Tuning Into The C-Suite

Featured in this latest episode of Tuning In to the C-Suite podcast is Paul Fronstin, director of health benefits research at EBRI, who shed light on the evolving landscape of health benefits with editors of Managed Healthcare Executive. Fronstin discussed the challenges employers face in designing health plans that steer employees toward high-value care. He also shared insights on high-deductible health plans (HDHPs), noting that while they initially lead to reduced healthcare usage, they don't deliver significant long-term savings. Looking ahead, he highlighted the potential of technology, such as AI and mobile apps, to empower employees to better understand their health benefits and make more informed decisions during open enrollment.

In this latest episode of Tuning In to the C-Suite podcast, Briana Contreras, an editor with MHE had the pleasure of meeting Loren McCaghy, director of consulting, health and consumer engagement and product insight at Accenture, to discuss the organization's latest report on U.S. consumers switching healthcare providers and insurance payers. One of those surveys were on payer experiences and the other on patient experiences. McCaghy shared that ease of interaction, rather than clinical experience, is a primary reason for switching. He stressed the importance of building trust through positive experiences and meeting patient needs digitally, starting with basic functionalities could help patient turnover.

In our latest "Meet the Board" podcast episode, Managed Healthcare Executive Editors caught up with board member, Eric Hunter, CEO of Care Oregon, to discuss a number of topics, with one including the merger that never closed with SCAN Health Plan due to local opposition from Oregonians, emphasizing the need for partnerships to meet scaling and capital requirements.  On the other hand, Hunter also praised Oregon's careful Medicaid redetermination, resulting in a smaller enrollment decline than expected.  He also highlighted a new preventive medicine residency program with Oregon Health and Science University to improve healthcare for populations most at need.  Before concluding the conversation with a question on what public official or figure of past or present he'd love to sit down over dinner with, Hunter briefly covered cybersecurity challenges and the potential impact of healthcare issues in the upcoming election.

In the latest episode of the Meet the Board podcast series, Managing Editor, Peter Wehrwein, catches up with Chief Clinical Officer at Optum Rx and EAB member, David Calabrese, about his new role alongside his team's progress in improving quality, patient safety and health equity in healthcare. David highlights efforts to address pharmacy deserts and medication shortages; and the two discuss the challenges and future of retail pharmacies, the impact of cell and gene therapies and the rise of GLP-1 weight loss drugs, noting their cost and regulatory scrutiny. David also emphasized the importance of comprehensive patient support programs.

A limited pharmacy benefit manager (PBM) reform bill may be used as a "pay for" to offset the costs of extending Medicare telehealth flexibilities, shares Kelly, of Capitol Advocacy & Government Affairs.

In this month's episode of Meet the Board, MHE's Managing Editor Peter Wehrwein and spoke with a new member of our editorial advisory board, Marci J. Chodroff, MD, FACP, VP of Medical Affairs at Magellan Rx Management, a Prime Therapeutics company. The two discussed Chodroff's career transition from clinical practice to pharmacy benefits management, then crossed over to highlight challenges like Medicare regulations and the growth of specialty pharmacy, focusing on oncology and GLP-1 agonists. The conversation also touched on Magellan's acquisition by Prime Therapeutics and Chodroff's focus which remains on ensuring seamless healthcare access, especially for Medicare beneficiaries, and addressing emerging challenges like cell and gene therapies.

In this episode, MHE's Peter Wehrwein spoke with Patrick Cooney, president of The Federal Group, discussing Washington's focus on Pharmacy Benefit Managers (PBMs). Cooney highlighted increased federal attention on PBMs, with legislative activity indicating bipartisan interest in reform. Despite recent setbacks in negotiations over PBM-related provisions, both Democrats and Republicans aim for transparency and change. Cooney also predicts eventual PBM legislation in 2024, emphasizing the bipartisan recognition of reform necessity.

As we bring back our "Meet the Board" Series podcast series, Managed Healthcare Executive welcomes our newest Editorial Advisory Board member Greg Baker, CEO of AffirmedRx. In this conversation, Baker and Peter Wehrwein, MHE managing editor, discussed insights from Baker's career journey. Drawing from his experiences at Walgreens and Premise Health, Baker highlighted the importance of patient-centered care and process orientation. He discussed AffirmedRx's mission to bring transparency to the PBM industry through innovative approaches such as a cloud-based system and clinically-driven formulary. Expressing concerns about opaque pricing practices, he shared the need for industry reform and cautioned against the proliferation of corporate entities within PBMs.

In this second part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein spoke with Ceci Connolly and Margaret "Meg" Murray about Medicare Advantage utilization and challenges, highlighting proposed CMS payment cuts and prior authorization issues. Murray emphasized MA's growth and benefits, while Connolly introduced MA for Tomorrow proposals. They also tackled drug pricing transparency concerns, Medicaid coverage challenges, and predicted affordability as a key issue in the 2024 elections.

In this first part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein kicks off our new podcast series "DC Roundtable," with guests Margaret "Meg" Murray, CEO of the Association of Community Affiliated Plans, and member of MHE's Editorial Advisory Board, and CeCi Connolly, president and CEO of the Alliance of Community Health Plans, for a discussion on healthcare policy issues. The trio addressed the impact of Medicaid redetermination, emphasizing ongoing challenges and the need for policy flexibility. While recognizing the ACA's success in expanding access, they highlighted affordability concerns and partisan divides. The conversation also highlighted efforts to advocate for solutions prioritizing access, affordability and quality care.

In this month's episode of Tuning In to the C-Suite, Briana Contreras, an editor of Managed Healthcare Executive, got to chatting with Sanjula Jain, Ph.D., chief research officer at Trilliant Health.  In the conversation, Sanjula shared the concerning rise in cancer cases among those in their 30s and 40s, despite declining mortality rates. In this age range, neoplasm-related deaths are notably increasing, which could possibly be linked to pandemic-induced declines in primary care and screenings.  Sanjula added that rising cancer care costs and increased pharmaceutical investments highlight the need for a comprehensive approach in this space.

In this month's episode, Briana Contreras, an editor of MHE, chatted with Lynn Carroll, executive of HSBlox, about the difference between predictive and generative AI, yet how each works together in preventive healthcare. In the discussion, Carroll expressed the challenges and opportunities with generative AI in clinical documentation, pharmaceutical research, and medical device manufacturing. Also shared were strategies for aligning primary and specialty care in value-based initiatives, along with emerging use cases, best practices for Generative AI and much more.

Briana Contreras, an editor of Managed Healthcare Executive, spoke with Fred Turner, CEO of Curative, in this month's episode. The two talked about the challenges middle-class Americans face in dealing with medical debt, exploring the causes behind it and the impact on overall health. Fred also touched on potential solutions, both from the perspective of organizations like Curative and through collaborative efforts between various stakeholders in the healthcare system. The solutions mentioned in the conversation focus on making healthcare more financially accessible and creating a sustainable and inclusive healthcare system for all Americans.

Briana Contreras, an editor with Managed Healthcare Executive, spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare. Dr. Rajasimha also shared some examples of rare diseases that have been affected most by the lack of diversity in clinical trials, but even some strategies or initiatives that are being implemented to address the diversity gap in rare disease clinical trials.

Managing Editor of Managed Healthcare Executive, Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series. Shrank, a member of MHE's Editorial Advisory Board, also shared what has been "on his mind" as of late with Wehrwein. A topic that has been of focus includes personalized care and how it can result to better outcomes for that patient. "We spend a lot of time thinking at a high level about how to optimize a health system, how to make sure patients have access to therapies and treatments and providers," Shrank said. "But the critical feature to anyone's health really has to do with 'what motivates them', 'what they get out of bed to focus on', what they want to be able to do that day, that week, that month, that year with their parents, their family, their children."   He added the barriers to health often aren't the issues that the healthcare system are focused on.  "There's a whole host of things that impact one's ability to achieve their best health," Shrank said. "Trying to make sure we have a health system and a way of delivering care that really meets people where they are and understands what their motivations are, what means the most to them, what challenges they face, is the job of a really effective healthcare system."

Managed Healthcare Executive's Managing Editor Peter Wehrwein, and Editor Briana Contreras, had a discussion in July with Mostafa Kamal, president and CEO of Prime Therapeutics, an organization in which Kamal acquired this position in July 2023. Kamal addressed his newer role, plans for Prime, the company's more recent acquisitions and previous partnerships and some of his thoughts on the multimillion gene therapies and price transparency from a PBM perspective. 

In this month's episode, Briana Contreras, an editor of Managed Healthcare Executive, had the pleasure of catching up with MHE Editorial Advisory Board Member, Ateev Mehrotra, who is a professor of healthcare policy at Harvard Medical School and an Associate Professor of Medicine and Hospitalist at Beth Israel Deaconess Medical Center. What's been on Ateev's mind or has been a focus, lately, are most things in the digital health and telehealth space, as well as practice licensure in the U.S. Among many topics discussed in the conversation, Ateev shared his thoughts on the push for better virtual visit opportunities and the fact that insurers are now offering virtual first health plans with lower premiums.  

Welcome back to another episode of "Tuning In to the C-Suite," where Briana Contreras, an editor of Managed Healthcare Executive, had the pleasure of chatting with Cindy Gaines, chief clinical transformation officer at Lumeon. In the conversation the two mainly addressed how automation is filling in the gaps electronic health records are not able to meet and how these gaps are affecting staff, increased costs, workflows and more. 

Briana Contreras, an editor of Managed Healthcare Executive, spoke with Brian Adams, President and CEO of Tabula Rasa HealthCare, in this month's episode of Tuning In to the C-Suite podcast. In the episode, Brian and Briana got to chatting about value-based care and why the transition to this type of model has been slower than expected for some practices to adopt. Most of the discussion focused on Brian's suggestion of simplifying and personalizing value-based care models to improve health outcomes for patients and reduce costs for organizations who've adopted these models.

In this episode, Briana Contreras, an editor with Managed Healthcare Executive, and Peter Wehrwein, managing editor of MHE, got to chatting with the newest editorial advisory board member, Jeffrey Casberg, who is vice president of Clinical Pharmacy at IPD Analytics.  In the discussion, Casberg shared the most pressing or prominent issues on his mind, he explained what the drug life-cycle is at IPD, and what the latest is on drugs in the pipeline. Casberg also shared his predictions for Sarepta Therapeutics' DMD drug for young children and Mounjaro's Type 2 Diabetes Drug, and even touched on some common misconceptions he notices about drug approvals, pricing and cost.

Briana Contreras, an editor of Managed Healthcare Executive, spoke with Leah Dewey, vice president of clinical and consumer engagement operations at Cotiviti, in this month's podcast episode. In our discussion, Leah talked about what she's seeing as the process of Medicaid Redetermination is well underway and some of the issues affecting consumers, as many are at risk of losing coverage. Leah also shared best practices for health plans when reaching out to consumers and ways to keep members informed and engaged in the redetermination process.  

This month's episode of the "What's On Your Mind" podcast series features President and CEO of CareOregon, Eric Hunter. MHE Managing Editor, Peter Wehrwein, and Editor, Briana Contreras, picked Hunter's brain to see what's in fact on his mind when it comes to healthcare. Throughout the discussion, the MHE editors got an idea of enrollment or how Medicaid redetermination is going for CareOregon, and were even able to take a deeper look at the collaboration or “combination” underway between SCAN Health and CareOrgeon.

This month's episode of Tuning In to the C-Suite features Erica Jain, CEO & co-founder of digital health company, Healthie. In this discussion, Jain shared some of the challenges or things to avoid when creating a digital health startup, based on her journey with starting Healthie in 2016. She also addressed some best practices and tools that can help those working toward a digital health startup.

In this month's episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx's former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation Calabrese also touched on the market's hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics. 

Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month's episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.

A pandemic is not on anybody's wish list. But the one that COVID-19 has wrought has ushered in some constructive changes to U.S. healthcare that previously has been more talked about than done, according to Rodrigo Cerdá, senior vice president of health services and chief medical officer at Independence Blue Cross in Philadelphia. Cerda is this month's guest on the “What's on Your Mind?” podcast, and in this episode, he talks with Managing Editor Peter Wehrwein, about another pandemic silver lining: the recognition of the significance of behavioral health. Cerdá refers to it as “whole-person health” and how it helps spur Independence to integrate coverage and management of behavioral health services into its other offerings.

Briana Contreras, an editor of Managed Healthcare Executive, chats with Bronwyn Spira, CEO and founder of Force Therapeutics, in this week's episode about CMS' new CPT codes introduced in 2022. These codes focus on musculoskeletal and respiratory conditions and the data collected from patients affected. According to Spira, these codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed.

Our guest in this month's episode of the “What's on Your Mind” podcast is Margaret Murray, M.P.A., founding CEO of the Association for Community Affiliated Plans (ACAP) and a longtime member of Managed Healthcare Executive® editorial advisory board. Murray is an expert on Medicaid and healthcare policies that affect people with low incomes. In the interview with Managing Editor of MHE, Peter Wehrwein, she discusses ACAP's growth and its legislative wins, Medicaid redetermination, “junk insurance,” and state Medicaid programs carving out pharmacy benefits.  

In this month's episode of Tuning In to the C-Suite, Managing Editor Peter Wehrwein talks with Rick Bates, MBA, president and CEO of RxSense. In his conversation with Wehrwein, Bates described RxSense as a “technology platform company that has expertise in the direct-to-consumer business.” He emphasized that RxSense is not a pharmacy benefit manager (PBM) — but, rather, a company that supplies PBMs with technology, including some of the up-and-coming PBMs, such as EmsanaRx and Vivid Clear Rx. Bates and Wehrwein also discussed the Mark Cuban Cost Plus Drug and RxSense launching a standalone business intelligence product called Rx IQ.

In this debut podcast series of What's on Your Mind podcast, Perry Cohen, Pharm.D., CEO of The Pharmacy Group, recently shared his thoughts on the current state of healthcare and especially the management of pharmacy costs. This new monthly series brings listeners into the minds of Managed Healthcare Executive's Editorial Advisory Board members. Cohen has decades of experience in managed care and has been on the editorial advisory board of Managed Healthcare Executive® since 1994. 

In this week's episode of Tuning In to the C-Suite podcast, Briana Contreras, an editor of Managed Healthcare Executive spoke with Julien Pham, MD, founder and managing partner of Third Culture Capital (3CC). In the discussion they talked about the concern of having to find other means of access to care to address disparities now that funding for innovations like telehealth are expected to decline. Pham added why he believes funding for telehealth is declining and ways organizations can still address disparities and improve access to care.

In this week's episode, Briana Contreras, editor of Managed Healthcare Executive, spoke with Chuck Salvo managing director of ToneyKorf Partners about some of the common challenges and trends he sees in healthcare organizations today. The pair also touched on topics involving mergers between healthcare organizations, the question whether CEO's are being replaced and the importance of a board in a healthcare organization.

In this week's episode of "Tuning In to the C-Suite" podcast Briana Contreras, editor of Managed Healthcare Executive, spoke with Ted Quinn CEO and founder of Activate Care. During the conversation, Quinn touched on where the need to address social determinants of health is today as we are still in the COVID-19 public health emergency. Also discussed was how analyzing data and tools like artificial intelligence can address these the issues inside health inequities.

In this week's episode of "Tuning In to the C-Suite," Briana Contreras, editor of Managed Healthcare Executive, spoke with Ramin Bastani, CEO of Healthvana. Ramin addressed the ongoing issue of underserved communities lacking access to care and shared the efforts made specifically through digital health to help. He also discussed the steps that remain to be taken to improve access to care.

In this week's episode, Editor of Managed Healthcare Executive, Briana Contreras, had the pleasure of speaking with Chief Clinical Officer of WellSky, Tim Ashe, about the issue of Centers for Medicare and Medicaid Services cutting rates for Medicare home health. Tim addressed the solutions that are either underway or those that can potentially preserve access to these services. 

In this episode of Tuning In to the C-Suite, Briana Contreras, editor with Managed Healthcare Executive spoke with Dr. Yuri Fesko, oncologist and vice president of Medical Affairs at Quest Diagnostics. In the conversation, Dr. Fesko addressed the ongoing issue of long gaps of times between receiving a diagnosis for a type of cancer and finally getting the treatment for it. Dr. Fesko shared the benefits a number of sectors receive when treating patients sooner and the steps to get there.

In this episode of Tuning In to the C-Suite, Managing Editor of Managed Healthcare Executive, Peter Wehrwein, speaks with President of Value Evolutions and MHE Editorial Advisory Board Member, Doug Chaet, FACHE, about value-based care's current standing, the status of various payment models and more. 

In this week's episode, MHE Editor Briana Contreras and Managing Editor Peter Wehrwein met with CIO of Prime Therapeutics, Jim Graham to discuss the process of an organization's digital transformation from a traditional Pharmacy Benefit Manager to a complete data-driven drug management system. Graham addressed the risks an organization may come across to successfully transition to this system, but also mentioned the benefits to come. 

Hi everyone, I'm Briana Contreras and I'm an editor for Managed Healthcare Executive. Back from a brief hiatus, MHE brings you a brand new episode of Tuning In to the C-Suite podcast where I had the pleasure of speaking with Lissy Hu, President of Connected Care Networks at WellSky. Lissy and I discussed the shift to home-based care and where it stands after becoming much more of a norm three years into COVID-19. We also addressed the benefits and challenges of home-based care from a payer and patient's perspective, as well as the cost of this service as its demand rises.

This week welcomes Managed Healthcare Executive's 100th podcast episode featured on "Tuning In to the C-Suite" podcast! Guests on this episode are members of 1upHealth, CEO Joe Gagnon and Chief Strategy Officer, Don Rucker. The two were featured on the latest episode of "Tuning In to the C-Suite's" podcast series "MHE Talks: Improving Patient Access" to discuss the adoption of FHIR, or Fast Healthcare Interoperability Resource, in healthcare and how it's not only simplifying healthcare through care quality, outcomes and costs, but how it's providing further access to health data for patients and payers. The guests of the 100th episode also shared some strategies for payers and providers in using FHIR to implement and scale modern data, and more.

Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization's innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company. 

In this week's episode, Briana Contreras, editor of Managed Healthcare Executive, spoke with Dr. Paige Kilian, chief medical officer at Inovalon. In the discussion, Dr. Kilian broke down the current issues health plans are facing when it comes to risk adjustment and how it's affecting members of these plans. She also shared some solutions that can help plans improve risk adjustment and quality programs with one in particular being health plans identifying care gaps through data and analytics. 

Briana Contreras, editor of Managed Healthcare Executive spoke with Emad Rizk, M.D., chairman, president, and CEO of Cotiviti in this week's episode of Tuning In to the C-Suite. In the discussion, they talked about the issues of risk in healthcare and how they have led to inequalities in care. They also addressed how adopting risk assessment tools that expand access to data around social determinants of health can help reduce bias and improve care. 

In this latest episode of the "Meet the Board" podcast series, Briana Contreras, editor of Managed Healthcare Executive, spoke with Managed Healthcare Executive Editorial Advisory Board Member Ateev Mehrotra, who is professor of Healthcare Policy and Medicine at Harvard Medical School; and a hospitalist at Beth Israel Deaconess Medical Center in Boston. In the discussion, Briana gets to know Ateev more on a personal level and picks his brain on some of his research interests like telehealth, alternative payment models and price transparency.

In this week's episode, Briana Contreras, editor of Managed Healthcare Executive, spoke with Peter Durlach, chief strategy officer of Nuance. The two discussed how artificial intelligence drives value for patients and providers and how AI tools and solutions are helping health systems reach the quadruple aim of care.

Chief Operating Officer of Hint Health, Mark Nolan, discussed direct contracting in healthcare among his organization with Managing Editor of Managed Healthcare Executive, Peter Wehrwein, in this week's episode of Tuning In to the C-Suite podcast.

Briana Contreras, editor of Managed Healthcare Executive spoke with Jason Warrelmann, global director of Healthcare and Life Sciences at UiPath, in this week's episode of Tuning In to the C-Suite podcast. In the discussion Jason addressed the incline of automation in healthcare, why it's necessary for patients and providers and how other healthcare organizations can better overcome the challenges of adopting automation within their health system.

Welcome back to another episode of the returned MHE Talks: Improving Patient Access podcast. In this episode Briana Contreras, editor of Managed Healthcare Executive, spoke with Wes Gilson, senior director MR of Business Development at Siemens Healthineers. In the conversation, the two discussed why improving access to magnetic resonance imaging (MRI) is crucial to advancing health equity. Gilson addressed the barriers many face when accessing MRI services and its solutions from tackling the barriers specific to areas affected, alternative technologies, developing new innovations in MRI tech and more.

Briana Contreras, editor of Managed Healthcare Executive spoke with Luis Mosquera, CEO of Health Network One, a provider of specialty benefit management services for health insurers, in this week's episode. In this discussion, Luis and Briana talked about how value-driven decisions in a more value-based market can not only better manage costs for health plans, but create a plan of care to best meet patient's needs. In order to do this, Luis strongly encouraged healthcare executives to experience alternative payment models and shared what payers should check off their list with a new model.

In this episode, Peter Wehrwein, managing editor of Managed Healthcare Executive, speaks with Dr. Rodrigo Cerda. Dr. Cerda has been recently promoted to the position of senior vice president of health services and chief medical officer of Independence Blue Cross in Philadelphia. He is also a member of Managed Healthcare Executive's editorial advisory board. Peter and Dr. Cerda discuss his new role at the Independence Blue Cross, what it means to be a chief medical officer at an insurer these days, valued-based care, social determinants of health, and, of course, the pandemic.