Becker’s Payer Issues Podcast

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.