Becker’s Payer Issues Podcast

This episode of the Becker's Healthcare Podcast dives into the future of in-home care with Joseph Buchanan, SVP of Clinical Network at Matrix Medical Network, about how they prioritize high-quality care delivery in patients' homes. They discuss the importance of a clinician-led approach to in-home assessments and how it improves access, patient experience, and health equity for payers.This episode is sponsored by Matrix Medical Network.

Tune in for today's industry updates.

Tune in for today's industry updates.

In this episode, Dr. Tommy Ibrahim, President and CEO of Sanford Health Plan, discusses his journey from clinical practice to leading a health plan, the challenges and opportunities in rural healthcare, and his strategies for driving growth and innovation in a rapidly evolving industry.

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In this episode, Dr. Johanna Vidal-Phelan, Chief Medical Officer of Quality and Pediatrics, and Rebecca Nagle, Director of Medicaid and CHIP Quality Programs at UPMC Health Plan, discuss strategies to address vaccine hesitancy. They share insights on effective communication, community partnerships, and initiatives to increase vaccination rates and improve public health.

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Join Erika Spicer Mason on Becker's Healthcare podcast as she discusses the evolution of healthcare data with Dr. Karl Serrao from Driscoll Health Plan and Dr. Katherine Schneider from Medecision. They explore the significance of real-time data, the integration of technological advancements, and the impact on community health outcomes.This episode is sponsored by Medecision.

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Steve Sutherland, Senior Vice President at CERIS, dives into how AI and machine learning are transforming payment integrity in healthcare. He explores the benefits payers can experience, challenges to widespread adoption, and best practices for leaders implementing these powerful tools.This episode is sponsored by CERIS.

In this episode, Jakob Emerson speaks with Guy A. Medaglia, President & CEO of Saint Anthony Hospital in Chicago, and Michael Shakman, Partner at Miller Shakman Levine and Feldman, about St. Anthony's transformative role in community healthcare and their ongoing lawsuit against the state of Illinois over Medicaid payment issues. Guy shares his unconventional journey into healthcare and personal motivation rooted in his upbringing, while Mike explains the complexities and current status of their legal fight for fair and transparent Medicaid reimbursements.

In this episode, Jakob Emerson interviews Krischa Winright, President of Medicare Advantage at Blue Cross Blue Shield of Michigan. They discuss Krischa's extensive background in healthcare, the unique needs of seniors in the Medicare Advantage market, and how BCBS Michigan is addressing these needs through innovative partnerships and strategies. Krischa also shares insights on the recent changes in Medicare Advantage star ratings and how her team is navigating industry headwinds to continue providing high-quality, affordable care to their members.

Tune in for today's industry updates.

Tune in for today's industry updates.

Tune in for today's industry updates.

In this thrilling episode, Stephen Anderson, VP of Provider Contracting & Network Administration at Blue Cross Blue Shield of Michigan, discusses the significance of GLP-1 medications and the importance of making them affordable and accessible for those in need. He also explores the future growth prospects for Blue Cross, highlighting factors driving up costs in the healthcare system and the strategies being implemented to manage these challenges.

In this episode of the Becker's Healthcare Podcast, Mariah Muhammad interviews Drew Thompson, Head of Sales and Growth at Northwell Direct. Drew discusses the challenges employers face with rising healthcare costs, the benefits of direct-to-employer healthcare models, and the importance of exploring alternative solutions like self-insurance and captive models to manage expenses and improve coverage.

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In this episode of the Becker's Healthcare Podcast, Laura Dyrda interviews Joanne Mizell, COO of Banner | Aetna, to discuss the joint venture's innovative efforts to transform healthcare and enhance patient experiences. They explore current trends and challenges in the industry, Banner | Aetna's focus on transparency and technology, and successful initiatives to improve member engagement and satisfaction.

Chris Carmody, CTO and Senior Vice President at UPMC, joins Laura in a discussion on the need for caution when implementing new technologies into our healthcare system. He discusses the increasing cybersecurity threats facing healthcare institutions and the importance of safeguarding patient data. Chris also highlights strategies for optimizing care for both patients and hospital workers, ensuring that technological advancements contribute positively to healthcare delivery and safety.

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In this episode of the Becker's Healthcare Podcast, Laura Dyrda speaks with Dr. Tenbit Emiru, Chief Medical Officer at UCare. Dr. Emiru discusses her role and insights into current healthcare trends, including the challenges of increased medical utilization, advancements in therapeutics, and the critical need for mental health services, while also sharing UCare's strategies for growth and innovative partnerships.

Join Laura Dyrda on the Becker's Healthcare Podcast as she interviews Troy W. Williams, MBA, Vice President of Health Systems Partnerships at First Choice Health. Troy shares his extensive experience in healthcare, the importance of transparency, and how First Choice Health is expanding its geographic footprint and enhancing health plan incubation to improve efficiencies and patient care.

In this episode of the Becker's Healthcare Podcast, Laura Dyrda is joined by Sonny Goyal, Senior Vice President and Head of Diversified Businesses at Blue Cross North Carolina. Sonny discusses innovative strategies to improve access to quality, affordable care, focusing on trends such as telehealth, AI advancements, and value-based care models, while also addressing significant headwinds like rising healthcare costs and provider shortages.

In today's podcast, we explore how optimizing provider data management (PDM) is key to boosting operational efficiency for health plans. Parvathy Sashidhar, Senior Director of Product Management for HealthEdge, dives into the common challenges plans face with outdated provider information and how these issues can be mitigated. Learn how advanced PDM solutions can streamline data integration and ensure accurate provider details, ultimately improving care delivery and strategic growth.This episode is sponsored by HealthEdge.

This Becker's Healthcare podcast episode dives into whole-person care with Catherine Tabaka, CEO of Matrix Medical Network. Matrix delivers whole-person care by assessing patients’ health in all its dimensions, including physical, emotional, spiritual and social, which can improve outcomes and health equity. Matrix home-based services uncover factors such as social determinants of health and empower patients to manage their health. Leaders can prepare for the future of healthcare by focusing on care coordination and ensuring patients don't fall through the cracks.This episode is sponsored by Matrix Medical Network

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In this episode, Erin Drinkwater, Chief of Government Relations and Strategic Partnerships at MetroPlusHealth discusses her background, the initiatives at MetroPlusHealth focused on enhancing healthcare access and equity for New Yorkers, and the organization’s strategic priorities, including their integrated behavioral health services and the Food as Medicine program.

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Edward Juhn, Chief Quality Officer of Administration at Inland Empire Health Plan, shares his strategies for ensuring top-tier care in clinical services, data innovation, and public health in this fascinating episode. Emphasizing the importance of partnerships, Edward discusses the continuous efforts to enhance all aspects of healthcare delivery. He also sheds light on the groundbreaking “pay for performance program,” which has led to remarkable improvements and outcomes.

In this episode of the Becker's Healthcare Podcast, host Laura Dyrda sits down with Hilary Marden-Resnik, President & CEO of UCare. Over the course of their conversation, they delve into the current trends and challenges in the healthcare industry. Hilary shares insights on UCare's innovative strategies for enhancing patient care and managing the complexities of the healthcare system.

In this episode of the Becker's Healthcare Podcast, host Laura Dyrda interviews Pankhuri Sharma, Strategy & Operations Leader at Humana. Pankhuri discusses her role at Humana, the strategic initiatives she's leading, and the operational challenges in the healthcare industry. Tune in for an insightful conversation on driving innovation and efficiency in healthcare. ​

In this episode, we explore the latest trends in AI-powered automation with Paul Torrey, Senior Industry Practice Director, UiPath. We discuss how businesses are leveraging automation to improve scalability, efficiency, and integrate cutting-edge technologies like ML and NLP. We'll also get insights on how to navigate the ever-evolving landscape of automation and implement successful AI-driven solutions within your organization.This episode is sponsored by UiPath.

In this episode of the Becker's Healthcare Podcast, host Laura Dyrda talks with Dr. Darren Wethers, the Chief Medical Officer of ATRIO Health Plans. Dr. Wethers shares his experiences and insights on the current healthcare landscape, the challenges faced, and the opportunities available. Tune in to hear an engaging discussion on healthcare management and delivering quality patient care.

Join us for an insightful conversation with Alessa Quane, Executive Vice President and Chief Insurance Officer at Oscar Health. Alessa discusses key healthcare trends, including consumer expectations, ACA growth, and disruptive technology, while highlighting Oscar Health's innovative HolaOscar program for the Hispanic and Latin communities.

Health plans rely on complex networks of providers to deliver care to their members. But how do they measure success? This episode dives into health plan network performance benchmarking with Subhash Seelam, SVP of Applied Network Analytics at Quest Analytics®, and Bob Tavernier, Solutions Executive at Quest Analytics. They discuss key metrics, the challenges of benchmarking, and how it can be used to better differentiate and optimize networks thereby improving member satisfaction and retention.This episode is sponsored by Quest Analytics.