Becker’s Payer Issues Podcast
608 episodes - English - Latest episode: 14 days ago -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
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Episodes
Beyond Maternity Closures: Personalized Care for a Changing Women's Health Landscape
April 09, 2024 14:30 - 20 minutes - 37.3 MBIn 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.
Prepay Claims Review: A Strategy for Reducing Healthcare Costs
April 08, 2024 13:46 - 8 minutes - 16.5 MBPayer 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.
Navigating the Future of Medicare Advantage: HEI and Social Risk Factors
April 05, 2024 18:23 - 16 minutes - 29.9 MBThis 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.
CMS finalizes 2025 MA rates + more
April 05, 2024 02:00 - 7 minutes - 14.5 MBTune in for today's industry updates.
Unlocking Growth: How Insourcing Credentialing Drove Surprising Benefits for Humana
April 04, 2024 18:15 - 16 minutes - 29.6 MBTune 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.
AI-Driven Engagement: How Tech is Transforming Member Care Navigation
April 03, 2024 19:40 - 9 minutes - 17.2 MBIn 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 appr...
Part 2 - Supporting Complex Diabetes Care in 2024: Challenges, Opportunities, and a Look Ahead
April 02, 2024 14:02 - 10 minutes - 19.8 MBIn 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.
Lawmakers set date for UnitedHealth CEO hearing + more
April 01, 2024 22:00 - 5 minutes - 11 MBTune in for today's industry updates.
Taming the Tide: How Payers Can Leverage Care Management for Chronic Disease
March 29, 2024 14:35 - 6 minutes - 11.5 MBThe 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 ...
Biden cracks down on junk plans + more
March 28, 2024 22:00 - 5 minutes - 10.2 MBTune in for today's industry updates.
Unlocking Payer Growth: Overcoming Barriers and Embracing Tech
March 28, 2024 18:23 - 19 minutes - 35.6 MBPayers 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.
Star Strategies: Improving Medicare Ratings with Provider Data
March 27, 2024 17:25 - 18 minutes - 34.6 MBJoin 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 mem...
Change to begin processing claims + more
March 25, 2024 22:00 - 9 minutes - 17.8 MBTune in for today's industry updates.
Top 10 health insurers of 2024 + more
March 20, 2024 21:19 - 5 minutes - 11.1 MBTune in for today's industry updates.
Centralizing provider data to improve healthcare with Anshul Rathi of CertifyOS
March 19, 2024 10:00 - 15 minutes - 27.9 MBJoin 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 fac...
Bridging the Behavioral Health Gap: Payers Take Action
March 18, 2024 16:09 - 14 minutes - 27.1 MBJoin 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 Optimi...
Dr. John Bulger, Chief Medical Officer of Geisinger Health Plan
March 14, 2024 21:00 - 13 minutes - 25.1 MBTune 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.
UnitedHealth CEO summoned to White House + more
March 13, 2024 22:00 - 8 minutes - 15.5 MBTune in for today's industry updates.
Caroline Carney, President of Behavioral Health and Chief Medical Officer at Magellan Health
March 12, 2024 17:28 - 17 minutes - 31.9 MBJoin 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
February 25, 2024 12:00 - 12 minutes - 23 MBPaula 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.
The tide turns on healthcare M&A + more
February 21, 2024 23:00 - 9 minutes - 16.8 MBTune in for today's industry updates.
Dr. Don Berwick, Former CMS Administrator & Health Policy Lecturer at Harvard Medical School
February 21, 2024 05:00 - 26 minutes - 48.7 MBJoin 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 comprehe...
Health systems ditch their health plans + more
February 19, 2024 23:00 - 9 minutes - 17.3 MBTune in for today's industry updates.
James Holland, President & CEO of Johns Hopkins Health Plans
February 18, 2024 12:00 - 17 minutes - 33.1 MBJoin 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.
Brian Pieninck, President and CEO of CareFirst BlueCross BlueShield
February 16, 2024 19:28 - 20 minutes - 38 MBJoin 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.
No Surprises? Unpacking Challenges and Solutions in the Era of Surprise Billing Protection
February 14, 2024 16:15 - 17 minutes - 31.6 MBDive 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...
Insurers decry proposed MA rates + more
February 12, 2024 22:35 - 6 minutes - 11.2 MBTune in for today's industry updates.
Susan Beaton, Vice President of Health Plan Strategy at Wellframe
February 08, 2024 18:29 - 14 minutes - 27.6 MBSusan 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.
CMS pitches Medicare Advantage rate cut + more
February 06, 2024 17:52 - 7 minutes - 13.9 MBTune in for today's industry updates.
Damanjeet Chaubey, Senior Medical Director and Vice President of Clinical Affairs at Clover Health
February 04, 2024 14:20 - 19 minutes - 36.1 MBIn 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.
Cigna, HCSC ink $3.3B Medicare deal + more
February 02, 2024 00:21 - 7 minutes - 13.6 MBTune in for today's industry updates.
Navigating Healthcare M&A and Payment Integrity Challenges with Greg Dorn, President of CERIS
January 30, 2024 14:19 - 8 minutes - 14.8 MBTune 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...
Musculoskeletal-care navigation with Rachel Winokur, TailorCare Co-Founder and CEO
January 23, 2024 21:44 - 14 minutes - 26.9 MBHalf 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
Waystar fights lawsuit after buying Olive AI, Epic accused of patent infringement + more
January 22, 2024 23:00 - 8 minutes - 15.4 MBTune in for today's industry updates.
Payer - UnitedHealth post $5.5B in Q4 + more
January 17, 2024 22:00 - 7 minutes - 13.6 MBTune in for today's industry updates.
UnitedHealth post $5.5B in Q4 + more
January 17, 2024 22:00 - 7 minutes - 13.6 MBTune in for today's industry updates.
Tom Grote, CEO of Banner | Aetna
January 13, 2024 22:00 - 11 minutes - 22 MBJoin 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.
CVS braces for MA pressure + more
January 10, 2024 23:00 - 4 minutes - 8.99 MBTune in for today's industry updates.
UnitedHealth accuses former execs of trade theft + more
January 08, 2024 22:47 - 6 minutes - 11.8 MBTune in for today's industry updates.
The Rapidly Evolving Specialty Pharmacy Landscape with Mark Conklin, Chief Technology Officer at Free Market Health
January 04, 2024 19:52 - 8 minutes - 16.1 MBIn 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.
Layoffs at Blue Shield of California + more
January 03, 2024 23:03 - 7 minutes - 13.9 MBTune in for today's industry updates.
Dr. Adam Wolk, Regional Chief Medical Officer at Alignment Health
December 26, 2023 10:00 - 4 minutes - 7.93 MBThis 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!
Dr. Arta Bakshandeh, Chief Medical Informatics Officer at Alignment Health
December 22, 2023 20:11 - 6 minutes - 12.1 MBThis 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
December 22, 2023 10:00 - 13 minutes - 25.9 MBHenriette 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.
Elevance, HCSC reportedly eye Cigna's MA business + more
December 21, 2023 00:00 - 6 minutes - 12.4 MBTune in for today's industry updates.
Shifting Horizons: Understanding the Rise of Virtual-First Health Plans with Matt Cook, CCO at Firefly Health
December 20, 2023 20:00 - 16 minutes - 31.5 MBIn 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....
Elevance, HCSC reportedly eye Cigna's MA business + more
December 19, 2023 00:00 - 6 minutes - 12.5 MBTune in for today's industry updates.
Kimberly Reich, Interim Executive Director & Compliance & Privacy Officer, Lake County Physicians' Association (LCPA)
December 16, 2023 10:00 - 5 minutes - 10.3 MBThis 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.
Ashish Shah, CEO of Dina
December 15, 2023 10:00 - 5 minutes - 10.5 MBThis 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.
Bob Darin, CEO of Blue Health Intelligence (BHI)
December 14, 2023 20:13 - 22 minutes - 42.4 MBThis 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.