Becker’s Payer Issues Podcast

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, Dental & Vision. He discusses Cigna Dental'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.