Becker’s Payer Issues Podcast

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.