pegasystems.
In this episode we are joined by Bryan O. Buckley, DrPH, MPH, MBA, NCQA’s Director of Health Equity Initiatives to discuss how health equity influences both internal and external stakeholders of an organization. Tune in to hear about programs that have started people on the journey toward health equity!
This episode is sponsored by NCQA.
Douglas Nemecek, Chief Medical Officer - Behavioral Health, Evernorth Health Services joins the podcast to discuss his background, his focus on mental & behavioral health, programs and initiatives that have been needle-moving, and more!
Jim Bostian, President of Aetna's Midsouth and Capitol markets joins the podcast to discuss why North Carolina was looking to replace its state health plan administrator, how he's been communicating the benefits of this major change to all involved stakeholders, why Aetna is a leader in price transparency, and more!
This 15 minute conversation features the Vice President of Growth at MDI Health, Ariel Efergan. Tune in for tips on managing the rising costs of care, best practices for measuring progress and the clinical impact, and more.
This episode is sponsored by MDI Health.
Chanin Wendling, Senior Director at Contigo Health, joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
In this episode we are joined by Scott Taylor, CEO and Co-Founder of Perx Health to discuss how digital healthcare is failing at risk patients. Tune in to hear what digital health strategies can be utilized to effectively engage users.
This episode is sponsored by Perx Health.
In this 20 minute conversation you'll hear from Dr. Manish Oza, Physician Lead for Clinical Strategy & BD at AWS; Dan Rosenthal, Advisory Partner at a16z, Former CEO UnitedHealthcare West and President, UnitedHealth Networks; and Nate Maslak, co-founder and CEO at Ribbon Health. Tune in as these leaders dig into how provider data affects stakeholders across the industry, where health plans should invest in innovation, and their vision for the future of provider data.
This episode is sponsored by Ribbon Health.
Marie Zimmerman, EVP of Public Affairs and Chief Strategy Officer at UCare joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Tune in to the Becker's Healthcare Podcast as Rich Weiss, President of Aetna's Southeast market, delves into the transformative world of value-based care arrangements. In this insightful interview, Rich provides a comprehensive perspective on value-based care, answering key questions like: What exactly is a value-based care arrangement, and why is it crucial in today's healthcare landscape? He discusses the intricate process of identifying and defining key performance indicators to reward providers within these arrangements and explores the risk continuum with real-world examples. Rich sheds light on how to shift the industry's focus from high-cost, high-service delivery to value-based care, highlighting relevant market penetration statistics. Discover how payers can incentivize providers and strengthen existing value-based relationships in this compelling discussion, concluding with Rich's valuable insights in the healthcare arena.
Michael Bagel, Associate Vice President - Public Policy at Alliance of Community Health Plans, joins the podcast to discuss his background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Dr. Tenbit Emiru, EVP at UCare joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Will Johnson, Vice President & General Manager at +Oscar, Modular Solutions joins the podcast to discuss his background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Onyinyechi “Onyi” U. Daniel - VP of Data & Analytics Strategy at Highmark Health joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
This episode features Hilary Marden-Resnik, President of UCare. Here, she discusses her background & key insights into UCare, top priorities going into the end of 2023, the different DEIA initiatives her organization is implementing, and more.
Don Antonucci, President and CEO at Providence Health Plan joins the podcast to discuss his background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Shelley Turk, Divisional Senior Vice President - Illinois Health Care Delivery, BCBS Illinois joins the podcast to discuss her background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
Angela Jenkins, VP of Accountable Communities at Prisma Health joins the podcast to discuss her background & key insights into Prisma Health, what she is focusing on going into the end of 2023, how her organization is implementing health equity initiatives in their communities, and more.
Robert Groves, EVP & Chief Medical Officer, Banner|Aetna joins the podcast to discuss his background, top priorities for the rest of the year, programs and initiatives that have been needle-moving, and more!
In this episode, we are joined by two guests from Real Time Medical Systems, Nancy Cocozza, Senior Advisor of Payer Solutions, and Phyllis Wojtusik, EVP of Value-Based Care. They dive into why live post-acute data and analytics is valuable, how payers can use this data to improve member care, what benefits this data brings for payers and a lot more.
This episode is sponsored by Real Time Medical Systems.
This episode features JC McWilliams, Vice President of Managed Care at BJC HealthCare. Here, he discusses his background, his focus on challenges surrounding value-based care, exciting initiatives BJC Health is working on, and more.
Dennis Hillen, SVP - Market Leader at Oscar Health joins the podcast to discuss his background, current excitements, issues he's spending most of his time on today, and what the most effective healthcare leaders need to be successful.
Ashish V. Shah, President and Chief Executive Officer at Dina joins the podcast to discuss his background & the focus & mission of Dina, current excitements, issues he's spending most of his time on today, and what the most effective healthcare leaders need to be successful.
Mac Davis, VP of Digital Product and Data, Belong Health joins the podcast to discuss his background, current excitements, issues he's spending his time on, and what healthcare leaders need to be successful.
In this episode we are joined by Nate Maslak, the CEO of Ribbon Health, to discuss the importance of provider data management. Tune in to hear strategies on how to improve data efficiency in your organization on a razor-thin budget, as well as how strong data management is reflected in patients' experiences and outcomes.
This episode is sponsored by Ribbon Health.
In this episode, we are joined by City of Hope leaders, Harlan Levine, MD, President of Health Innovation and Policy, and Debra Fields, Executive Vice President and Chief Transformation Officer to discuss how City of Hope is bringing the benefits of academic medicine to the community and creating a unified culture and workforce as it expands nationally.
This episode is sponsored by City of Hope.
In this episode, we are joined by City of Hope's President of Medicine & Science, Maurie Markman, MD, and Chief Medical Officer, Vijay Tristal, MD. They discuss how City of Hope’s research, scientific and patient care strengths are being exported to their locations in Atlanta, Chicago and Phoenix to create a one-of-a-kind national, integrated, cancer-focused health system.
This episode is sponsored by City of Hope.
In this episode, we are joined by City of Hope's President of Medicine & Science, Maurie Markman, MD, and Chief Medical Officer, Vijay Tristal, MD. They discuss how City of Hope’s research, scientific and patient care strengths are being exported to their locations in Atlanta, Chicago and Phoenix to create a one-of-a-kind national, integrated, cancer-focused health system.
This episode is sponsored by City of Hope.
In this episode, we are joined by John Tam, Chief Strategy Officer with Evolent, to discuss the urgency around specialty care, the priorities for payers within specialty care, the challenges payers face in managing specialty costs and a lot more.
This episode is sponsored by Evolent.
In this episode we are joined by F. Marc Stewart, MD, Vice Chair, Department of Hematology & Hematopoietic Cell Transplantation, Jeffrey R. Schriber, MD, FRCP, Director of Hematologic Malignancies, City of Hope Atlanta, Chicago and Phoenix, and Syed A. Abutalib, MD, Co-director, Hematologic Malignancies and Stem Cell Transplant Program, City of Hope Chicago as they discuss City of Hope's BMT and CAR T cell therapy programs, being leaders in the space, and ensuring integration across their national clinical network.
This episode is sponsored by City of Hope.
Dr. Onyinye Enyia Daniel, Vice President of Data and Analytics Strategy at Highmark Health, joins the podcast to discuss her background, her focus on leveraging data & analytics to simplify patient experience, trends surrounding the ethical use of data, where she sees the best opportunities for growth in the future and more.
This episode features Tom Grote, CEO of Banner | Aetna. Here, he discusses his background, Banner | Aetna’s diabetes reversal program, his focus on member experience and engagement, what the most effective healthcare leaders need to be successful in the next 2-3 years, and more.
In this episode, we are joined by Virgil Bretz, the CEO and co-founder of MacroHealth, to discuss some of the biggest challenges leaders of payer organizations are facing, the roadblocks met when trying to address these challenges, how leaders can overcome these roadblocks and more.
This episode is sponsored by MacroHealth.
In this episode we discuss improving vendor-provider relations, essential technologies for Payers right now, and much more. Tune in and hear the insights of Angela Adams, the Director of Professional Services, Healthcare Payer at Kiriworks.
This episode is sponsored by Kiriworks.
Dr. Rajaie Batniji, CEO and Co-Founder of Waymark, joins the podcast to discuss the opportunity to innovate in Medicaid managed care, how Medicaid is structured in the US and organized in each state, why Medicare Advantage startups pull in much more outside capital than Medicaid startups, and more!
In this episode, we are joined by Kimberly Clawson, MSHA, FAHM, Senior Associate Director of Payor Relations at The Joint Commission, to discuss how health plans use advanced certifications, what relationships they have with leading associations, which certifications are most valuable to payors and a lot more.
This episode is sponsored by The Joint Commission.
In this episode, Dr. Edo Paz, Senior Vice President of Medical Affairs, and Victoria Andrews, RNP, Senior Director of Solutions Consulting at Hello Heart, join us to discuss digital therapeutics and their role in managing heart disease and improving the patient experience. Learn how a user-friendly experience can make tracking and caring for chronic conditions easier for the physician and the patient.
This episode is sponsored by Hello Heart.
In this episode we are joined by Bobby Sepucha, CEO of Interwell Health, and Dr. Stephen Friedhoff, Senior Vice President of Healthcare Services at Blue Cross North Carolina, to discuss what's the biggest challenge in caring for kidney disease patients, why treatment for chronic kidney disease is tricky, how new models of value based kidney care improve outlooks for patients and a lot more.
This episode is sponsored by Interwell Health.
In this episode Paul Merrild, President, HealthSparq & Kyruus and Jeff Stewart, System Director, Strategic Marketing at CHRISTUS Health out of Texas join us for an important discussion on member experience. Tune in as they dive into how putting a strong focus on accurate data shapes the consumer's perspective.
This episode is sponsored by HealthSparq.
This episode features Dr. Alexander Iribarne, Chairman - Department of Cardiothoracic Surgery, Staten Island University Hospital | Northwell Health. Here, he discusses his background, top issues he’s watching in cardiology, how he sees heart health evolving in the short & long term, and more.
Mario Schlosser, Co-Founder & CEO of Oscar Health joins the podcast to discuss his tech heavy background, how that led to him co-founding Oscar Health - a health insurance that ‘uses technology and personalized service to give members transparency into the healthcare system and empower them to choose quality, affordable care’, & more.
In this episode, we are joined by David Stratton, Vice President of Payer Strategy & Managed Care Operations at Northern Light Health, to discuss his experience working on both the payer and provider side of healthcare, his focus on streamlining care to make it more accessible, and more.
In this episode we talk with John Keith, CEO, & Nikhil Mendhi, President & COO of Exponential AI. Tune in to learn why Healthcare Payers need AI today, areas to invest in, and more.
This episode is sponsored by Exponential AI.
Hear from the Vice President of Health Plans at Headspace Health, Jeffry Greene, in this episode of the podcast. We cover addressing challenges to mental healthcare access, key results and outcomes of a value-based model, predictions Jeff is most excited about, and more.
This episode is sponsored by Headspace Health
In this episode, we are joined by John Snyder, President at Sanford Health Plan, to discuss issues he is facing going forward in 2023, his focus on member engagement & leveraging virtual care in rural areas to increase access, and more.
Want to network with peers and hear more conversations like this? Apply to be one of our complimentary guest reviewers at our upcoming Annual Meeting April 3-6, 2023 here.
This episode features Joanne Mizell, Chief Operating Officer at Banner | Aetna. Here, she discusses ways that health insurance has evolved throughout the years, the growth of Banner | Aetna, where the best opportunities to transform healthcare are, and more.
In this episode, we are joined by Madhavi Kasinadhuni, VP of Market Strategy, New Century Health, to discuss three key trends impacting the future of cancer care in 2023 and beyond, and how health plans can respond.
This episode is sponsored by New Century Health.
This episode features Stacy Meyr, Vice President of Payer Relations, Athletico Physical Therapy. Here, she discusses her experience as clinically trained chiropractor & her transition into payer relations, what she is currently most focused on, the importance of preventative health in PT, and more.
This episode features Mark Miller, Chief Commercial Officer at Wildflower Health. Here, he discusses his background & what led him to Wildflower Health, key areas he & his team are focusing on, how he is looking at growth & investments going forward, and more.
This episode features Dustin Craik, Assistant Chief Financial Officer, Local Government Health Insurance Board. Here, he discusses his and his team’s focus on specialty drug trends, biosimilars that help drive drug prices down, new innovative biometric technologies he’s excited about, and more.
This episode features Christopher Ault, MBA, FACHE, Chief Revenue Officer, Cooper University Health Care. Here, he discusses his background, what he is currently focused on, Cooper University’s “Revenue Defense Strategy”, and more.
This episode features Gregg Mylin, System Vice President of Payer Strategy at SSM Health. Here. he discusses how he is spending most of his time today, his experience working with both payers and providers, how he is looking at growth & investments, and more.
This episode features Jennifer Houlihan, Vice President of Value Based Care and Population Health at Atrium Health Wake Forest Baptist. Here, she discusses her background, her focus on strengthening Wake Forest Baptist’s value proposition, how she is looking at growth & investments in the next 2 years, and more.
This episode features Shannon Fernandez, Vice President of Billing, Yakima Valley Farm Workers Clinic. Here, she discusses her focus on challenges surrounding workforce shortages & access to staff education, the importance of having a culture that encourages creativity, and more.
This episode features Kathryn Carpenter, VP of Sourcing, Contracting, Clinical Strategy, Implementation, and Supply Chain at CommonSpirit Health. Here, she discusses her background, the steps CommonSpirit is taking in order to recover from pandemic disruptions, the importance of transparency between suppliers & providers, plus more.
This episode features Matthew Rish, Senior Director of Finance, Planning & Analytics at NC State Health Plan. Here, he discuss his background and current role with the NC State Health Plan, top issues he’s focused on, how he is looking at growth & investments in the next 2 years, and more.
This episode features Kate Finke, Senior Director of Managed Care at Trinity Health of the Mid-Atlantic. Here, she discusses her background & what led her to her current role, her focus on revenue recovery, how policies have evolved since the beginning of the pandemic, and more.
In this episode, we are joined by Paul Merrild, President of HealthSparq & Kyruus, to discuss creating a consistent healthcare experience for members and patients regardless of where they begin their search. Tune in to learn what health plans can do to ensure members have access to the information needed to select a trusted provider and how health plans & health systems can maximize their partnerships to deliver a better experience.
This episode is sponsored by HealthSparq.
This episode features John Snyder of President of Sanford Health Plan. In this conversation, he discusses his focus on being an efficient partner to Sanford, Medicare Advantage, roadblocks he’s anticipating going into the last part of 2022, and much more.
In this episode, we are joined by Laura Isaacson, Manager of Cardiometabolic Care at Vida Health, and Dr. Richard Frank, Chief Medical Officer at Vida Health, to discuss driving stronger outcomes through inclusive cardiometabolic management. Tune in to learn more about the most significant barriers impacting underserved communities from proper cardiometabolic care. Hear insights on ways that a provider like Vida can drive inclusivity and personalization in developing a member's care journey and how inclusivity drives better cost savings across diverse populations.
This episode is sponsored by Vida Health.
John Baackes, CEO of L.A. Care Health Plan discusses executing through the challenges of the last few years, L.A. Care Health Plan’s goals for growth & investments over the next two years, and a lot more.
Carl Brodarick, Senior Vice President Managed Care Contracting & Value Based Purchasing at Accent Care, Inc. joined the podcast to discuss his background, his key focus for the second half of 2022, what Accent is doing to become an employer of choice, and a lot more.
Gayla Harvey, Vice President Payor Strategy at WakeMed Health & Hospital joined the podcast to discuss her background & what led her to WakeMed, her key focuses for the second half of 2022, how payer/price transparency laws have changed the game, and a lot more.
Tune in for recent news in the Payer industry. Jacob Emerson covers the 6 states recognized for Medicaid programs + more.
Gayla Harvey, Vice President of Payor Strategy at WakeMed Health & Hospital joined the podcast to discuss her background & what led her to WakeMed, her key focuses for the second half of 2022, how payer/price transparency laws have changed the game, and a lot more.
Sharon Williams, Senior Vice President Payer Relations & Contracting at Cancer Treatment Centers of America, shares her focus on expansion & transformation, what she is most excited about going into the latter half of 2022, and more.
Bart Fiser, Vice President of Revenue Cycle and Managed Care at Cape Fear Valley Health System shares how he is using remote work in order to retain staffing, what he is doing to prepare for anticipated roadblocks, and a lot more.
Jennifer Atkins, Senior Vice President Managed Care Strategy, Advocate Aurora Health, shares roadblocks she anticipates in the coming years, her key focus for the end of 2022, and a lot more.
Tune ins for insights from Sukanya Soderland, Senior Vice President and Chief Strategy Officer, Blue Cross Blue Shield of Massachusetts. We learn about how BCBS of Massachusetts will evolve in the value-based care environment, the best opportunity to support members over the next decade, and more!
In today's episode, we are joined by Dave Etling, SVP and GM of InComm Healthcare to discuss the importance of the patient payer experience. Join us to hear discussion on the necessary expansion of supplemental healthcare benefits as well as engagement within the member experience
This episode is sponsored by Incomm Healthcare.
Gary May, Vice President of Managed Care at Stanford Health Care, joined the podcast to talk about payer negotiations, price transparency and the business of healthcare.
David Jeans, Senior Vice President of Payer, Employer and Health Plan Strategy at Parkview Health, joined the podcast to talk about value-based care, digital tech and chronic care management.
In this episode, we are joined by Jen Dieter, Vice President of Payer Markets at nThrive to discuss the importance of having a better understanding of a member and community’s unique health needs. Tune in to learn more about what specific changes payers can make today to improve loyalty and member experience.
This episode is sponsored by nThrive.
Dr. Jaime Murillo, Senior Vice President and Chief Medical Officer of Optum Labs, joined the podcast to talk about the future of value-based care, consumerism initiatives and more.
Dr. Bill Johnjulio, Chief Population Health Officer at Allegheny Health Network, joined the podcast to talk about value-based care and big population health projects on the horizon.
Dr. Neema Stephens, National Medical Director for Health Equity at Cigna, joined the podcast to talk about the big trends in behavioral health, health equity and more.
This episode features William Kenley, CEO at AnMed Health. Here, he discusses 5 pieces of advice for emerging leaders, AnMed’s partnerships in their community as an independent system, their focus on value-based care, and more.
In this episode, we are joined by Richard Resnick, CEO of Cureatr, a tech-enabled, medication management optimization clinic, to discuss the challenges associated with patient discharges, transitions of care, and medication management. Tune in to learn why these are such pain points for providers and what they can do to overcome these challenges and improve patient care.
On today's episode, Dr. Robert Bessler, CEO and Founder of Sound Physicians, joins the podcast to dig deeper into the topic of value-based care. Here he discusses bundled payments, how Medicare Advantage plans are changing the approach to care, the future of where things are headed, and much more.
This episode is sponsored by Sound Physicians.
This episode features Pooja Ika, Founder & CEO at eternalHealth. Here, she discusses eternalHealth, a medicare advantage plan based in Massachusetts. She shares how integral her parents were in inspiring her to start this plan in October 2020, advice she would give to other founders, and more.
Zoe Barnard, Senior Advisor at Manatt Health, joined the podcast to talk about behavioral health, virtual care, and how insurers are improving access to care.
Dr. Meera Atkins, Regional Medical Director for Oscar Health, joined the podcast to talk about member growth, consumerism in healthcare and how value-based care is evolving.
In this episode, we talk with the Vice President of Growth and Operations at Zelis, Eileen Dougherty. Tune in to learn how payers can strengthen provider relationships in a way that potentially supports more timely payment, the benefits of a multi-directional payment solution, and more.
This episode features Emily Snow, Director of Behavioral Health Initiatives at Blue Cross and Blue Shield of Kansas City. Here, she discusses the increased suicide rates for individuals aged 10-34, the need to engage medical students early about psychiatry, the increase in opioid overdoses during the pandemic, and more.
Tune into this episode to learn from Xtend's CCO, Linda Corley. Linda clarifies for whom and when a Good Faith Estimate is required, talks about what's next for the No Surprises Act, and covers more.
Sponsored by Xtend Healthcare
In this episode, we are joined by Jen Dieter, Vice President of Payer Markets at nThrive to discuss the importance of having a better understanding of a member and community’s unique health needs. Tune in to learn more about what specific changes payers can make today to improve loyalty and member experience.
This episode is sponsored by nThrive.
In this episode, we are joined by Jen Dieter, Vice President of Payer Markets at nThrive to discuss the importance of having a better understanding of a member and community’s unique health needs. Tune in to learn more about what specific changes payers can make today to improve loyalty and member experience.
This episode is sponsored by nThrive.
This episode features John Snyder, President of Sanford Health Plan. Here, he discusses how healthsystem owned insurance plans can compete with big named insurance companies, why so few provider owned plans end up working out, and more.
Dr. Mitchell Fogel, Senior Medical Director of Provider Transformation and National Accounts at Horizon Blue Cross Blue Shield of New Jersey, joined the podcast to talk about the pilot programs his organization has with health systems to improve access to care and the patient experience.
UnitedHealth Group's Optum targets more physician practices, payers bring on health equity execs and more
Dr. Paul Merrick, Co-Chairman and Chief Physician Executive of Duly Health, joined the podcast to talk about the evolving role of independent physician groups, transition to value-based care and Duly's future growth.
This episode features John Snyder, President of Sanford Health Plan. Here, he discusses how healthsystem owned insurance plans can compete with big named insurance companies, why so few provider owned plans end up working out, and more.
Dr. Arthur Southam, Vice President of Health Plan Operations and Chief Growth Officer, joined the podcast to talk about how Kaiser Permanente is growing and the health plan's digital transformation.
Diane Holder, Executive Vice President and President of UPMC Insurance Services Division and President and CEO of UPMC Health Plan, joined the podcast to talk about how value-based care will evolve and the health plan's goals in the next year.
In this episode we are joined by Eileen Dougherty, Executive Vice President of Solutions at Zelis, to discuss why the healthcare payment experience is fragmented, what other challenges healthcare's misaligned incentives create for payers, providers and more.
This episode is sponsored by Zelis.
Dr. Caroline Carney, President of Behavioral Health at Magellan Healthcare and Chief Medical Officer of Magellan Health, joined the podcast to talk about trends in behavioral health, digital transformation and care coordination.
Dr. Lisa Thompson, Plan Performance Medical Director of Anthem Nevada Medicaid, joined the podcast to talk about health equity, evolving population health strategies and the next important partnerships to transform care.
Tuli Banerjee Paparizos, Vice President of Payer Strategy at Akron Children's Hospital, joined the podcast to talk about value-based payments in pediatric care.
Dr. Gonzalo Paz-Soldan, Medical Director of Partner Transformation at Horizon BlueCross BlueShield of New Jersey, joined the podcast to talk about building a relationship with providers and how the healthcare ecosystem is changing.
Stephen Anderson, Vice President of Provider Contracting and Network Administration at BlueCross BlueShield of Michigan, joined the podcast to talk about collaboration, population health and where telehealth is headed.
Dr. Peter McCauley, Medical Officer of Cigna Health Care. joined the podcast to talk about health equity initiatives, partnering with providers and the best opportunities for digital transformation.
Dr. Jerry Allison, a medical director at Molina Health of Texas, joined the podcast to talk about quality improvement, virtual care, primary care and more.
Dr. Jaime Murillo, Senior Vice President and Chief Medical Officer of Optum Labs, joined the podcast to talk about innovation in population health, personalized care and more.
Kurt Wrobel, President of Geisinger Health Plan and Executive Vice President of Insurance Operations at Geisinger, joined the podcast to talk about the health plan's goals and big opportunities for growth.
Dr. Richard Embrey, Medical Director of BlueCross BlueShield of Alabama, joined the podcast to talk about price transparency, innovation in mental health coverage, prior authorizations and more.
Doug Sturnick, Vice President of Managed Care and Payer Relations at Cedars-Sinai, joined the podcast to talk about the challenges with inflation, risk-based contracts and what the future holds for payer partnerships.
Paul Kane, Senior Vice President, Actuarial and Underwriting and Chief Risk Officer of Independence Health Group, joined the podcast to talk about consumer trends, data transparency, new initiatives and more.
Dr. Robert Groves, Executive Vice President and Chief Medical Officer of Banner | Aetna, joined the podcast to talk about evolving value-based care opportunities, precision medicine and collaboration between payers and providers.
Dennis Bolin, Chief Experience Officer of Health Plan Alliance, joined the podcast to talk about the long-term implications of COVID-19 for payers and providers, and what growth will look like in the future.
Laura Dyrda outlines the biggest potential policy changes for Medicare Advantage and Part D.
Karl Gyden, Director of Payer Contracts at Harbin Clinic, joined the podcast to talk about how payer negotiations are changing, compliance with the No Surprises Act and more.
Lisa White, Director of Value-based Partner Transformation for Horizon Blue Cross Blue Shield of New Jersey, joined the podcast to talk about cultivating the relationship between payers and providers for the future of value-based care.
Karl Hess, a consultant to health plans and former President of Texas Health | Aetna, joined the podcast to talk about the next opportunities in healthcare, innovation and lasting impact of COVID-19.
Jack Cox, Senior Advisor and the Leader of Transformational Strategy of the THEO Executive Group, joined the podcast to talk about healthcare delivery innovation, disruptors and transformation ahead.
Tune into today's Payer industry update. The episode includes details on Humana's Medicare advantage enrollment outlook, Cigna's new President of US Government Business, rulings on the Aetna class-action lawsuit, and more.
Tune in to hear the latest Payer News - Today we cover the Signa acquisition and the majority bill in the House of Representatives.
Tune in to hear about Anthem's report on their 2021 operating gain, Blue Cross Blue Shield's new VP and Chief Information Security Officer, an update from the Biden administration on Americans enrolling in health insurance, and more.
Tim Maloney, Vice President of Payer Relations at UC Health in Cincinnati, joined the podcast to talk about new developments in value-based payments, care coordination and the impact of inpatient capacity on margins.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon. If you would like to recommend a guest for the Payer Issues podcast, please email us at podcasts@beckershealthcare.com.
This episode features Anne Corley Baum, Lehigh Valley Market President at BlueCross. Here, she discusses her book “Small Mistakes, Big Consequences”, the importance of the image you are presenting to others, and more.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
If you would like to recommend a guest for the Payer Issues podcast, please email us at podcasts@beckershealthcare.com.
Anisha Sood, Chief Financial and Strategy Officer at First Choice Health, joined the podcast to discuss trends in benefits administration and the patient-physician relationship.
Alan Sager, Professor of Health Law, Policy and Management at Boston University School of Public Health, shared his view of the current healthcare climate wand where insurers are headed in this episode.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Dr. Luke Hansen, Chief Medical Officer of UnitedHealthcare Medicare and Retirement Illinois, joined the podcast to talk about value-based care, risks and key partnerships for social determinants of health.
*This was recorded on September 21st, 2021.
This episode features Steve Abramson, Senior Vice President and Chief Market and Payer Relations Officer at Southwestern Health Resources. Here, he joined the podcast to talk about evolving contract negotiations, the future of fee-for-service and how his team is strategizing for the future.
For more episodes like this, tune in to Becker's payer Issues Podcast.
In this episode, we are joined by Nicole Sunder, Director Health Plan Solution Design, PointClickCare and Paul Stout, Program Manager HIE Quality Improvement, Health Services at L.A. Care Health Plan to discuss the meaning of quality, what information is necessary to share to drive outcomes, what Alternative Payment Models mean for the healthcare ecosystem and much more.
This episode is sponsored by PointClickCare.
Dr. Paul Merrick, Co-Chairman and Chief Physician Executive of Duly Health, joined the podcast to talk about the evolving role of independent physician groups, transition to value-based care and Duly's future growth.
Ngan MacDonald, Chief of Data Operations for the Institute of Augmented Intelligence, joined the podcast to talk about data transparency among insurers and future innovation.
Donald Sinko, Chief Integrity Officer at Cleveland Clinic, joined the podcast to discuss his role, organizational priorities and more.
The new Transparency in Coverage Rule (TiC) has wide ranging implications to the healthcare communications ecosystem. Zelis has been monitoring this healthcare legislation, strategizing with clients and partners, and advancing our product plans to new requirements. In this episode, we are joined by Leah Silver, Director of Business Solutions at Zelis, to discuss advanced EOBs, new ID card requirements, future planning to fortify member communications and more.
This episode is sponsored by Zelis.
Dr. David Nill, Vice President and CMO of Cerner, joined the podcast to talk about how employer health plans are changing and exciting developments in managing chronic conditions.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Tim Maloney, Vice President of Payor Relations at UC Health in Cincinnati, joined the podcast to talk about roadblocks in prior authorization and his evolving collaboration with payers.
In this episode, we are joined by Nicole Sunder, Director Health Plan Solution Design and Michael Keyes, VP Health Plan Business Development, at PointClickCare. They discuss why readmissions are top of mind, the healthcare industry's pain points, how to address provider and member engagement, and more. This podcast is sponsored by PointClickCare.
Dr. Talya Schwartz, President and CEO of MetroPlus Health, joined the podcast to talk about population health, the COVID-19 vaccine and consumerism trends.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Steve Abramson, Senior Vice President and Chief Market and Payer Relations Officer of Southwestern Health Resources, joined the podcast to talk about evolving contract negotiations, the future of fee-for-service and how his team is strategizing for the future.
Shara McClure, Divisional Senior Vice President of Texas Health Care Delivery for BlueCross BlueShield of Texas, joined the podcast to talk about her career journey, growing membership and how COVID-19 is affecting insurers.
For more episodes like this, tune in to Becker's payer Issues Podcast.
This episode features Dr. Jeremy Friese, President of Payer Market at Olive. Here, he discusses his career journey, his pride in Olive, his transition from doctor to entrepreneur, and more.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
In this episode, Beth Griffin, Vice President of Security Innovation at Mastercard, who leads the Healthcare Vertical for the Cyber and Intelligence division, dives into the world of digital transformation in healthcare and why more focus in this area is necessary to improve the consumer experience. Beth also discusses the impact of legislation in the United States that’s enabling consumers to have more insight and control of the cost of their healthcare.
This episode is sponsored by Mastercard.
John Baackes, CEO of L.A. Care Health Plan, joined the podcast to talk about his passion for expanding access to care, addressing healthcare inequities and reaching new members.
Dr. Rodrigo Cerda, Vice President of Clinical Care Transformation at Independence Blue Cross in Pennsylvania, joined the podcast to discuss organizational growth, access to care and digital transformation.
Angel Hovanessian, Vice President of Revenue Cycle and Health Information Management at Emanate Health, joined the podcast to talk about big RCM challenges and how complex contracts are evolving.
Karl Hess, Interim CEO of Texas Health | Aetna, joined the podcast to talk about technology in the payer space, interoperability and organizational growth.
Dr. Mitchell Fogel, Senior Medical Director of Provider Transformation and National Accounts at Horizon Blue Cross Blue Shield of New Jersey, joined the podcast to talk about the pilot programs his organization has with health systems to improve access to care and the patient experience.
There is an emerging ecosystem made of equal parts Payer, provider and member. The benefits and impact of digitization in healthcare will have far reaching implications for payer, provider and the member. This session will focus on how payers are improving the overall provider and member experience through lower payments abrasion, clearer and more concise electronic communication and simple, easy to read Explanation of Payments and Explanation of Benefits.
This episode is sponsored by Zelis
Shara McClure, Divisional Senior Vice President of Texas Health Care Delivery for BlueCross BlueShield of Texas, joined the podcast to talk about her career journey, growing membership and how COVID-19 is affecting insurers.
Amy Acker, Vice President of Payer Relations at Advantia Health, joined the podcast to talk about negotiating pay for performance contracts and quality metrics that are most important to both sides.
In this episode, we are joined by Billy Padilla, Chief Information Officer at Xtend Healthcare, as he discusses the benefits of robotic process automation and artificial intelligence in the revenue cycle. This episode is sponsored by Xtend Healthcare.
Vijay Venkatesan, VP and Chief Analytics Officer at Horizon Blue Cross Blue Shield of New Jersey, joined the podcast to talk about automation, healthcare data and the workforce of the future.
Richard Sanchez, CEO of CalOptima, joined the podcast to talk about managing social determinants of health, increasing vaccination rates among members and organizational growth.
Dr. Darren Wethers, Vice President of Clinical Operations at BlueCross BlueShield of Arizona, to talk about growing members hip from government payers and how COVID-19 has transformed the field.
Stephen Kinsely, Group Vice President of Strategy and Payer Engagement at Surgical Care Affiliates, joined the podcast to talk about the transition to value-based care and what's on the horizon for ASCs.
Karen Ignagni, President and CEO of EmblemHealth, joined the podcast to talk about digital empowerment for members, population health and the big policy issues in healthcare today.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space.
In this episode we are joined by Laura Anderson, Senior Vice President of RCM Product Management at Change Healthcare to discuss the key challenges revenue cycle leaders face today and how to address those challenges. She will also dive into topics around price transparency, consumerism and the role of innovation and technology in the revenue cycle.
This episode is sponsored by Change Healthcare.
Dr. Caroline Carney joined the podcast to talk about growing accessibility to mental health services, emerging therapies, and new partnerships to increase access to care.
Ceci Connolly, President and CEO of Alliance Community Health Plan, joined the podcast to talk about vaccine requirements, telehealth and the shift to value-based care from the payer perspective.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space.
Matt Eyles, President and CEO of AHIP, joined the podcast to talk about ongoing COVID-19 vaccine efforts and coverage, and some of the big policy issues affecting insurers over the next year.
There has been a number of Payments solution innovation and optimization advances that have served to offer a greater Provider payment experience. Through increase speed of delivery, reduce processing costs and payment accuracy, Providers have been the beneficiary of an improved aggregation experience and payer reputation. As we look to the future, join this podcast as we discuss and explain the benefits payers and providers can realized from specific innovations and what future holds regarding improvements, enhancements and anticipated results.
This episode is sponsored by Zelis.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space.
This episode features Sachin Jain, President and CEO at SCAN Group and Health Plan. Here, he discusses priorities in his career, what he’s working on at SCAN Group, and more.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space.
In this episode, we are joined by Ashish V. Shah, CEO & Co-founder of Dina, Mary Naylor, Marian S. Ware Professor in Gerontology & Director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing and Alexandra Drane, CEO & Co-founder of ArchAngel.They discuss the growth in Medicare Advantage, what MA plans can do now to support people as they receive care at home, and how that differs from fee-for-service, with Supplemental Benefits as the perfect example.
This podcast is sponsored by Dina.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
This episode features a conversation between Michael Keyes and Nicole Sunder from Collective Medical, a PointClickCare company. Here they discuss challenges payers face and the barriers for solving them. They also talk about the importance of collaboration between payers and providers in the current environment and the industry's movement from volume to value based care.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
This episode features Michael Stubee, Assistant Vice President of Managed Care at Orlando Health. Here, he discusses the trends he’s watching in Managed Care and more.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon
Matt Eyles, President and CEO of AHIP, joined the podcast to talk about ongoing COVID-19 vaccine efforts and coverage, and some of the big policy issues affecting insurers over the next year.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Kara Martinezmoles, Vice President of Revenue Cycle at Renown Health in Reno, joined the podcast to talk about the patient financial experience and the role of tech in supporting RCM efforts.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Dr. Madhura Mansabdar, Medical Director of MidMichigan Collaborative Care Organization and MidMichigan Health Network, joined the podcast to talk about tackling population health and how ACOs will evolve in the future.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Kristin Rosemond, Executive Director of the Southern California Integrated Care Network and ACO Executive at Dignity Health Care Network, joined the podcast to talk about how value-based care is changing the payer landscape and the big initiatives Dignity is undertaking to address healthcare inequities for communities in need.
Praveen Thadani, president of Priority Health, a $5 billion health plan, joined the podcast to talk about value-based care initiatives and using analytics for better managing risk.
In this recap episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming next week!
Dr. Paul Hain, Chief Medical Officer of GoHealth, joined the podcast to talk about Medicare enrollment trends and value-based care.
In this recap episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief rundown of some of this week's top headline in the payer industry, looks back at this week's episodes, and previews next week's exciting episode.
Subscribe to the Becker's Payer Issues Podcast to stay up to date on all things happening in the payer space.
This episode features Randy Farmer, Chief Operating Officer of the Delaware Health Information Network. Here, he discusses what he’s seeing with cyber security issues in healthcare and more.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, gives a brief overview of some news in the payer space, recaps some recent fascinating discussions she's had with guests on the podcast in the past week, and previews some exciting episodes coming soon.
Aparna Abburi, President of Medicare and CareAllies for Cigna, joined the podcast to talk about whole-body, social determinants of health and virtual care for the Medicare Advantage beneficiaries.
Dr. Talya Schwartz, CEO of MetroPlus Health Plan in New York City, joined the podcast to discuss big priorities for today and promoting diversity and inclusion in healthcare executive teams.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, recaps some recent fascinating discussions she's had with guests on the podcast and previews some exciting episodes still to come in the next few weeks.
Bret Hart, Chief Behavioral Health Officer of Centene Corporation, joined the podcast to talk about the big trends in behavioral health, access to care and the movement to value-based care.
Susan Diamond, Chief Financial Officer of Humana, joined the podcast to talk about the shift to more remote care and payment trends in the future.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, recaps some recent fascinating discussions she's had with guests on the podcast and previews some exciting episodes still to come in the next few weeks.
Sukanya Soderland, Chief Strategy Officer and Senior Vice President for Blue Cross Blue Shield of Massachusetts, joined the podcast to discuss how the competitive market is keeping up and the pivots her organization is making to meet the needs of members and providers today. She also talked about business planning in light of the pandemic and digital transformation.
Dr. Robert Groves, Chief Medical Officer at Banner| Aetna joined the podcast to talk about how pooling resources between Banner Health and Aetna will help the organizations tackle issues such as behavioral health and diabetes more effectively. He also talked about digital health and what it will take to lower healthcare costs.
In this wrap-up episode, Laura Dyrda, Editor in Chief at Becker's Healthcare and host of the Payer Issues Podcast, recaps some recent fascinating discussions she's had with guests on the podcast and previews some exciting episodes still to come in the next few weeks.
Sandra Clarke, CFO of Blue Shield of California, joined the podcast to talk about how the company is partnering with health systems to drive cost savings and promote value-based care.
Dr. Jaime Murillo, Senior Vice President and Chief CardioMetabolic Health Officer of UnitedHealth Group, joined the podcast to talk about the big trends in cardiovascular care and what it takes to stay on the cutting-edge of healthcare delivery today.
In this bonus episode, Laura Dyrda, Editor in Chief of Becker's ASC and Spine Review at Becker's Healthcare and host of the Payer Issues Podcast, recaps some recent fascinating discussions she's had with guests on the podcast and previews some exciting episodes still to come in the next few weeks.
This episode is sponsored by Ontrak.
Steve Anderson, Vice President of Provider Contracting and Network Administration at Blue Cross Blue Shield of Michigan, joined the podcast to discuss trends in value-based care, consumerism and how technology is changing the game.
This episode is sponsored by Ontrak.
Dr. Daphne Bascom, Vice President of Population Health at Saint Luke's Health System in Kansas City, Mo., shared how she is working with community partners to implement health equity strategies, value-based care and data management in this episode.
This episode is sponsored by Ontrak.
Meghan Joyce, COO and Executive Vice President of Platform for Oscar, joined the podcast to talk about growth in the payer industry, value-based care and where Oscar is headed next.
This episode is sponsored by Ontrak.
Curtis Barnett, President and CEO of Arkansas Blue Cross Blue Shield, shared insights on how he's working with rural healthcare providers to make sure healthcare is accessible, promote digital health and explore behavioral health options.
This episode is sponsored by Ontrak.
Krista Hoglund, Chief Actuary and Financial Officer of Security Health Plan, shared how partnering with health systems on innovative approaches to quality and cost initiatives can yield better outcomes for patients in this episode.
This episode is sponsored by Ontrak.
Dr. Richard Embrey, medical director of BlueCross Blue Shield of Alabama, shared his unique perspective as a clinician and payer executive on what the two sides most often misunderstand about each other, and where he expects healthcare delivery to head over the next few years.
This episode is sponsored by Ontrak.
Dr. Amit Prasad, Chief Medical Officer of the UnitedHealthcare C&S Plan in Mississippi, talked about the big challenges in population health today and how managed care companies are partnering with providers on outreach efforts and connecting members with technology-based patient care options.
This episode is sponsored by Ontrak.
Steven Abramson, Senior Vice President and Chief Market and Payer Relations Officer at Southwestern Health Resources in Dallas, joined the podcast to talk about how conversations with payers are changing, innovation in payment models and what healthcare providers need to better manage population health.
This episode is sponsored by Ontrak.
Dr. Charles Rosen, medical director in the department of contracting and payer relations at Mayo Clinic, joined the podcast to talk about his career journey, virtual care transitions and where future reimbursement models are headed.
This episode is sponsored by Ontrak.
Wesley Chick, Vice President of Payer Strategies at Covenant Physician Partners, joined the podcast to talk about the big issues for ambulatory care, telemedicine and prior authorizations today.
This episode is sponsored by Ontrak.
Lisa White, Director of Value-based Transformation at Horizon Blue Cross Blue Shield of New Jersey, joined the podcast to talk about how payers are working collaboratively with health systems today, the transition to value-based care and technology simplifying healthcare delivery.
This episode is sponsored by Ontrak.
Dr. Sandhya Rao, Chief Medical Officer of Blue Cross Blue Shield of Massachusetts, joined the podcast to discuss innovation in healthcare delivery, value-based payments and key trends influencing health plans today.
This episode is sponsored by Ontrak.
In this episode, Sudheen Kumar, entrepreneur in residence and chief innovation officer for Blue Cross & Blue Shield of Rhode Island and Founder of Health-Chain.io, talks about digital transformation in the payer space, member engagement and how consumer preference is shaping payer strategy going forward.
Stephanie Signore, Vice President of Payer Relations at North Shore Healthcare in MIlwaukee, joined the podcast to talk about how payer relationships are changing and the shift to paying more attention to post-acute care facilities.
Mukesh Kakkar, Staff Vice President of Analytical Solutions at Anthem, joined the podcast to talk about how the health insurance industry is changing to match consumerism trends in healthcare, comply with regulatory updates and meet digital health needs in the future.
Viewpoints provided are personal and do not represent employer's.
Dr. James Grant, Chief Medical Officer of Blue Cross Blue Shield of Michigan, joined the podcast to discuss virtual care, behavioral health and educating members about COVID-19.
Dr. Robert Vissers, President and CEO of Boulder (Colo.) Community Health, joined the podcast to talk about population health efforts amid the pandemic, maintaining independence and why his system chose to partner with Optum.
Dr. Shiva Chandrasekaran, Chief Population Health Officer and ACO Executive Director at Einstein Healthcare Network in Philadelphia, joined the podcast to talk about new partnerships amid the pandemic and the rapid movement toward alternative payment models. He also discussed what clinical leaders need to succeed with transforming care models.
Dr. Amy Khan, Executive Medical Director for Regence Health Plans, joined the podcast to discuss the shift to virtual care, improving access to behavioral health services and how data integration will promote better outcomes in the future. She also talked about how the pandemic has transformed the payer/provider relationship.
Amar Gurivireddygari, vice president and chief data and analytics officer of Blue Cross Blue Shield of Rhode Island, joined the podcast to talk about how data interoperability regulations, virtual care and automation are changing healthcare delivery. He also talked about the payer-provider relationship and what to expect in the future.
This episode features John Snyder, President at Sanford Health Plan. Here, he discusses how the Biden administration could affect or change managed care plans, his top priorities in the coming months, and more.
This episode features Tom Lindquist, Allina Health | Aetna's Chief Executive Officer. Here he discusses the White House's recent price disclosure rule, how Allina Health | Aetna is working to lower healthcare costs for members, and innovations in handling the ongoing coronavirus pandemic into 2021.
This episode features a session from Becker's Payer Virtual Event: Top Concerns for Payers in 2020
The conversation includes insights from the following speakers:
- Ceci Connolly, President and CEO, Alliance of Community Health Plans (ACHP)
- Michael Carson, President and CEO, Harvard Pilgrim Health Care
- John Kao, Chief Executive Officer, Alignment Healthcare
- Moderated by Ayla Ellison, Managing Editor, Becker's Healthcare
This episode features a session from Becker's Payer Virtual Event: The Effect of COVID-19 on VBC Contracting / Reimbursement for Telemedicine
The conversation includes insights from the following speakers:
- Kelly Cavin, RN, BSN, MA, MBA, Vice President, SDoH, Change Healthcare
- Rodrigo Cerdá, Vice President, Clinical Care Transformation, Independence Blue Cross
- Eric Hoag, Vice President, Provider Relations, Blue Cross Blue Shield of Minnesota
- Moderated by Ayla Ellison, Managing Editor, Becker's Healthcare
This episode features John Snyder, President of Sanford Health Plan. Here, he discusses the things that make a system’s own health plan successful, his relocation from central Illinois to the plain states, and more.
This episode features Lori Johnston, President of Paramount, ProMedica’s Insurance Company. Here, she discusses the various roles she’s held in the ProMedica system, important things to know about the healthcare insurance business, and more.
This episode features Karen Xie, Chief Technology Officer at Blue Shield of California. Here, she discusses her career, the important role that data and technology play in healthcare today, top priorities for herself and her company, and more.
This episode features Craig Samitt, President and CEO of Blue Cross and Blue Shield of Minnesota. Here, he discusses his top priorities in the coming months, what recovery from the pandemic looks like, and more.
This episode features Steve Hamman, President, Blue Cross and Blue Shield of Illinois. Here, he discusses changes in the payer landscape, unique pressures COVID-19 has placed on payers, and much more.