Becker’s Payer Issues Podcast

This episode of the Becker's Healthcare Podcast dives into the critical issue of payment integrity with Debra Hamer, Director of Product at CERIS. We discuss why proactive strategies are essential in the fight against fraud, explore new innovations, and look towards the future of this evolving landscape.This episode is sponsored by CERIS.

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In this episode, Dr. Wyatt Decker, Executive Vice president and Chief Physician for Value-Based Care and Innovation at UnitedHealth Group, shares insights on the transition to value-based care, its impact on patient outcomes, and the challenges facing healthcare providers. Tune in for a deep dive into how UnitedHealth Group is leading efforts to reshape the U.S. healthcare system.

In this episode, Piyush Khanna, Vice President of Clinical Services at CareFirst BlueCross BlueShield, joins the podcast to discuss the importance of timely data from provider networks. He shares insights on quality reporting requirements, operational challenges, and how advancements in data exchange are shaping the future of healthcare delivery.

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In this episode, Rushil Desai, President and CEO of Aetna Better Health of Illinois, discusses key trends in Medicaid managed care, including the integration of behavioral health and social needs, the impact of digital health solutions, and the future of value-based care. He also shares insights into the innovative programs improving access and equity for Illinois' most vulnerable populations.

In this episode, George Halvorson, Chair and CEO of the Institute for InterGroup Understanding and former CEO of Kaiser Permanente, shares insights on the evolution of Medicare Advantage, its success in delivering quality care, and its role in shaping the future of healthcare. Halvorson delves into key topics like capitation, healthcare cost management, and the ongoing challenges facing the Medicare system.

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In this episode, Chronis Manolis, Senior Vice President, Pharmacy and Chief Pharmacy Officer at UPMC Health Plan, shares his perspective on the evolving pharmacy and drug access landscape. He discusses the challenges surrounding rising drug costs, GLP-1 medications, and the future of pharmacy benefit management in a complex healthcare environment.

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In this episode, Laura Dyrda speaks with Joanne McFall, Market President of Keystone First and AmeriHealth Caritas Pennsylvania. Joanne shares her insights on post-pandemic Medicaid unwinding, rising healthcare costs, and the role of managed care in addressing social factors like housing and food insecurity to improve health outcomes.

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In this episode, Joe Glinka, Director of PA HealthChoices at Highmark Whole Care, delves into the complexities of managing Medicaid in Pennsylvania, addressing issues like rising healthcare costs, the impact of social determinants on health, and the innovative community initiatives Highmark is undertaking to support vulnerable populations.

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In this episode, Dr. Lisa Saul, UnitedHealthcare’s National Medical Director of Maternal Child Health, discusses the key findings from the 2024 Maternal and Infant Health Disparities Data Brief. Dr. Saul highlights persistent disparities in health outcomes and shares how UnitedHealthcare is working to improve maternal and infant care through community engagement and collaborative efforts.

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In this episode, Karen Walker Johnson, interim CEO at Clever Care, discusses her career journey in healthcare, Clever Care's mission to serve vulnerable populations, and the company’s culturally tailored approach to Medicare Advantage.

In this episode, Fred Turner, CEO of Curative, shares the journey of scaling the company from a COVID-19 testing powerhouse to a disruptive force in the commercial health plan space. He discusses Curative's unique no-deductible model, the importance of early patient engagement, and the challenges of entering a highly regulated industry dominated by a few major players.

In this episode, Dr. John Kim, Chief Medical Officer for Alignment Health's West Coast Markets, discusses the significant social barriers affecting senior healthcare, including transportation, economic insecurity, and loneliness. He shares how Alignment Health is tailoring benefits and programs to meet the evolving needs of seniors, emphasizing the importance of holistic care and support.

In this episode, Ananya Banerjee, Chief Commercial Officer at Aledade, Inc., discusses the challenges of healthcare access, cost management, and physician independence, while highlighting Aledade's impact on rural communities and the future of value-based care.

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Tune in for today's industry updates.

In this episode, Dr. Robert Groves, Executive Vice President & Chief Medical Officer of Banner/Aetna, discusses the evolving healthcare landscape, the impact of cost pressures, and the innovative approaches Banner/Aetna is taking to improve care delivery. Discover how community-driven programs and advancements in AI are shaping the future of patient care.

In this episode, Boyd Faust, Chief Strategy Officer at GoHealth Urgent Care and newly elected member of the Urgent Care Association Board of Directors, discusses the critical role of value-based care, strategic payer partnerships, and patient engagement in the evolving urgent care landscape.

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