Podcasts about anthem blue cross

In this episode, Amanda Free, Anthem Blue Cross and Blue Shield of Georgia Commercial President, discusses improving healthcare affordability, expanding access in rural communities, strengthening value-based care partnerships and helping members make smarter choices about where and how they receive care.

In this episode, Amanda Free, Anthem Blue Cross and Blue Shield of Georgia Commercial President, discusses improving healthcare affordability, expanding access in rural communities, strengthening value-based care partnerships and helping members make smarter choices about where and how they receive care.

"Healthcare becomes more affordable when we make the better choice the easy choice." In this episode of Bright Spots in Healthcare, Eric Glazer sits down with Beth Keyser, President of Anthem Blue Cross and Blue Shield's West Region Commercial Health Benefits business, to explore why healthcare affordability isn't just about lowering prices, it's about helping people make better decisions earlier. Throughout the conversation, Beth shares how Anthem is redesigning the member journey by combining data, navigation, provider collaboration, and whole-person care to guide members toward the right care at the right time and in the right setting. Rather than focusing on healthcare after the bill arrives, Beth explains why the greatest opportunity to improve affordability happens long before treatment begins. In this episode: Why healthcare affordability starts before anyone receives a medical bill Helping members choose the right site of care without sacrificing quality Moving beyond price transparency to true care navigation How Sydney Health and HealthOS are helping members and providers make better decisions together Why whole-person care is also an affordability strategy What the industry's strongest payer-provider partnerships are doing differently Why healthcare leaders should focus less on protecting data, and more on using it The opportunity healthcare may still be underestimating over the next five years If you're leading a health plan, provider organization, employer health strategy, or healthcare company, this conversation offers practical ideas for improving affordability by making healthcare easier to navigate, not simply cheaper. Resource: Anthem Blue Cross and Blue Shield and USA TODAY Network's in-house branded content studio launched a new five-part video series designed to help Americans better understand their health plan benefits, make informed care decisions and manage costs with greater confidence. https://www.usatoday.com/interactives/sponsor-story/anthem-blue-cross-blue-shield/5-key-health-insurance-terms-made-simple/ About Beth Keyser: Beth Keyser is a 30-year healthcare industry veteran with a passion for leading organizations that are on a mission to make people healthier.  Beth was named president of the Anthem Blue Cross and Blue Shield West Region for the Commercial Health Benefits division in 2025, which includes Colorado, Indiana, Kentucky, Missouri, Nevada, Ohio and Wisconsin. She is also responsible for Sales Enablement and Centralized Sales Support within the Commercial Health Benefits division. Previously, Beth served as president of Anthem Blue Cross and Blue Shield of Indiana from 2020 to 2025. The Anthem health plan in Indiana is the largest in the state with nearly 5,000 Indiana-based associates, serving more than four million members. Before joining Anthem, Beth focused on improving doctor-patient relationships as the president of Create® health plans in New York City. Prior to her time at Create®, Beth held several leadership roles at Healthways where she was accountable for domestic and international revenue growth, customer experience, call center operations and establishing partnerships with health plans, employers, physician organizations and hospitals. Early in her career she helped stand up Gordian Health Solutions, a Nashville start-up, that was eventually sold to Blue Cross Blue Shield of Tennessee. Beth currently serves on the Board of Directors of Women in Health Care Leadership at University of Alabama at Birmingham, which provides mentoring and training programs to develop tomorrow's leaders. She also serves on the board of directors of the Indiana Sports Corp, Neuraxis and the WellPoint Holding Corporation. Beth is also a proud member of the Red Cross Tiffany Circle. Keyser is a graduate of the University of Southern Mississippi and earned a master's degree from the University of Alabama at Birmingham. Connect with Beth: https://www.linkedin.com/in/beth-keyser-589a184/     About Bright Spots Ventures Bright Spots Ventures helps healthcare leaders discover what's working—and how to scale it. Through our podcast, executive councils, private events, and strategic advisory work, we bring together health plan, provider, and healthcare innovation leaders to exchange practical ideas that improve care, lower costs, and accelerate innovation. Learn more: https://www.brightspotsinhealthcare.com      

In this episode, Jessica Lopez-Liggett, Commercial State Plan President for Anthem Blue Cross and Blue Shield in Indiana, discusses rising healthcare costs, simplifying the member and provider experience through technology, and expanding high-quality, lower-cost care through provider partnerships. She also shares why addressing social determinants of health and bringing employers, providers and community organizations together is critical to improving healthcare.

In this episode, Jessica Lopez-Liggett, Commercial State Plan President for Anthem Blue Cross and Blue Shield in Indiana, discusses rising healthcare costs, simplifying the member and provider experience through technology, and expanding high-quality, lower-cost care through provider partnerships. She also shares why addressing social determinants of health and bringing employers, providers and community organizations together is critical to improving healthcare.

Emily McAndrews from Anthem Blue Cross and Blue Shield joins us for a conversation about home and vehicle modifications and how thoughtful changes can help older adults stay safer, more independent, and more comfortable. We talk about the parts of daily life that can become harder over time, from moving through the house to getting in and out of the car, and why planning ahead can bring relief before a crisis happens. We also reflect on legacy and share ways families can spot scams during vulnerable seasons.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

AI-generated content is flooding the internet, making it harder for audiences to distinguish real from fake (deepfakes, AI-written articles, synthetic video/audio). People were already becoming skeptical of what they read on Google, websites, and social media, and now AI-content has driven consumer trust in online content to historic lows. For marketers, this means driving online leads and standing out as credible is much more difficult. In this episode, Katie and I talk about ways brand journalism and human-centered storytelling can help cut through the "AI Slop" by using things AI can't develop - real interviews, quotes, stats, anecdotes, and case studies. We also talk about how to approach this journalistic style of content creation in a way that facilitates meaningful connection. *About Katie Wagner: * Katie Wagner spent 15 years as a television and radio journalist, working for news outlets all over the world, including ABC, CBS, Fox, CNN & National Public Radio. As a professional storyteller, Katie knows how to engage an audience and build credibility, and she believes those skills are just as valuable for business owners as they are for journalists. Today, Katie owns a full-service digital marketing agency made up of journalists like herself. The agency, KWSM, was founded in 2010, and specializes in lead generation, content creation, social media management, digital advertising, website design, and SEO. They work with clients like Mitsubishi, Anthem Blue Cross, F45 Fitness Studios, Rakuten, Caesar's Entertainment, Lorna Jane Active Wear, and small to mid-sized companies across the country. KWSM has offices in Orange County, CA, San Diego, CA, Atlanta, GA and Las Vegas, NV. Katie also works as a consultant, helping businesses integrate digital marketing into their traditional marketing plans. She is a popular speaker, and regularly gives keynote presentations and leads workshops and breakout sessions for both corporate and small business audiences. Katie lives in San Diego, CA with her husband and their 6 rescue dogs. Links: Website: https://kwsmdigital.com/ LinkedIn: https://www.linkedin.com/in/katiewagnerkwsm/

Few physicians ever experience healthcare from the perspective of a health plan, but Jacob Asher, MD, is an exception. A former ENT surgeon with Kaiser Permanente, Asher shifted gears in 2008 to pursue a career in commercial health plan management. Over the next 14 years, he served as California Commercial Market Medical Director for Anthem Blue Cross, Cigna, and UnitedHealthcare. Today, he shares his expertise by mentoring students in Stanford University's Master's Program in Medical Informatics. In this conversation with host Michael Sacopulos, Asher pulls back the curtain on commercial insurance — from how contracts are structured, to who holds pricing power, why behavioral health has been siloed, and what AI might finally be able to fix in a system long defined by friction and misaligned incentives. Asher also shares how serving on Kaiser Permanente's Medical Group Board of Directors helped prompt his move from surgery into health plan leadership. He also discusses the role of AAPL (then ACPE) in preparing physicians for non-clinical career paths. Learn more about the American Association for Physician Leadership. https://doi.org/10.55834/sp.2297884529

Few physicians ever experience healthcare from the perspective of a health plan, but Jacob Asher, MD, is an exception. A former ENT surgeon with Kaiser Permanente, Asher shifted gears in 2008 to pursue a career in commercial health plan management. Over the next 14 years, he served as California Commercial Market Medical Director for Anthem Blue Cross, Cigna, and UnitedHealthcare. Today, he shares his expertise by mentoring students in Stanford University's Master's Program in Medical Informatics. In this conversation with host Michael Sacopulos, Asher pulls back the curtain on commercial insurance — from how contracts are structured, to who holds pricing power, why behavioral health has been siloed, and what AI might finally be able to fix in a system long defined by friction and misaligned incentives. Asher also shares how serving on Kaiser Permanente's Medical Group Board of Directors helped prompt his move from surgery into health plan leadership. He also discusses the role of AAPL (then ACPE) in preparing physicians for non-clinical career paths. Learn more about the American Association for Physician Leadership at www.physicianleaders.org.

On this episode of Fostering Change, Rob Scheer is joined by leaders and advocates working directly with young people transitioning out of foster care: Sarah Baumgartner of Anthem Blue Cross and Blue Shield, Brian Robinson of Kids' Voice of Indiana, and Princess Martinez Casanova, a foster youth leader and member of the Youth Impact Board at Kids' Voice.For Comfort Cases, partnerships have always been central to the mission. The organization's first corporate Packing Parties began in Indiana with Elevance Health and Anthem Blue Cross and Blue Shield in 2008. Since then, Anthem has remained a longstanding partner, demonstrating an ongoing commitment to corporate responsibility and to supporting children and youth experiencing foster care.Today, that commitment continues through collaboration with Kids' Voice of Indiana, working together to raise the voice of youth transitioning out of foster care by creating resources, providing transition support, and expanding opportunities for education and career advancement.As Foster Care Awareness Month approaches in May, this conversation highlights the importance of recognizing the needs of young people preparing to age out of the system — and the role partnerships play in helping them build strong, independent futures.Episode HighlightsThe importance of supporting youth as they transition out of foster careHow corporate partnerships can expand resources and opportunities for young peopleThe role of Kids' Voice of Indiana in advocating for older youth and preparing them for independenceThe impact of mentorship, advocacy, and youth voice in shaping better outcomesReal-life success stories, including pathways to higher education and career developmentAbout the GuestsSarah Baumgartner is the Older Youth Case Manager on the Foster Care Team at Anthem Indiana Behavioral Health Services. She brings more than 20 years of experience in mental health, including residential treatment, school-based counseling, and private practice. Her work focuses on supporting older youth as they transition from foster care to adulthood.Brian Robinson is the Director of Older Youth Initiatives for Kids' Voice of Indiana. With more than 25 years of experience working with children and families, including serving as a Guardian ad Litem since the early 1990s, he centers his work on preparing older youth in foster care for independence.Princess Martinez Casanova is a bilingual education advocate, foster youth leader, and member of the Youth Impact Board at Kids' Voice of Indiana. After immigrating from Mexico as a teenager and entering foster care at fourteen, she is now attending DePauw University on a full scholarship, studying Education Studies and Spanish, and advocating for foster youth and immigrant communities.About the WorkThe collaboration between Anthem Blue Cross and Blue Shield and Kids' Voice focuses on:Transition support for youth aging out of foster careElevating youth voice and advocacyExpanding access to education and career pathwaysThese efforts reflect a shared commitment to helping young people move from foster care into adulthood with the tools, support, and opportunities they need to succeed.Connect & Learn MoreKids' Voice of Indiana: https://kidsvoicein.org/Facebook: @AnthemMedicaidInstagram: @anthembcbsX (Twitter): @AnthemBCBSLinkedIn: Anthem Blue Cross Blue Shield – Medicaid Health Plans

Dustin Ziegler and Kelley Brown join us to talk about National Family Caregivers Month and National Alzheimer's Disease Awareness Month. They walk through the growing needs of aging Hoosiers and the challenges that come with complex care. We also touch on RJ Mitte and his new partnership with Can Do Canines and the importance of clear communication between families and care teams.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

As we age, managing health becomes more complex. Multiple doctors, medications, and appointments can make it hard to keep everything connected. Dr. Zaidi, Plan Performance Medical Director at Anthem Blue Cross & Blue Shield, joins Tina McIntosh to talk about what coordinated care really means for seniors and their families. He explains the role of a hospitalist, why preventive care matters, and how screenings and vaccines can help older adults stay healthier for longerShow notes:www.Joyshouse.orghttps://www.anthem.com/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Falls are the leading cause of injury for older adults, but the Stepping On program is helping change that. This evidence-based program, now launched as a pilot through a partnership with Anthem Blue Cross and Blue Shield, supports older adults and caregivers in building strength, confidence, and independence. Emily Tisdale, Executive Director of the Center for Aging & Community at the University of Indianapolis, joins us to share how the program works, who it's for, and how to get involved. Special thanks to Anthem for sponsoring this important conversation.Show notes:www.Joyshouse.orghttps://uindy.edu/cac/stepping-on-info-registrationhttps://www.anthem.com/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

On today's episode of Fostering Change, we continue our special acknowledgment that May is National Foster Care Awareness Month. We hope you have taken some moments to reflect on what you can do to support those in the foster care system: donate, volunteer your time, mentor, or even consider taking steps to be a CASA or foster parent. Thank you for all you do!If you'd like a simple way to support Comfort Cases, here's an idea: You can participate in the Hundred X program. Click on the following link, and you'll be guided to complete surveys about brands and companies you are familiar with. Comfort Cases will receive $1.60 for every survey you fill out (and it only takes 2 minutes max for each!) https://programs.hundredx.com/givewithoutspendingNow, on to today's episode: For 8 years, we have worked with the team at Anthem Blue Cross Blue Shield in Indiana, and have expanded that partnership throughout the country, literally giving away THOUSANDS of our Comfort Cases backpacks to social service agencies and youth experiencing foster care.Today, we speak with Aimee Christian, a Fostering Connections Case Manager with Anthem Blue Cross Blue Shield. Aimee and Rob Scheer have a lively discussion that focuses on the positive changes that can be made to improve the foster care system.Some of the points they cover include changing our vocabulary so we're not labeling these youth, changing the focus from just on the child to the entire family, and building and improving relationships with the birth family and the foster family.Aimee and Rob will certainly motivate you to—at minimum—give new thoughts to the foster care system and—at best—possibly motivate you to consider becoming a foster parent yourself!We know you'll enjoy this interview. Thank you again to Anthem Blue Cross Blue Shield for being such a valuable and supportive partner to Comfort Cases all these years! ​​The partnership between Anthem Blue Cross and Blue Shield and Comfort Cases has grown since 2018. Since the expansion, Anthem Blue Cross and Blue Shield's affiliated health plans have hosted dozens of packing parties across 16 states, Washington DC, and Puerto Rico, providing thousands of Comfort Cases and XL duffel bags to youth in foster care nationwide.For more information about the foster care system or how you can support Comfort Cases, please visit our website: www.comfortcases.org. If you have any questions, comments, or guest suggestions, please reach out to us at info@comfortcases.org. Hosted on Acast. See acast.com/privacy for more information.

Options abound for paid parking systems in Balboa Park meant to help the city's budget shortfall. And San Diego County is also looking for budget solutions, this time toward its reserve. Also, part one of a two-part story looking at the Trump Administration's fixation on birthrates. Then, an East County school is helping kids eat healthy away from school by sending food home with them on the bus. And relief is here for tens of thousands of Anthem-Blue Cross customers unable to access Scripps Health due to a contract dispute.

Today we talk with Maria Proulx, president Anthem Blue Cross and Blue Shield in NH, about health insurance costs and how she is leading the state's largest health insurance provider and its clients through a turbulent economic time. Sponsored by the Business of the Year Awards.

In today's newscast, protesters gathered outside an event in Salinas that featured pardoned January 6th insurrectionists. And, Anthem Blue Cross and Aspire Health have reached an agreement to restore coverage for Monterey County medical providers.

In today's newscast, protesters gathered outside an event in Salinas that featured pardoned January 6th insurrectionists. And, Anthem Blue Cross and Aspire Health have reached an agreement to restore coverage for Monterey County medical providers.

Join John Williams and Patric Woodcock in the Williams Broadcasting Studio with special guest Denise McDonough President of Anthem Blue Cross Blue Shield of Maine.

Drs. Adam Striker and Brooke Trainer discuss hot button issues facing the specialty today. Their lively conversation touches on the recent Anthem Blue Cross decision to propose and then rescinded a cap on anesthesia time, how the media covers anesthesiology, potential legislative solutions, and more. Recorded December 2024. 

I got the opportunity to talk to Dr. Liz Kwo, Chief Commercial Officer at Everly Health, Board member of Walmart Mexico, and experienced venture capitalist and angel investor. We talked about running the first online medical group in the US, telehealth, her angel investments, being on the board of several NASDAQ listed companies, remote surgery, Da Vinci robot and minimally invasive surgery, experience working as the Chief Clinical Officer at Anthem Blue Cross, one of the largest healthcare providers in the US, and working as the Chief Commercial Officer at a Shark Tank company called Everly Health. ---------------------------------------------------------------Thanks to the sponsors:Audible: Use my link for a 30-day free trial: http://audibletrial.com/diamondgoatNewsly: https://newsly.mepromo code to receive a 1-month free premium subscription: EARLYMORNING Libysn: https://libsyn.compromo code: DG Dubby Energy: https://www.dubby.ggpromo code for 10% off: DIAMONDGOATOpus Clips:  https://www.opus.pro/?via=diamondgoat----------------------------------------------------------------------------------Listen on:Podcast website: https://www.spreaker.com/podcast/dg-early-morning-show--5943922Spotify: https://open.spotify.com/show/0EuhA6WyuerHtVAqcFrFeOPodcast YT channel clips: https://www.youtube.com/@dgearlymorningshowTiktok: @dgearlymorningshowApple Podcast: https://podcasts.apple.com/us/podcast/dg-early-morning-show/id1575451533Amazon Music: https://music.amazon.com/podcasts/f050b86c-1dad-4bc3-b12f-6aa5fa62438c  Goodpods: https://goodpods.com/podcasts/dg-early-morning-show-211830RadioPublic: https://radiopublic.com/dg-earlymorning-show-WoML4rBreaker: https://www.breaker.audio/dg-early-morning-showReason: https://reason.fm/podcast/dg-earlymorning-show--------------------------------------Check out my other stuff:Instagram: @itzdiamondgoatTwitter: @lildiamondgoatMain YT channel: youtube.com/diamondgoatTiktok: @lildiamondgoatSoundcloud: @Lil DiamondgoatSpotify: @Lil DiamondgoatMerch store: https://diamondgoat.creator-spring.com

After months of failed contract negotiations, Scripps Health has been removed from the Anthem Blue Cross insurance networks of 125,000 San Diegans. Reporter Melissa Mae shares what could happen next. Then, a Catholic school in El Cerrito is fighting to keep its doors open after the diocese of San Diego said it could no longer cover its budget deficit. Plus, reporter Amita Sharma shares how people are navigating dating in a deeply divided time.

In this informative solo episode of the Bendy Bodies podcast, Dr. Linda Bluestein, the Hypermobility MD, dives into pressing topics impacting the hypermobility community. Learn about the new anesthesia time limit policy from Anthem Blue Cross (that was then reversed), how to manage Mast Cell Activation Syndrome (MCAS), understand food allergy testing, and find the best coaching options for those with complex conditions.  Takeaways: New Anesthesia Policy Impacts EDS Patients: Anthem Blue Cross introduced time limits on anesthesia coverage, potentially shifting extra costs to patients if surgeries exceed these limits, making communication with providers essential. (This decision was then reversed after widespread public outcry demonstrating the importance of using our voices) MCAS Management is Personalized: Keeping a detailed symptom journal and identifying unique triggers are critical for managing mast cell activation syndrome effectively. Food Allergy Testing Limitations: Standard allergy tests may not reliably identify food triggers for those with MCAS, emphasizing the importance of symptom tracking and tailored elimination diets. Coaching vs. Medical Appointments: Coaching offers faster access and flexibility for guidance, but differs from medical services as it doesn't include prescriptions or lab orders. Hypermobility Hacks for Surgery Prep: Stay informed about your insurance policies, maintain open communication with your healthcare team, and advocate for alternative payment or scheduling options if needed. Modifying Supplements for Surgery: Nutritional supplements that increase bleeding risk and/or interfere with medications used for anesthesia are discussed.  Connect with YOUR Hypermobility Specialist, Dr. Linda Bluestein, MD at https://www.hypermobilitymd.com/. Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/. Learn more about Human Content at http://www.human-content.com Podcast Advertising/Business Inquiries: sales@human-content.com YOUR bendy body is our highest priority! Keep up to date with the HypermobilityMD: YouTube: youtube.com/@bendybodiespodcast Twitter: twitter.com/BluesteinLinda LinkedIn: linkedin.com/in/hypermobilitymd Facebook: facebook.com/BendyBodiesPodcast Blog: hypermobilitymd.com/blog Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

In this informative solo episode of the Bendy Bodies podcast, Dr. Linda Bluestein, the Hypermobility MD, dives into pressing topics impacting the hypermobility community. Learn about the new anesthesia time limit policy from Anthem Blue Cross (that was then reversed), how to manage Mast Cell Activation Syndrome (MCAS), understand food allergy testing, and find the best coaching options for those with complex conditions.  Takeaways: New Anesthesia Policy Impacts EDS Patients: Anthem Blue Cross introduced time limits on anesthesia coverage, potentially shifting extra costs to patients if surgeries exceed these limits, making communication with providers essential. (This decision was then reversed after widespread public outcry demonstrating the importance of using our voices) MCAS Management is Personalized: Keeping a detailed symptom journal and identifying unique triggers are critical for managing mast cell activation syndrome effectively. Food Allergy Testing Limitations: Standard allergy tests may not reliably identify food triggers for those with MCAS, emphasizing the importance of symptom tracking and tailored elimination diets. Coaching vs. Medical Appointments: Coaching offers faster access and flexibility for guidance, but differs from medical services as it doesn't include prescriptions or lab orders. Hypermobility Hacks for Surgery Prep: Stay informed about your insurance policies, maintain open communication with your healthcare team, and advocate for alternative payment or scheduling options if needed. Modifying Supplements for Surgery: Nutritional supplements that increase bleeding risk and/or interfere with medications used for anesthesia are discussed.  Connect with YOUR Hypermobility Specialist, Dr. Linda Bluestein, MD at https://www.hypermobilitymd.com/. Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/. Learn more about Human Content at http://www.human-content.com Podcast Advertising/Business Inquiries: sales@human-content.com YOUR bendy body is our highest priority! Keep up to date with the HypermobilityMD: YouTube: youtube.com/@bendybodiespodcast Twitter: twitter.com/BluesteinLinda LinkedIn: linkedin.com/in/hypermobilitymd Facebook: facebook.com/BendyBodiesPodcast Blog: hypermobilitymd.com/blog Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

Franklin Fire UPDATE. Dr. Jim Keany, Co-Director of the Emergency Room at Mission Hospital in Mission Viejo, joins The Bill Handel Show for 'Medical News'! Dr. Keany talks with Bill about drinking coffee daily showing benefits for aging, Anthem Blue Cross' proposed policy limit to anesthesia, and a potential link between ultra-processed food and cancer.

Dr. Jim Keany, Co-Director of the Emergency Room at Mission Hospital in Mission Viejo, joins The Bill Handel Show for 'Medical News'! Dr. Keany talks with Bill about drinking coffee daily showing benefits for aging, Anthem Blue Cross' proposed policy limit to anesthesia, and a potential link between ultra-processed food and cancer.

Local health care consultant John Bartimole discusses Anthem Blue Cross Blue Shield pulling back its anesthesia decision, plus the slaying of UnitedHealthcare's CEO full 568 Fri, 06 Dec 2024 12:20:47 +0000 hv5WoioAcY65GMiXcew3icukgHba62JM news,wben,anesthesia,brian thompson,unitedhealthcare,john bartimole,anthem blue cross blue shield A New Morning news,wben,anesthesia,brian thompson,unitedhealthcare,john bartimole,anthem blue cross blue shield Local health care consultant John Bartimole discusses Anthem Blue Cross Blue Shield pulling back its anesthesia decision, plus the slaying of UnitedHealthcare's CEO Collection of LIVE interviews from Buffalo's Early News on WBEN 2024 © 2021 Audacy, Inc. New

Rollout, backlash, rollback: Anthem Blue Cross toes the line with anesthesia coverage. Hour 2 12/5/2024 full 2119 Thu, 05 Dec 2024 21:00:08 +0000 ulTr5OHuuKZFHdXR1SGVlqXvoqE2VzEP news The Dana & Parks Podcast news Rollout, backlash, rollback: Anthem Blue Cross toes the line with anesthesia coverage. Hour 2 12/5/2024 You wanted it... Now here it is! Listen to each hour of the Dana & Parks Show whenever and wherever you want! 2024 © 2021 Audacy, Inc. News False

Anthem Blue Cross Blue Shield cancels anesthesia coverage policies    Please Subscribe + Rate & Review KMJ's Afternoon Drive with Philip Teresi & E. Curtis Johnson wherever you listen!  ---     KMJ's Afternoon Drive with Philip Teresi & E. Curtis Johnson is available on the KMJNOW app, Apple Podcasts, Spotify, Amazon Music or wherever else you listen.  ---   Philip Teresi & E. Curtis Johnson – KMJ's Afternoon Drive  Weekdays 2-6 PM Pacific on News/Talk 580 & 105.9 KMJ  DriveKMJ.com | Podcast | Facebook | X | Instagram  ---   Everything KMJ: kmjnow.com | Streaming | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.

Anthem Blue Cross Blue Shield cancels anesthesia coverage policies    Please Subscribe + Rate & Review KMJ's Afternoon Drive with Philip Teresi & E. Curtis Johnson wherever you listen!  ---     KMJ's Afternoon Drive with Philip Teresi & E. Curtis Johnson is available on the KMJNOW app, Apple Podcasts, Spotify, Amazon Music or wherever else you listen.  ---   Philip Teresi & E. Curtis Johnson – KMJ's Afternoon Drive  Weekdays 2-6 PM Pacific on News/Talk 580 & 105.9 KMJ  DriveKMJ.com | Podcast | Facebook | X | Instagram  ---   Everything KMJ: kmjnow.com | Streaming | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.

Send us a textTheoretically, having a full view of a patient's medical records could lead to more personalized treatment, stronger data security, and new research breakthroughs.But in practice? That's a tall order.Could AI be the solution?In this episode of HealthBiz Briefs, Bo Holland, Founder and CEO of All Clear ID, talks about the risks patients face with medical record security and the critical task of helping patients easily navigate and control their health data.This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.

Did you know that over 75% of Hoosiers want to age at home or in their community? In this episode of Caregiver Crossing, we're joined by Dustin Ziegler from Anthem Blue Cross & Blue Shield to discuss how they're helping caregivers, and their loved ones navigate Indiana's new PathWays for Aging program, designed to support that goal. Dustin also shares insights into caregiver health, focusing on mental well-being and self-care, and introduces Joy's House's new resource, Caregiver Way, which Anthem Blue Cross & Blue Shield proudly supports. Show notes:www.Joyshouse.orgwww.caregivercrossingradio.orghttps://visitcaregiverway.com/https://www.anthem.com/https://www.in.gov/pathways/home/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, we kick off a 3-week series featuring various insurers who will discuss the value-added benefits and free wellness programs they offer. This series is designed for you and your employees. Today, we're joined by Lisa Pearl from Anthem to highlight what Anthem brings to the table. Are you considering Anthem for this renewal season? Already with Anthem and looking for fresh ideas for your Open Enrollment? Or maybe you're with another carrier and want to explore how insurers can enhance your benefits package? Tune in for valuable insights!About the Show:The H.I.T. Podcast (Powered by Montage Insurance Solutions): A thought leader in the space, curating the top news and information to deliver a brief, high impact overview designed specifically for the Human Resources professional, business person, and company executive.Find out more here: www.hitpodcast.comSpecial thanks to our Platinum Sponsors: TruHu AND Excel Health PlansThank you to our Gold Sponsors: Kingdom Legacy Benefits (KLB) AND Cigna

Also, on our Medicare Advantage minute: Anthem Blue Cross is engaged in a dispute that could penalize hundreds of thousands! We revisit the Medicare Wikipedia page with a description of the historical development of this massive government program. Finally, a survey: What do people on Medicare think about Medicare? Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)   Inspired by: "MEDICARE FOR THE LAZY MAN 2024; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

Newly uncovered emails reveal that health care organizations like Anthem Blue Cross were literally bribing doctors to encourage their patients to take the COVID vaccines. Jimmy and Americans' Comedian Kurt Metzger speak with Dr. Pierre Kory about this controversial practice and how these sorts of "incentives" undermine the entire medical profession. Plus segments on the Israeli military suffering its deadliest day in the Gaza fighting, the Slovakian Prime Minister calling Ukraine a “puppet” of the United States and revelations that Boeing KNEW about the safety issues with its aircraft and flew them anyway. Also featuring Stef Zamorano, Keaton Weiss and Russell Dobular!

Dr. Erkeda DeRouen talks to Scott Becker, the Founder of Becker's Healthcare, a leading healthcare media company that offers news, analysis, and guidance relating to the healthcare industry. They discuss the trending topics in American healthcare, the benefits of having hobbies outside of medicine, and the significant problems with the U.S. healthcare system.  [00:00] Introducing Scott Becker  [02:44] The Journey to Launching Becker's Healthcare [04:50] What You Must Do to Succeed in Your Journey to Medicine [07:38] Don't Let Medicine Define Who You Are [09:48] The Hottest Topics in Healthcare Right Now [13:37] What Scott Would Change About Healthcare [16:37] The Big Gap in the American Healthcare System [19:52] Parting Thoughts The Journey to Medicine Medicine is one of the most challenging yet rewarding career paths in the world. And although the journey is not always a straight line, Scott reveals the three mindsets that will help you become the very best at what you do.   1. Be Clear About Where You're Going  Be clear about your destination. Your journey to medicine needs a GPS. Having a general sense of where you're headed in your medical career provides a guiding light, steering your decisions and actions. 2. Your First Job is Not Your Last Job Always remember your first job won't be your last. Don't stress too much about having the perfect first job straight out of med school. The journey to use medicine is like a marathon, and your initial job is merely the starting line.  3. Have Hobbies Outside of Medicine According to Scott, the only way to become the best at what you do is to become a physician and something else. Being a doctor is essential, but it's equally as important to explore other things that define you. The physicians who burn out build their lives sorely around seeing patients. The solution lies in realizing that your medical career is not just about medicine; it's about creating a fulfilling life within and beyond the realm of clinics and hospitals. The 3 Big Problems Plaguing American Healthcare There are numerous problems plaguing the American healthcare system. According to Scott, they are all born from three primary issues. 1. The Math Problem There is a huge imbalance of numbers in the American healthcare system. The American population is rapidly growing, yet the number of medical professionals remains the same. According to Scott, we are a country of about 330 million people with approximately 1,070,000 doctors. The imbalance in supply and demand in healthcare is a substantial concern. The shortage of physicians is the number one reason our country struggles to provide adequate healthcare services to the ever-expanding population. 2. The Thinking Problem Although physicians are generally considered intelligent, we still face a thinking problem. Healthcare, according to Becker, requires a multifaceted strategy that acknowledges the complexity of the issues at hand. Rather than seeking singular solutions, the industry must adopt a comprehensive mindset that integrates various facets – from technology advancements to the thoughtful inclusion of human caregivers.  3. The Power Problem American healthcare has a power problem - the disproportionate influence wielded by major players, such as United, Aetna, Cigna, and the former Anthem Blue Cross (now Elevate). The dominance of these major players creates an inherent power imbalance, as healthcare systems and providers find themselves dwarfed in size and influence. This power dynamic introduces challenges in decision-making, resource allocation, and overall system functionality, posing a substantial hurdle to achieving a balanced and equitable healthcare landscape. You can reach Scott Becker on LinkedIn and check his Website for more details about his work.    To learn more about how MedSchoolCoach can help you along your medical school journey, visit us at Prospective Doctor.  You can also reach us through our social media: Facebook: https://www.facebook.com/MedSchoolCoach Dr. Erkeda's Instagram: https://www.instagram.com/doctordgram/ YouTube: www.youtube.com/@ProspectiveDoctor

Corporate Responsibility. You hear that phrase often. But how many businesses truly follow through on being good corporate citizens? On today's episode of Fostering Change you will meet one organization that does just that: Anthem Blue Cross and Blue Shield's Indiana Medicaid Health Plan. In fact, this organization was Comfort Cases' very first corporate sponsor - we are celebrating working with them for six years!You will hear Rob Scheer speak with April Lam, Chief of Staff for the health plan. April has a strong connection to Comfort Cases' mission, as she not only works closely with non-profit organizations, but has also been a foster parent and adopted a child out of foster care.Since the partnership with Comfort Cases began 6 years ago, Anthem Blue Cross and Blue Shield has packed more than 7,000 Comfort Cases® to support youth living in foster care.The partnership between Anthem Blue Cross and Blue Shield and Comfort Cases has grown since 2018. Since the expansion, Anthem Blue Cross and Blue Shield's affiliated health plans have hosted 24 packing parties across 16 states, Washington DC, and Puerto Rico, providing over 12,000 Comfort Cases and XL duffel bags to youth in foster care nationwide.To learn more about Anthem Blue Cross and Blue Shield of Indiana, please visit: https://mss.anthem.com/in/indiana-hom...To listen to previous episodes of Fostering Change, please visit: www.comfortcases.org/podcast or your favorite podcast outlets.If you have any comments, questions, or guest suggestions, we'd love to hear from you! Please write us at info@comfortcases.org.Thank you for listening and we'll see you next Tuesday! Hosted on Acast. See acast.com/privacy for more information.

Greater Richmond Fit4Kids, a regional non-profit dedicated to improving children's health and wellness through physical activity and healthy eating, has received a ,000 grant from the Anthem Blue Cross and Blue Shield Foundation.   The grant from the foundation's Food as Medicine initiative will fund Fit4Kids' school-based Learning Gardens program, which seeks to empower children to make healthier choices and foster a sustainable food culture through a combination of garden tastings, cooking classes, seedling distribution, and surplus produce redistribution.   Prior to participating in Fit4Kids Learning Gardens, many students report never having tasted vegetables such as squash, cauliflower, or snap...Article LinkSupport the show

On this episode of the ASC Podcast with John Goehle, we discuss the latest news, review the rising crisis in Anesthesia in ASCs and the supervision of CRNAs, discuss the concerns about the role of Private Equity in the Anesthesia Crisis, Celebrate Sterile Processing Week and in our focus segment, for Cybersecurity Awareness Month discuss Cybersecurity with Paul Alcock from Surgical Information Systems.    This episode is sponsored by Surgical Information Systems.   Notes and Resources from this Episode: Abbott Medical Recall of Proclaim Spinal Cord Stimulators https://www.fda.gov/medical-devices/medical-device-recalls/abbott-medical-recalls-proclaim-and-infinity-ipgs-inability-exit-magnetic-resonance-imaging-mri-mode Texas ASC Operator to Settle False Claims Allegation Beckers ASC review on September 14th 2023 https://www.beckersasc.com/asc-news/asc-operator-to-pay-8-9m-to-settle-false-claims-allegations.html?origin=ASCE&utm_source=ASCE&utm_medium=email&utm_content=newsletter&oly_enc_id=5567B4088734C3Z FTC Challenges Private Equity Firms (suppressing competition in the anesthesia market) https://www.ftc.gov/news-events/news/press-releases/2023/09/ftc-challenges-private-equity-firms-scheme-suppress-competition-anesthesiology-practices-across California Medical Association reported in April 2023 that Contracted Physicians with Anthem California will be required to maintain privileges with at least one participating ASC https://www.cmadocs.org/newsroom/news/view/ArticleId/50123/Anthem-Blue-Cross-to-require-in-network-ambulatory-surgical-center-privileges Focus Segment - Cyber Security Month with Paul Alcock Surgical Information Systems (http://sisfirst.com)   Join one of our Membership Programs! Our Patron Program: Patron Members of the ASC Podcast with John Goehle have access to ASC Central - an exclusive membership website that provides a one-stop  ASC Regulatory and Accreditation Compliance, Operations and Financial Management resource for busy Administrators, nurse managers and business office managers.  More information and Become Member The ASC-Central Premium Access Program A Premium Resource for Ambulatory Surgery Centers including access to bootcamps, education programs and private sessions More Information and Become a Premium Access Program Members Today! Important Resources for ASCs: Conditions for Coverage: https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#se42.3.416_150 Infection Control Survey Tool (Used by Surveyors for Infection Control)https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107_exhibit_351.pdf Updated Guidance for Ambulatory Surgical Centers - Appendix L of the State Operations Manual (SOM)https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_l_ambulatory.pdf https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-ambulatory-surgical-centers-appendix-l-state-operations-manual-som Policy & Memos to States and RegionsCMS Quality Safety & Oversight memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions Other Resources from the ASC Podcast with John Goehle: Visit the ASC Podcast with John Goehle Website Books by John Goehle Get a copy of John's most popular book - The Survey Guide - A Guide to the CMS Conditions for Coverage & Interpretive Guidelines for Ambulatory Surgery Centers 

The Business of Sports Minute is presented by Southern Company Robert Bunch, 2023 Atlanta Heart Walk Chairperson and Anthem Blue Cross & Blue Shield of Georgia President, joined Nick Cellini and Chris Dimino to talk about the 2023 Greater Atlanta Heart Walk happening Saturday Sept. 30th at Atlantic Station. Find out how you or your company can participate at Greater Atlanta Heart WalkSee omnystudio.com/listener for privacy information.

This is a salty podcast for our life and times. Owen Scott Muir, MD writes the newsletter— The Frontier Psychiatrists!— he also records the podcast. I hope you enjoy this short. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

This summer short is about the dynamic between payers and providers. An opening point that Jacob Asher, MD, my guest in this healthcare podcast, makes in the interview that follows is that, for a payer, it's super hard to competitively differentiate from both a cost and/or a quality perspective when you and all of your payer competition use the exact same PPO (preferred provider organization) networks. I mean, what? Are these same exact doctors gonna somehow do a better job with your members than with the rest of their patients? This is even more true if you think about this from a physician or a practice point of view. Will clinical teams in their clinical workflow figure out who your members are, first of all, which is a thing, and then switch up what they choose to do for your members that is special? Even theoretically, that sounds like an executional fandango, which is exacerbated in markets with lots of payers. I guess I am not shocked when I hear stories like Dr. Asher was talking about: Doctor sits down at desk after a long day and sees 27 “Dear Doctor” letters from all of the payers in his or her payer mix. “Hey, Doc. Let me tell you about our amazing new thing.” And Doc's like, “Pajama time awaits.” And—boom!—the letters, unopened, right in the recycle bin. From a payer's standpoint, back to square one, I guess. Now, I will chuck in the mix here—and this has nothing to do with the conversation with Dr. Asher that follows—but one thing I've spent my entire career doing is helping organizations set up programs to collaborate with other organizations. If I authentically solve an actual, authentic, prioritized problem, I usually can find many people who seem pretty pleased to work with me. Now, is this easy to do? No. It takes strategic thinking and executional competence and/or grit to see it through. You really have to understand and account for vested interests and all the weird perverse incentives. Personally, I gotta work with a whole team of others coming at this from all different directions to untie this Gordian knot. But anyone who really wants to or needs to reach across the aisle and engage with other stakeholders or customers, even in any sort of systemic way, it's just not possible to phone it in. Anyway, I just want everyone to succeed in working together. It is impossible to have a longitudinal patient journey if everybody is all up in their own silos fragmenting care.   You can learn more by connecting with Dr. Asher on LinkedIn.   Jacob Asher, MD, completed a residency in otolaryngology–head and neck surgery at the University of California, San Francisco, after receiving degrees from Brown University and the Boston University School of Medicine. Dr. Asher then practiced as an ENT (ear, nose, and throat) surgeon with Kaiser Permanente in Northern California and also served on the board of directors of The Permanente Medical Group, where he focused on physician compensation reform, member satisfaction initiatives, and retirement benefits. After transitioning to full-time health plan management, Dr. Asher served as a California commercial market medical director between 2008 and 2022 for Anthem Blue Cross, Cigna, and UnitedHealthcare. In those roles, he supported membership growth and retention in both fully insured and self-funded product lines and promoted value-based reimbursement, including capitation. He has led utilization management teams, collaborated with internal and external population healthcare advocates, and worked to develop clinical initiatives that sought to achieve the Triple Aim. In his role as the clinical face of the health plan to the local market, he worked with network colleagues on accountable care organization partnerships and hospital and physician contract renewals with integrated pay for performance, supported Obamacare exchange participation, engaged in quality improvement collaboratives, and supported regulatory compliance efforts. Currently, Dr. Asher is serving as a mentor for the Stanford Master in Medical Informatics program while exploring innovative solutions to healthcare delivery.   03:38 Why providers contracted with multiple health plans don't have a financial incentive to do something unique with one payer over another. 04:01 Why it doesn't make sense for providers to offer unique pathways for different payer organizations. 05:23 Why, broadly speaking, standards of care between payer policies aren't really differentiators in clinical practice. 06:47 Why financial incentives might not be aligned to make providers want to standardize their care. 09:16 What improvement has there been in plans making providers more aware of the benefits they offer? 11:47 Why won't providers off-load their pop health?   You can learn more by connecting with Dr. Asher on LinkedIn.   @JacobAsher18 discusses #payers and #providers on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Eric Gallagher (Summer Shorts 4), Dan Serrano, Larry Bauer, Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2), Brennan Bilberry (Summer Shorts 1), Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg  

In this episode, Scott discusses the 4 payors in the top 20 of all US companies by revenues. 1. UnitedHealthGroup 2. CVS Health 3. Cigna down 11% YTD 4. Elevance. formerly Anthem Blue Cross. Down 8% YTD

In this episode, Scott discusses the 4 payors in the top 20 of all US companies by revenues. 1. UnitedHealthGroup 2. CVS Health 3. Cigna down 11% YTD 4. Elevance. formerly Anthem Blue Cross. Down 8% YTD

In this episode, we interview Licensed Marriage & Family Therapist Kate Pieper. Kate has been in professional practice for over 30 years and currently only see first responders and their families. She is the former Coordinator for the Northern California Trauma Response Network, is a part of the Sacramento EMDR Regional Network Leadership, and volunteers as an EMDR therapist for the West Coast Post Trauma Retreat for first responders.  She provides Critical Incident Stress Debriefing at incidents in Northern California, most recently the Camp Fire, CHP incidents and CalFire incidents. She is an adjunct professor for a local graduate school, teaching “Crisis Trauma, and Community Mental Health.” Kate is an EMDRIA Approved Consultant who provides consultation and training for other therapists to use EMDR with their clients.  Kate has provided departmental resiliency training to Cal Fire, CHP, Bakersfield Police Department, San Jose Police Department and the California District Attorney's Association, as well as other agencies. In addition to discussing her professional life, Kate discusses her childhood trauma, as well as her own suicide attempt. Kate discusses the difficulty she had in her marriage, as well as many medical issues that arose in her family.  She recalls the difficulties she has encountered with various clients, including suicide attempts, stalking and death threats. Kate is currently in private practice in Auburn, California and accepts Magellan, Blue Shield, Optum, and Anthem Blue Cross insurance plans. She also offers EMDR Intensives and individual cash rates for all first responders.

Corey Costelloe and Key Budge recap the City of Tehachapi Council meeting from April 3, 2023 and take a deeper dive into an initiative backed by corporations that want to remove local control on your sales tax dollar and charge the taxpayer with their developing fees. There are approximately 40 corporations that have come together under the identity of "The California Business Roundtable Board" that have circulated petitions to place an initiative on the November 2024 ballot to remove local sales tax measures (Measure S in Tehachapi, Measure K in Kern County) passed by the citizens that fund essential services (fire, police, roads, etc) in our community and many more. Send your thoughts, and questions to Media@TehachapiCityHall.com. 

Yeah, so while the commercial payer marketplace is completely boring, the reasons it's boring are not. Let me walk you through this conversation I have in this healthcare podcast with Jacob Asher, MD. First, we establish that the relative number of each carrier's commercial members in California don't seem to change year over year … and this has been true for years. When you rank order carriers by member count, the song remains the same. It's Groundhog Day. Here's a link to the 2022 CHCF (California Health Care Foundation) enrollment almanac, which shows for the large group market, Kaiser has captured and retained just over half of enrollees. Anthem comes in next with 14%, Blue Shield gets 9%, and then bringing up the rear we have UHC, Aetna, Cigna, Centene, and all others in descending order splitting the remaining 21%. Hmmm … intriguing, the whole idea that these relative member counts remain so consistent. Then Dr. Asher and I dissect what is anybody actually doing to cut into the Kaiser market share or try to grab share from the two blues plans, if anything. Dr. Jacob Asher was a great guy to have this conversation with. He was a practicing head and neck surgeon with Kaiser Permanente, and then he also served on the Permanente Medical Group Board of Directors. Then he changed careers and became a full-time health plan chief medical officer for, first, Anthem, then Blue Cross, then Cigna, then UHC (UnitedHealthcare). Now he's “retired” and reflecting back on unsolved and unaddressed issues within healthcare. And we've covered one here: Why is the commercial payer market as boring as it appears to be in California? Now, after I had this conversation with Dr. Asher, I called up Wendell Potter, who everybody already knows (EP384), and Lauren Vela, who everybody also probably already knows, but she has spent her career at various employer coalitions and now works at a big employer transforming their health benefits (and she lives in California). I learned a few things that really helped me frame my thoughts on some of the issues that surfaced in the conversation that I had with Dr. Asher and that you'll hear today. So, let's get to it. Why doesn't the relative market share of the big payers change year over year in California in the commercial space. May I present six reasons: 1. Everybody I talked to—Dr. Asher, Wendell Potter, Lauren Vela—first thing right out of the gate that practically everybody mentioned is employer inertia. Trying to get an employer to switch carriers is like trying to pull Excalibur from its stone. And right, not so surprising, it's disruptive and obnoxious for employees and also benefit teams if carriers are switching all the time. 2. EBCs (employee benefit consultants). They have deals with carriers and others, and they also have a lot of power over employers. Listen to the show with AJ Loiacono (EP379) and Paul Holmes (EP397) for more on this. 3. As Wendell Potter put it, “The commercial market is [as a whole] stagnant. No real growth nationally. And in many states, the real money for carriers is not in the self-funded market; so they don't care much about aggressively competing for market share.” Given that chart that just came out the other day showing the insane relative gross margins that carriers are making on Medicare Advantage patients, which is over double other lines of business … yeah, totally. 4. Just keep this in mind before we barrel into reason #4 here for a stagnant and maybe not exactly competitive market. Kaiser excluded, all of the rest of the California payers have what amounts to largely the same provider network. I'm exaggerating slightly here, but largely the same hospitals, the same consolidated integrated delivery networks. And one thing that's pretty clear (not just in California but across the country): Plans who bring the most members get the best prices from these hospitals and other provider organizations. Also, as Dr. Asher mentions in the show today, he never saw an employer buy on quality. Most were far more concerned about discounts. So, right … we have some circular reasoning here or circular logic. The big plans get the best prices, and then, because they have the best prices, they maintain their market share. But wait … there's more to this one, and it's not just big gets you lower prices. Remember from episode 395 with Brennan Bilberry? He talked about the concept of the Most Favored Nation (MFN) anticompetitive clauses in hospital contracts. This concept is also super relevant here for payers as well if you think about it. This MFN Most Favored Nation anticompetitive clause, this is where a big hospital and “big carrier” have a chat … in a back room. The hospital agrees to not give any other carrier a lower price than the “big carrier.” These MFN clauses are, of course, terrible for competition and plan sponsors and any patient with cost sharing. A lot of states have started to ban, restrict, and limit these clauses. The DOJ brought a case in Michigan about this, and here's a great federal government summary of the problem: “The department and the state of Michigan alleged … that the MFN clauses in [Blue Cross Blue Shield of Michigan's (BCBSM's)] contracts with Michigan hospitals decreased competition among health plans. Some … clauses required hospitals to charge competitors more than the hospitals charged BCBSM, often by a specified percentage. Moreover, BCBSM often agreed to raise the prices that it paid hospitals, in part to obtain [the] MFN clauses.” Oh, hey … I'll let you raise your price so I can have a Most Favored Nation clause, just as long as I get a lower price, which is higher than it was originally. And this was actually back in 2013. I have no insight at all or knowledge, or I am not suggesting in any way that what was going on in Michigan is going on in California. However, this anticompetitive practice is common enough. If you're interested in how common, count the lawsuits. 5. Employers are unaware a lot of times of how they are being charged more than what might be appropriate. And they are largely unaware of options other than Blue Cross, United, Cigna, Aetna … the big payers. 6. As Dr. Asher talks about and which I never really thought about, Kaiser doesn't have Medicaid patients. [Correction: Kaiser does have some Medicaid members—just less than others.] And because their network and hospitals to a large extent are closed, they also don't have uninsured patients to a large extent. So, no charity care to speak of and, therefore (at least as it is posited), they can be cheaper because they don't have to cost offset. So, their price advantage has a structure element here that could make it even more untouchable. So, there's your six reasons. You can start to see basically all of these things solidify into the same thing. It's less about trying to get new business and more about locking in the existing business. It's not really a secret that this market is rock hard. Plans realize that. They realize that the cost of keeping an enrollee is cheaper than acquiring a new enrollee. So, carriers focus sales and marketing efforts on holding on to their existing customers, especially the coveted jumbo accounts. Interestingly (and I was talking about this with Lauren Vela), the more clinical programs a carrier has deployed for an employer, the more the carrier is locked in there. So, the more the clinical value proposition resonates, the more clinical stuff that gets integrated. Changing plans becomes even more disruptive, and employers are even more likely to remain where they are. So, there's more to clinical programs than payers catching themselves a little PMPM (per member per month) something something upcharge recurring revenue or trying to get new business. It's also locking in customer retention. Is any of this specific to California? Some of it is—like a lot of the Kaiser stuff—but most, not. Meaning a lot of the country doesn't exactly have a functioning commercial small group or large group marketplace either. To a certain extent, it's no wonder big employers don't change plans that often. Why would they bother, given probably fairly incremental differences between these big payer carriers? I realize I'm scrambling out on a limb here and making assumptions, but to achieve more than incremental improvements, a BUCA (Blue Cross, United, Cigna, Aetna) would need to invest all kinds of resources into being that shining star. And why would they do that when nobody can take down Kaiser? And for all the reasons that we just talked about, it's a hard row to hoe to grab new clients. There's a lot of ramifications to this, but this show can't be seven hours long.    You can learn more by connecting with Dr. Asher on LinkedIn.   Jacob Asher, MD, completed a residency in otolaryngology–head and neck surgery at the University of California, San Francisco, after receiving degrees from Brown University and the Boston University School of Medicine. Dr. Asher then practiced as an ENT (ear, nose, and throat) surgeon with Kaiser Permanente in Northern California and also served on the board of directors of The Permanente Medical Group, where he focused on physician compensation reform, member satisfaction initiatives, and retirement benefits. After transitioning to full-time health plan management, Dr. Asher served as a California commercial market medical director between 2008 and 2022 for Anthem Blue Cross, Cigna, and UnitedHealthcare. In those roles, he supported membership growth and retention in both fully insured and self-funded product lines and promoted value-based reimbursement, including capitation. He has led utilization management teams, collaborated with internal and external population healthcare advocates, and worked to develop clinical initiatives that sought to achieve the Triple Aim. In his role as the clinical face of the health plan to the local market, he worked with network colleagues on accountable care organization partnerships and hospital and physician contract renewals with integrated pay for performance, supported Obamacare exchange participation, engaged in quality improvement collaboratives, and supported regulatory compliance efforts. Currently, Dr. Asher is serving as a mentor for the Stanford Master in Medical Informatics program while exploring innovative solutions to healthcare delivery.   10:00 What is the competitive picture of California's health plans? 11:28 What was everyone doing in order to get market share? 15:07 EP387 with Betsy Seals. 15:22 EP379 with AJ Loiacono and EP397 with Paul Holmes. 15:26 Why is it difficult to take market share? 16:16 Who was Dr. Asher pitching to and why? 18:49 Did employers ever buy plans for quality? 22:43 What does this look like from the payer perspective? 27:01 What improvements have there been to engagement in health plans? 29:07 Have plans gotten better at communicating with employers? 30:38 Why is it hard to compare the Kaiser world to the non-Kaiser world? 33:00 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.   You can learn more by connecting with Dr. Asher on LinkedIn.   @JacobAsher18 discusses California's #commercialpayer marketplace on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak  

Tom Finn is the co-founder and CEO of LeggUP®, the first company to insure employee retention for their clients! Spending his entire career in the insurance industry, Tom possesses a wealth of experience in employee benefits, InsurTech, business development, and revenue strategies— all central to the company's unique offering, Talent Insurance™. Talent Insurance provides a single platform for personalized professional development and mental health support for a fraction of the cost to small and medium-sized businesses. Since launching in late 2017, LeggUP has helped organizations dramatically reduce staff turnover while increasing output, boasting impressive book of business results like a 73% improvement in employee job satisfaction, a 66% improvement in ability to avoid burnout, and a 39% improvement in physical health, lowering medical costs for companies. In addition to being an active member of SHRM and PIHRA, Tom is a member of the Young Entrepreneurs Council, a Forbes contributor, and a 2021 finalist for Innovator of the Year in his local business journal. His company, LeggUP, was also recognized as a “Great Place to Work,” thanks to their inclusive company culture efforts. Prior to LeggUP, Tom worked at Aetna as VP, growing regional earnings from $6 million to $50 million and expanding the business from 110,000 covered employees to 500,000+. He was also the Regional Managing Director of Anthem Blue Cross. Tom earned an MBA from USC and a B.S. in Business from The University of Arizona's Eller College of Business. https://www.leggup.com/ Social Media Links: https://www.linkedin.com/in/tomfinnleggup?trk=public_profile_browsemap https://www.facebook.com/LeggUPInc/ https://twitter.com/leggupinc https://www.instagram.com/leggupinc/?hl=en  

Veeneta Lakhani, the Chief Growth Officer for Vida Health joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how Vida Health is providing care for over 2 Million people through their digital platform that aims to treat both physical and mental illnesses in a combined effort.  Vida Health is a modular platform that aims to prevent, manage and even reverse chronic conditions by bringing together mental and physical healthcare through a ground-breaking digital platform that connects patients to therapists and coaches. Vida Health's clinical outcomes have led them to receive some of the highest customer satisfaction scores that we've seen on this podcast.  Veeneta joined Vida Health to ensure her work in the healthcare industry leads to a future of care where people are looked after day to day through combining physical and mental health work to achieve sustainable outcomes. Veeneta previously held multiple senior executive positions at Anthem Blue Cross and began her career in the insurance sector with McKinsey and company. Here's a glance at what you'll learn from Veeneta in this episode:  How Veeneta is working to make an impact on people's lives every day instead of just when they go to the doctor, and why she couldn't achieve this at a major national carrier How & why Vida Health combine both physical & mental health treatments Why the healthcare industry made significant progress during COVID-19 as it pertains to mental health, diversity, equity & inclusion. How Vida Health provides instant care when their clients sign up to their service by leveraging their digital platform The secrets behind Vida Health's high customer satisfaction scores and why digital healthcare may be the way forward Timestamps: 0:00 – Introduction 1:10 – Who is Veeneta Lakhani and what is Vida Health? 2:20 – Why did Veeneta leave a national carrier (Anthem) to join a digital health start up? 4:40 – What are the positive outcomes that can be taken from COVID-19? 9:20 – What is Vida Health and what problems are they attempting to solve? 12:00 – How Vida Health approaches their mental health support & care, and why they are leading the way for measuring the severity of mental health 16:50 – Coaches: How Vida Health is implementing mental health coaches into their service 20:30 – How Vida Health manages their team of clinicians and why they can provide instant care 23:30 – What conditions do Vida Health manage and what resources do they use to provide care 27:25 – The methods Vida Health uses to track the results of their patients' chronic conditions and does Vida Health consider themselves a wellness product? 30:40 – What is Vida Health's engagement rate and why is it outperforming their competitors? 33:00 – How are Vida Health tracking their customer satisfaction and what are the results/outcomes for their customers? 37:10 – How many employers/members are currently enrolled in Vida Health's program? 38:15 – What is next for Vida Health and what is their cost structure? Resources: Veeneta's LinkedIn: https://www.linkedin.com/in/veeneta-lakhani/ (https://www.linkedin.com/in/veeneta-lakhani/) Vida Health's Website: https://www.vida.com/ (https://www.vida.com/) Podcast Links: Website: http://www.reconstructinghealthcare.com/ (http://www.reconstructinghealthcare.com/) Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 (https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325) Instagram: https://www.instagram.com/reconstructinghealthcare/ (https://www.instagram.com/reconstructinghealthcare/) Facebook: https://www.facebook.com/ReconstructingHealthcare/ (https://www.facebook.com/ReconstructingHealthcare/) LinkedIn: https://www.linkedin.com/in/michaelmenerey/ (https://www.linkedin.com/in/michaelmenerey/)