Becker’s Payer Issues Podcast
The Becker's Payer Issues Podcast is a must-listen podcast exclusively created for health insurance executives. Two new 15-minute episodes are released weekly, featuring leaders who shape health insurance in America and discuss the cost of care, policy, and regulation.
Episodes
Earlier Signals, Better Outcomes: Rethinking Risk Stratification for New Members
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 informati
Medicaid, Food as Medicine, and the Future of Coverage with Kelly Munson
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.
Using Data and AI to Improve Care Coordination with Liz Signorella
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 Hippocrat
Tackling Healthcare Affordability Through Innovative Funding Models with Morgan Kendrick
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.
America’s Health Rankings Senior Report: Key Trends in Healthy Aging with Rhonda Randall, DO
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
Sharon Williams on Member Experience, Healthcare Access, and Smarter Payer Technology
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 coverag
Rethinking Risk Adjustment and Payer Provider Alignment in Value-Based Care
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-t
Rethinking Health Plan Design Through Access, AI, and Preventive Care with Adam Park
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 cr
AI, Interoperability, and Member Experience in Modern Payer Operations with Cara Wahmann
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
Using Data and AI to Drive Proactive Member Care
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 c
Building Trust and Member Engagement in Medicare Advantage with Garfield Collins
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
Navigating Risk Adjustment Data Validation (RADV) Audits with Confidence, and the Costs of Unsupported Diagnoses
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&
Using Data and AI to Drive Proactive Member Care
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 c
Navigating Medicare Advantage, AI & Member Experience with Rob Hitchcock
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,
Building Trust Through Culture, Community & AI-Enabled Member Engagement with Andy Higgins
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 experi
Rakesh Mathew, MS, MBA, CPHIMS, Interoperability Leader at Jefferson Health Plans
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 interoper
Ilan Shapiro, MD, MBA, FAAP, FACHE, Chief Health Correspondent and Medical Affairs Officer and Senior Vice President at AltaMed Health Services
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
Reimagining Proactive and Personalized Health Coverage with Michael Roan
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 H
How AI and Proactive Care Models Are Transforming Medicare Advantage with Damanjeet Chaubey
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 collabor
Redefining Member Engagement and AI in Health Insurance with Chris Gay
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 collaborati
Scaling Population Health with AI While Preserving the Human Touch
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
Healthcare Upside / Down: How BCBS Massachusetts Predicts Churn, Empowers Brokers, and Wins More Business
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 Manage
AI, Consumer Choice, and the Future of Benefits Administration with Brandy Thompson
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 w
Payer pressures, community-based care, and responsible AI adoption with Ceci Connolly
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 collab
AI, Affordability, and Consumer Experience in Healthcare with Siva Balu
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 collaborat
Lisa Baird, Chief Executive Officer of Aetna Better Health of Missouri
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.
Kelli Tice, MD, Vice President of Medical Affairs and Chief Health Improvement Officer at GuideWell and Florida Blue
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 a
Advancing Affordability & Member Experience Through Digital Innovation with Jennifer St Thomas
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.I
Leveraging Data and Human Centered Care in Medicare Advantage with Dr. Krystal Revai
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.
Balancing Medicaid Costs, Access, and Member Experience with Nora Leibowitz
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 A
Affordability, Innovation, and Transforming Healthcare in North Carolina with Dr. Tunde Sotunde
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.
Driving Affordability and Access Through Digital Innovation with Ellen Sexton
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 w
AI, Simplicity, and Collaboration: Redesigning Medicare Advantage Care Delivery with Dr. Saria Saccocio
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 wit
Hasan Shanawani, Associate Chief Medical Officer at Horizon Blue Cross Blue Shield of New Jersey
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.
Advancing Rural Health Access and Innovation with Brendan Harris & Patti Jackson-Gehris
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.
Three Years of Virtual Blue and the Future of Virtual First Care at Blue Shield of California
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.
Expanding Consumer Choice and Innovation in ICHRA Models with Alan Silver
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.
Building Trust and AI Driven Member Engagement in Health Plans with Howard Weiss
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.
HR1 Effects and How Organizations Can Prepare for Them
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
AI-Driven, Personalized Care for Chronic Conditions and How Payers Are Adapting Through Digital Health Innovation
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 out
How Dementia Care is Reshaping Population Health Strategy
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 impr
How Independent Providers Can Turn Insight Into Action
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 ac
Rob Andrews, Chief Executive Officer of the Health Transformation Alliance
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.
ICHRA’s Rise and the Future of Employer Sponsored Benefits with Brandy Thompson
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.
Harlon Pickett, President of Eagle Care Health Solutions
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.
Rebuilding Trust and Letting Consumers Drive Healthcare with Joseph Leach
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.
Reducing Administrative Friction & Advancing AI Driven Care with Dr. Benjamin Kornitzer
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,
Driving Affordability and Simplicity in Payer Strategy with Christina Ott
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
The Evolving Role of Provider Data in Healthcare
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 readine
Reframing GLP-1 Strategy Through Clinical Outcomes, Behavior Change, & True ROI
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 sustai
Harnessing AI to Deliver Breakthrough Healthcare Value, Faster
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.
Tackling Healthcare Affordability and Chronic Disease at Blue Shield of California with Mike Stuart
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
Steve Yurjevich, Chief Executive Officer of Optum Insight’s Payer Market and a member of the American Heart Association Executive Leadership Team
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
Jeff Bak, President and Chief Executive Officer of Imagine360
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.
How Health Plans Can Build Scalable High Performance Infrastructure to Support Growing Complexity & Enable AI
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 epi
Closing the Cancer Care Gap: How Integrated Screening and Treatment Support Improve Outcomes
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, proac
Pankhuri Sharma, Strategy and Operations Leader at Humana
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.
How to Optimize Behavioral Health Benefit Expense Management with a Great Tag Team of Guests
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.
Connected Intelligence: How AI Is Reshaping Group Health Insurance
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.T
Kevin Knight, Chief Marketing Officer at Sidecar Health
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.
Moving Payment Integrity Upstream with Jhana Spence of CERIS
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 spons
Medicaid Readiness and Building Trust Through Engagement
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.
Inside PsychPlus: Scaling Behavioral Health Nationwide
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 c
Why Domain-Specific AI Models Are Transforming Payment Integrity in Healthcare
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, fr
Driving Value and Innovation in Health Plan Operations with Gretchen Wagner
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 sustainab
Dr. Sameer Amin on Sustaining Medicaid and Social Determinants of Health Investments
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.
Simplifying the Digital Health Landscape for Employers with Brian Cheney
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.
UnitedHealthcare Expands Doula Coverage to Improve Maternal Health Outcomes
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.
Strengthening Payer Provider Collaboration to Improve Care and Efficiency with Dr. Daniel Elliott
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 healt
Advancing Value Based Care and the Future of Optum Health with Krista Nelson
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
Tackling Hypertension in Medicaid Through Community Partnerships with Dr. Kara Odom Walker
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 f
Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan
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, v
Data Driven Leadership in Medicare Advantage with Jennifer L. Kowalski of Elevance Health
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.
Advancing Culturally Competent Medicare Advantage with Karen Walker Johnson of Clever Care Health Plan
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.
Rethinking Employer Health Plans for Affordability with Jeff Bak
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.
Payer Innovation, Venture Investment, and Managing Rising Care Costs with Emily Durfee
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.
Strengthening Payer Provider Collaboration and Advancing Site Neutral Care with Saria Saccocio, MD, MHA,
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 healt
Navigating Medicaid Redeterminations and Market Shifts with CalOptima Health Leadership with Michael Hunn & Yunkyung Kim
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.
Navigating HR1 and Protecting Medi-Cal Coverage with Jennifer Schirmer
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 pop
Smarter, Faster, Fairer? The Next Evolution of Prior Authorization
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 b
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