Podcasts about health plans

Premiums are climbing, deductibles feel heavier every year, and most people still can't tell you why health care costs what it costs. From the Mackinac Policy Conference, we talk with Dominick Pallone, CEO of the Michigan Association of Health Plans, to get a clear look at what health plans actually do in Michigan and how state policy decisions ripple straight into employer coverage and family budgets.We start with the basics: MAHP represents nine health insurance companies covering nearly four million Michiganders, and their day-to-day work is advocacy with state lawmakers and regulators. From there, we dig into competition and choice in a market long shaped by a dominant carrier, and why employers and individuals should know they have other network options. The goal, Dom argues, is competing on access, quality outcomes, and real value rather than just headlines.Then we get to the affordability problem everyone feels. Dom explains why insurers often function as pass-through entities for underlying prices, and why pharmacy costs have become the biggest lever right now. We talk about double-digit premium trends, specialty drugs that are clinically remarkable but financially punishing, and the policy tightrope between supporting innovation and keeping coverage usable. We also explore practical fixes: value-based care arrangements, custom high-value networks, and health literacy tools like real-person call centers and apps that help members compare cost and quality for elective care.If you care about Michigan health care, health insurance affordability, pharmacy pricing, and what can actually move the needle, this conversation is for you. Subscribe, share this with a friend or colleague, and leave a review with the biggest cost question you want answered next.Support the showEngage the conversation on Substack at The Common Bridge!

In this Bright Spots in Healthcare episode, host Eric Glazer brings together health plan and specialty care leaders to examine a challenge becoming increasingly important to healthcare organizations: how to make sure the right specialty expertise reaches the right patient at the right moment without simply adding another disconnected program. The discussion explores what happens when organizations rethink specialty care as a pathway rather than an isolated episode. Across health plans and specialty care organizations, the conversation looks at how earlier identification, better triage, care navigation, workflow integration, physician engagement, and technology can help organizations improve access while making better use of limited specialist capacity. This is a practical discussion for health plan and provider leaders navigating rising specialty costs, growing demand, limited specialist capacity, and increasingly complex member needs. Our guests include: Shantanu Agrawal, MD, Chief Health Officer, Elevance Health Lora Council, MD, Chief Medical Officer, Fallon Health Sunil Shivaram, MD, Chief Medical Officer, Elite Health Plan Jessica Landin, CEO, Vori Health Together, they explore: How organizations can improve specialty access by identifying, triaging, and routing patients earlier, rather than simply adding specialist capacity How health plans and specialty organizations are redesigning care pathways to better connect primary care, specialists, behavioral health, navigation, and community resources How AI, predictive analytics, digital screening, and asynchronous care can extend clinical capacity while helping specialists focus on patients who need their expertise most What it takes to build more connected specialty care models that improve access, reduce fragmentation and unnecessary utilization, and deliver better outcomes and experiences for patients This episode offers an inside look at how leading organizations are rethinking specialty care not by adding more disconnected solutions, but by improving how expertise is allocated, coordinated, and delivered across the patient's journey. Panelist Bios here: https://www.brightspotsinhealthcare.com/events/rethinking-specialty-care-new-opportunities-to-improve-outcomes-experience-and-affordability/   Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/07/Episode-Guide-Bright-Spots-in-Health-Care-07-30-26.pdf  Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation.  Thank You to Our Episode Partner, Vori Health Vori Health helps health plans and provider organizations rethink musculoskeletal care through an integrated, physician-led model that brings physicians, physical therapists, health coaches, and technology together around the patient. Rather than treating specialty care as an isolated episode, Vori's approach is designed to provide coordinated, longitudinal support while helping patients access the right care at the right time. The model also reflects a broader shift discussed throughout this episode: using technology to extend the care team, identify patients earlier, support engagement between visits, and connect patients to the resources they need across the healthcare system. Vori's digital and AI-enabled tools can support asynchronous care, provide feedback to clinicians, and help identify patient needs before they escalate into higher-cost settings or worse outcomes. Learn more about Vori Health - http://vorihealth.com.  Schedule a Meeting with Jessica Landin, CEO, Vori Health To explore how Vori Health can help your organization rethink MSK care, improve access, reduce fragmentation, and build a more coordinated specialty care model, reach out to show producer Vekonda Luangaphay at vluangaphay@brightspotsventures.com to schedule a conversation with Jessica Landin, CEO, Vori Health. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.  

For years, regional health plans benefited from powerful tailwinds: Medicare Advantage growth, Medicaid expansion, and a prospering ACA marketplace. But many of those growth engines have stalled, just as new pressures emerged: rising utilization, runaway spend, pricing uncertainty and more scrutiny from patients and policy makers. The result is a dramatically different financial reality for health plans. In 2024, only eight of 33 Blues plans reported positive operating margins. In this episode, host Rae Woods sits down with Jared Landis, Vice President of Advisory Board's Health Plan Research practice, to unpack how regional plans got here and the three-year turnaround strategy regional and Blues plans are now pursuing. Together, they explore the market forces that upended the payer playbook, the operational and pricing changes plans are making to stabilize performance, and how AI-enabled transformation could reshape the future of the insurance business. Stay tuned to the end of the episode for an update on the Rural Health Transformation Program, including a key deadline this fall. We're here to help: Episode | Ep. 257: Paul Markovich on new builds, breakups, and bold healthcare bets Episode | 305: “The work isn't easy, but it's clear”: How healthcare leaders are responding to the market Episode | 302: CMS announced the 2027 MA final rate. What do payers and providers need to know? Playlist | Radio Advisory Provider Strategy and Financial Outlook playlist Expert Insight | Can health plans turn their MA business around this year? Research | Health plan strategy Report | Rural health transformation funds: Where they're really going Ready-to-Use Slides | Health Plan Market Explorer Webinar | Understanding health plan decision-makers Sponsor link: Precision in motion: How digital tools support diabetes care providers A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

UPMC and Birth Root Community Doula describe a 4-year partnership addressing food insecurity, housing, and maternal health disparities in Erie, Pennsylvania.

This episode covers the legislature's return and the 51-page Technical Corrections Bill that restored funding for some departments, extended Dolly Parton's Imagination Library, and included incentives for major sporting events, while the House prepares to take up the bill. We also discuss new election bills that shrink early voting, the escalating state health plan conflict with Atrium over pricing and network access, concerns about hospital and pension practices, Gen Z voting trends, and the podcast's new AI chatbot feature.

In January of 2027, people on Medicaid will need to meet a slate of new requirements mandated by the One Big Beautiful Bill Act, or HR1. Some people on the Oregon Health Plan will need to confirm that they are working, volunteering or attending school every six months. And everyone will need to renew twice a year, rather than once every two years. All this paperwork will be handled by the Oregon Department of Human Services, in collaboration with the Oregon Health Authority. Both departments are working hard to make sure they are ready for the January deadline. Vivian Levy, Interim Medicaid Director for the Oregon Health Authority, and Nate Singer, Director of Eligibility Partnership at the Oregon Department of Human Services, join us to explain how Oregonians will be impacted.

This episode of The SEANC View podcast discussed the new tier system of the State Health Plan, highlighting the controversy surrounding the exclusion of Atrium and WakeMed from preferred provider status. The plan aims to cap hospital reimbursements, which can sometimes reach over 800% of Medicare rates. Without the tier system, approved by the State Health Plan Board of Trustees, members faced premium increases of up to 21%. The discussion also touched on the financial reserves of these hospitals, the impact on rural healthcare, and the need for transparency in hospital pricing.

There are several ways to support the podcast! Join us at The49ersRush.com for all of our All22 film breakdowns and bonus content. This is the best way to support the show.We still have our Patreon as well https://www.patreon.com/49ersRushPodcast49ers Rush Road Trip details at https://www.49ersrushroadtrip.com/For the 49er Rush Hat go to https://hiveandpines.com/products/the-red-gateCheck out BetterHelp: https://www.betterhelp.comCheck out Troll Co Clothing and use my code RUSH25 for a great deal: https://www.trollcoclothing.comCheck out Outdoorsy and use my code 49ERS for a great deal: https://www.outdoorsy.comI am most active on Twitter please follow @JL_Chapman, Instagram: 49ers Rush Podcast, Email: 49ersRushPodcast@gmail.comIf you need help with website design/builds go to https://www.powerbrandsystems.com/crm949620?am_id=john874Get all 49ers gear at homage.sjv.io/MmYXO2#49ers #49ersrushOur Sponsors:* Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com* Check out Outdoorsy and use my code 49ERS for a great deal: https://www.outdoorsy.com* Check out Troll Co Clothing and use my code RUSH25 for a great deal: https://www.trollcoclothing.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

A court-ordered mental health plan for inmates moves forward.The chief of an Oklahoma tribe faces allegations of threats against a tribal representative.Oklahoma City is looking into a new design for its flag.You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment.You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, TikTok and Instagram at KOSU Radio.This is The KOSU Daily, Oklahoma news, every weekday.

State Treasurer Brad Briner and Plan Executive Administrator Thomas Friedman join us this week to recap the State Health Plan Board of Trustees meeting and explain major changes: a premium increase, a new three-tier provider network (preferred, access, non-preferred), and the decision to return Blue Cross Blue Shield of North Carolina as the third-party administrator and pharmacy benefit manager in 2028. They discuss why the changes are needed to control costs, how tiers work for members across urban and rural areas, protections for patients in active treatment, and next steps for implementation and member engagement.

In this explainer episode, we've asked Ella Davyson, Genomics Data Scientist, to explain the meaning of the term genomics. You can also find a series of short videos explaining some of the common terms you might encounter about genomics on our YouTube channel. If you've got any questions, or have any other topics you'd like us to explain, let us know on podcast@genomicsengland.co.uk. You can download the transcript or read it below. [00:00:00] Florence: What is genomics? My name is Florence Cornish, and today I'm joined by Ella Davyson, who is a genomics data scientist here at Genomics England, and she is here to explain the topic in much more detail So, Ella, we obviously both work at Genomics England. This podcast is called Genomics 101, so I guess it's fitting that we have an episode dedicated to explaining the term 'genomics'. [00:00:26] But before we get into that, I think it would be good if you could first explain what we mean by the term 'genome'. [00:00:32] Ella: Thanks, Florence. The genome is, essentially you can think of it like a manual booklet, or instructions that the body uses in how to grow, survive, and function, and this is a manual that's in every single cell within our body, and it tells our cells exactly how to divide, how to survive. [00:00:54] For example, the genome in the pancreas, in pancreatic cells will tell those cells how to produce proteins such as insulin that we need to control our blood sugar. And also, the genome within our eye cells will tell the cells how to generate photoreceptors to enable us to see. So the genome is essentially like the ultimate guide that our body uses to tell it how to create everything that we need to survive going forwards. [00:01:25] Florence: So then, what do we mean by the term 'genomics'? [00:01:30] Ella: So, genomics is essentially the study of the entire human genome. So we study its structure and also how it functions, in terms of how is this instruction manual being read by the body, and how does that result in healthy human beings that we see today. [00:01:48] Florence: So when we're talking about studying DNA, lots of our listeners might have heard the term 'genetics', which kind of also refers to the study of DNA and genes, so it might be a little bit confusing. [00:01:58] So what's the difference between the two? What's the difference between genetics and genomics? [00:02:04] Ella: So genetics is specifically the study of genes in the genome, and genes are part of the instruction manual, that specifically tell the body to produce a certain thing. So, in our insulin example, there is an INS gene, so, which is the gene in the genome or the instruction manual that specifically tells the cells to make insulin and to produce this product. [00:02:30] There are many different genes in our genome, and genetics is the study of all of these. In contrast, genomics is the study of the entire instruction manual altogether, so that includes all of the genes in genetics and also everything else in the manual. So, genetics is limited to the study of these parts of the manual that clearly encode certain proteins or products such as insulin. Genomics is the study of everything all at once, everything under the bathroom sink. So yeah, the confusion I think can arise a lot because historically when we first started looking at DNA and researching genetics, we didn't have the technology to look at the whole genome all at once, and with older sequencing technologies we would focus on particular genes that we knew important for certain diseases. [00:03:19] So in diabetes, for example, they would instead specifically look at the insulin gene and see how does this influence diabetes, rather than looking at the entire instruction manual at once. Nowadays, we do have that technology, and that is what we do here at Genomics England, just use that to look at the entire genome rather than specific subsets of the genome, so specific genes. [00:03:45] We can look at everything in its entirety. So, you can kind of think of genomics as a much broader, more complete study of genetics. [00:03:56] Florence: So speaking of genomic testing, I don't know if you saw, but in the government's 10-year Health Plan that they published last year, they predicted that genomics could play a role in up to 50% of healthcare interactions. [00:04:08] Could you tell me a bit about why genomics is important in healthcare? [00:04:12] Ella: So that's a really exciting point, and I think one that we should be all striving towards. So, genomics can play a role in healthcare in so many different ways. I think before going into each of them, it's kind of maybe important just to illustrate that our genomes between two, two people are 99.9% the same. [00:04:38] So we're both humans. We are both the same species. There is 0.1% difference between two people's genomes, and those differences underlie all the uniqueness that makes a person a unique individual. [00:04:54] So personality, appearance and also risk to different health and disease outcomes. So that is where the role of genomics can come in, is to understand how the differences between people and their genetic makeup can influence maybe their risk for being more predisposed to developing a condition. Conditions such as Cystic Fibrosis or Huntington's disease that are specifically caused by genetic variants or mutations in genes that directly cause the condition. So it's a bit more maybe obvious, if you like, about how studying genetics in those, in those conditions can directly inform on how they arise, potential ways that we can better treat them. [00:05:52] So another way that genomics can be used in healthcare is through screening. So this is being piloted at the moment in the Generation Study by Genomics England which is applying whole genome sequencing to newborn babies to look for a range of conditions which are caused by genetic changes, all of which are treatable. [00:06:13] But importantly, screening will enable clinicians and families to know about these conditions much earlier and start life-changing treatment much, much sooner. So this is kind of already beginning to be, I think it will be showcased with this study in the next couple of years and the power of this in healthcare, I think can't really be overestimated. [00:06:40] Florence: And finally, just to finish off, is there anything coming up in the field of genomics that you're especially excited about? [00:06:48] Ella: There are loads of different things that I'm excited about in the field of genomics. I think probably maybe one that's most kind of relevant to clinical care is the possibility of doing more personalised medicine with treatments. [00:07:05] Often, at the moment, we majority have kind of one treatment for all when treating certain conditions, and sometimes these treatments aren't tolerated well by some people, and also some of these treatments just don't work well in some people as well. Sometimes there's a clear reason for these things, but more often than not, it's not entirely clear why some people might benefit more for some treatments or some people don't respond or don't react well to some treatments as well. [00:07:35] And understanding more, so there's a whole field about how genomics interacts with drugs and medicines, which is called pharmacogenomics, and its aim is to understand which medicine might be most effective or well-tolerated in certain people based on their genetics. And I think that will be kind of life-changing as well for some people, who are suffering from diseases where the medication is either not effective enough or is also affecting their quality of life. [00:08:10] Florence: Mm-hmm. [00:08:10] Ella: Because that is a whole other part of it as well is that sometimes these treatments for certain conditions are really hard to tolerate. [00:08:19] Other things that I'm excited about are just the technologies that are coming out at the moment mean that we can measure and understand a whole lot more about genomics than we used to be. So now we can say this gene is influencing this disease, but sometimes, you know, it's more complicated, and we now have the technology to measure all sorts of different things, so how our environment can influence our genes and how our genes react with each other. [00:08:57] So we're just getting, we're getting able to look at more and more, and I think we'll expand our understanding in a lot of conditions that unfortunately aren't very simple. [00:09:12] Florence: Well, I think we'll finish there. Thank you so much, Ella, for coming on and for taking the time to explain genomics to us. [00:09:18] Ella: Thank you, Florence. Thanks so much for inviting me, and it was a pleasure to be on the podcast today. [00:09:23] Florence: If you want to hear more explainer episodes like this, you can find them on our website at www.genomicsengland.co.uk or wherever you get your podcasts. Thank you for listening.

Major healthcare changes are coming for hundreds of thousands of state employees, retirees and family members. Starting next year, State Health Plan premiums will go up, and a new provider system could change what members pay for care. WRAL State Government Reporter Will Doran explains the changes with WRAL News+ Anchor Elizabeth Holmes.

Sign up for my free newsletter and get 1-page action plans (Dr. Bobby's 1-page PrescriptionsA birthday can sneak up on you and suddenly you're asking a blunt question: what am I actually doing for my health, and am I focused on the right things? As I near 70, I share the health plan I actually follow, not as a template for you to copy, but as a clear way to think about your own evidence-based health plan for longevity, energy, and a life you still want to live.I organize my choices into three practical buckets. First: what I can influence directly, without needing anyone else or a prescription. That includes aerobic exercise (the easiest “yes” because I love endurance work), sleep (the hardest “yes” because it requires protecting bedtime), alcohol (a real tradeoff because it impacts sleep and raises concerns around dementia risk), and simple nutrition habits like maintaining a healthy weight and getting enough protein without obsessing over the perfect diet. I also talk about injury prevention as we age, because staying consistent beats proving you can suffer, plus the value of N-of-1 experiments like testing magnesium for muscle cramps.Second: where I need support from others. Knowing the evidence doesn't guarantee I do the work, and strength training is my best example. I explain why accountability and a trainer can be the bridge between knowing and doing, and I share how getting real help for emotional health, including EMDR, can succeed when decades of solo effort don't.Third: where medication is the right evidence-based tool. I push back hard on the wellness narrative that needing prescriptions means you failed, and I walk through how I think about blood pressure, cholesterol, blood sugar, and long-term mental health treatment.If this helps you rethink your own plan, subscribe, share the episode with a friend, and leave a review on Apple Podcasts or Spotify. What's one part of your health plan you can do today, and what's one part you need help with?Send us Fan MailSupport the show

"The most unused cash in the country right now is the money you're wasting on healthcare... If you save a million dollars a year, that's $20 million in market cap."Is your company treating its healthcare spend like a business strategy, or are you just writing a blank check to the major insurance carriers every year?In this episode, I was (finally) joined by Mark Cuban, Ann Lewandowski, and Matt Miron. After answering how he would approach healthcare for a hypothetical company on Shark Tank, Mark broke down his exact playbook for mid-market employers: why you should fire traditional networks, the massive ROI of hiring an internal "Healthcare CFO" to negotiate single-case agreements, and why "carve-out" is the most important phrase for your benefit strategy this year. Together, we also discussed the dark side of healthcare economics, including the exorbitant spread pricing of PBMs and distributors, how to use AI (like Claude or ChatGPT) to find the hidden "gotchas" in your ASO contracts, and the terrifying legal liabilities CEOs face when their carriers deny life-saving treatments.This one has been in the works for years, and I hope it doesn't disappoint. Tune in!Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Introductions: Mark Cuban, Ann Lewandowski, and Matt Miron (00:01:08) Mark Cuban's Healthcare Playbook for Shark Tank Companies (00:05:54) Single Case Agreements and Hiring an Internal Healthcare CFO (00:10:08) Why the Keyword for 2026 is "Carve Out" (00:14:32) Fiduciary Duty and Waiving Employee Deductibles (00:20:52) Starting with Out-of-Network Negotiations (00:25:09) The No Surprises Act, IDR Arbitration, and Secret Payouts (00:29:12) Why Mark Started Cost Plus Drugs (and Cost Plus Wellness)(00:32:10) How Distributors and PBMs Inflate Drug Prices (00:36:49) Using AI (Claude/ChatGPT) to Audit Your Carrier Contracts (00:37:52) The 340B Scam and Fiduciary Lawsuits (00:44:27) Increasing Enterprise Value: Why Healthcare Savings = Market Cap (00:47:46) CEO Liability for Life-Threatening Claim Denials (00:50:37) The Perverse Economics of Prior Authorizations and Appeals (00:52:59) Final Takeaways: Watch Your Money and Carve OutKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"The most unused cash in the country right now is the money you're wasting on healthcare... If you save a million dollars a year, that's $20 million in market cap."Is your company treating its healthcare spend like a business strategy, or are you just writing a blank check to the major insurance carriers every year?In this episode, I was (finally) joined by Mark Cuban, Ann Lewandowski, and Matt Miron. After answering how he would approach healthcare for a hypothetical company on Shark Tank, Mark broke down his exact playbook for mid-market employers: why you should fire traditional networks, the massive ROI of hiring an internal "Healthcare CFO" to negotiate single-case agreements, and why "carve-out" is the most important phrase for your benefit strategy this year. Together, we also discussed the dark side of healthcare economics, including the exorbitant spread pricing of PBMs and distributors, how to use AI (like Claude or ChatGPT) to find the hidden "gotchas" in your ASO contracts, and the terrifying legal liabilities CEOs face when their carriers deny life-saving treatments.This one has been in the works for years, and I hope it doesn't disappoint. Tune in!Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Introductions: Mark Cuban, Ann Lewandowski, and Matt Miron (00:01:08) Mark Cuban's Healthcare Playbook for Shark Tank Companies (00:05:54) Single Case Agreements and Hiring an Internal Healthcare CFO (00:10:08) Why the Keyword for 2026 is "Carve Out" (00:14:32) Fiduciary Duty and Waiving Employee Deductibles (00:20:52) Starting with Out-of-Network Negotiations (00:25:09) The No Surprises Act, IDR Arbitration, and Secret Payouts (00:29:12) Why Mark Started Cost Plus Drugs (and Cost Plus Wellness)(00:32:10) How Distributors and PBMs Inflate Drug Prices (00:36:49) Using AI (Claude/ChatGPT) to Audit Your Carrier Contracts (00:37:52) The 340B Scam and Fiduciary Lawsuits (00:44:27) Increasing Enterprise Value: Why Healthcare Savings = Market Cap (00:47:46) CEO Liability for Life-Threatening Claim Denials (00:50:37) The Perverse Economics of Prior Authorizations and Appeals (00:52:59) Final Takeaways: Watch Your Money and Carve OutKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

Dominick Pallone, executive director, Michigan Association of Health Plans, joined Rich Helppie from The Common Bridge Podcast May 27 at the 2026 Mackinac Policy Conference to discuss healthcare affordability challenges, policy priorities, health literacy and the importance of partnering with Michigan hospitals to enhance access to quality care.

In this episode, Dr. Brian Miller — hospitalist, policy advisor, and vice chair of the North Carolina State Health Plan Board — explores why health care is so expensive and what can be done about it. We discuss hospital consolidation and the Atrium–WakeMed merger, steering and preferred provider strategies, income‑adjusted premiums, price transparency, drug costs, and practical steps the state health plan is taking to lower costs and protect members.

Your health plan might be robbing you blind. The fun part? You may be paying someone to let it happen. Healthcare benefits are one of the biggest expenses for small business owners, and most employers are stuck playing a game where the rules are hidden, the prices move, and somehow the bill always gets worse. In this episode of The Liquid Lunch Project, hosts Matthew R. Meehan and Luigi Rosabianca sit down with Donovan Ryckis, CEO of Ethos Benefits, to rip the lid off employer-sponsored healthcare. Donovan breaks down why insurance costs keep rising, how brokers can create conflicts of interest, why pharmacy benefit managers deserve a long side-eye, and how small businesses can start asking much better questions before renewal season punches them in the face.  

Best Of 2GG: Jay's Health Plan For Brooke Pt1 by Two Girls and a Guy

Best Of 2GG: Jay's Health Plan For Brooke Pt2 by Two Girls and a Guy

Provider-sponsored health plans have been around for years. Has this "pay-vider" business model fulfilled its promise to lower costs and improve outcomes? David W. Johnson and Julie Murchinson critique their promise and performance on, “Do Hospitals and Health Plans Mix?” the new episode of the 4sight Health Roundup podcast, moderated by David Burda. 

In this episode, Chase Cannon and Suzanne Spradley discuss a recent HHS Office for Civil Rights settlement showing that self-insured employer-sponsored group health plans are not outside the reach of HIPAA enforcement — especially when ransomware, electronic PHI, and incomplete risk analysis are involved.

Dominick Pallone, executive director at the Michigan Association of Health Plans, joins us on today's episode of Rural Health Today. Health plans are an essential component to healthcare affordability and accessibility in the United States, but the cost of premiums continues to climb. Dominick is here to provide insights in healthcare affordability in Michigan. We'll talk about upcoming legislation, payer-hospital negotiations, and of course, what it all has to do with rural health.  Follow Rural Health Today on social media! https://x.com/RuralHealthPod https://www.youtube.com/@ruralhealthtoday7665  Follow Hillsdale Hospital on social media! https://www.facebook.com/hillsdalehospital/ https://www.twitter.com/hillsdalehosp/ https://www.linkedin.com/company/hillsdale-community-health-center/ https://www.instagram.com/hillsdalehospital/  Follow our guest! https://www.linkedin.com/in/dominick-pallone-200b3269/ https://www.linkedin.com/company/mahp/ https://www.facebook.com/MichiganAssociationofHealthPlans

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.

Heart disease is still the number one killer, and Dr. David Brownstein says the current approach is not working.In this episode of The Natural Heart Doctor Show, Dr.Brownstein joins Dr. Jack Wolfson to discuss food quality, iodine deficiency, thyroid health, fluoride exposure, statins, and why preventing heart attacks and strokes requires looking beyond prescriptions.- - - - - About the Guest:Dr. David Brownstein is a board-certified family physician and the Medical Director of the Center for Holistic Medicine in West Bloomfield, Michigan. A graduate of the University of Michigan and Wayne State University School of Medicine, he is a member of the American Academy of Family Physicians and serves on the board of the International College of Integrative Medicine.Dr. Brownstein is an internationally recognized speaker and the author of 17 books, including Iodine: Why You Need It, Why You Can't Live Without It. His work focuses on holistic medicine, thyroid health, iodine, natural hormones, nutrition, and helping patients address the underlying factors that contribute to chronic illness.Social Handles:Website: https://www.drbrownstein.com/Instagram: https://www.instagram.com/centerforholisticmedicine/- - - - -Jack Wolfson, DO, FACCWebsites: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drjackwolfson.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠; ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://naturalheartdoctor.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/drjackwolfson⁠⁠⁠⁠⁠⁠⁠Ready to move past the confusion and fear of typical heart health approaches? Visit ⁠⁠⁠⁠⁠⁠⁠naturalheartdoctor.com/discovery⁠⁠⁠⁠⁠⁠⁠ to schedule your free discovery call and start your journey toward a 100-year heart with real, evidence-based answers.- - - - -PODCAST Thank you for listening. Please subscribe and share. This podcast is produced by DrTalks.com ⁠⁠⁠⁠⁠⁠⁠https://drtalks.com/podcast-service/

In this episode, Jakob Emerson, Associate News Director, Becker's Healthcare, discusses Cigna's decision to drop GLP-1 weight loss drug coverage for employees, the financial pressures facing health insurers, the challenges of implementing new Medicaid work requirements, and the ongoing retreat of provider-sponsored health plans.

This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Adam Park, Director of Network Development, Curative Health Plan, who discusses how Curative is redesigning employer-sponsored healthcare by removing financial barriers to care and investing in prevention. He also shares how AI is improving credentialing, prior authorization, and member support while helping create faster, more personalized healthcare experiences.In collaboration with Hippocratic AI.

For most employers, the annual health insurance renewal cycle is a source of pure frustration. It's often marked by rising costs, confusing packages, and a total lack of control. In this episode of Healthcare Americana, host Christopher Habig sits down with Niko Caparisos, Program Architect at Community-Owned Health Plans (COHP). Together, they explore how shifting the focus back to local, independent vendors can dramatically reduce costs while improving the patient experience. Niko discusses his mission to educate benefits brokers and empower employers to ditch rigid, one-size-fits-all national plans in favor of grassroots, community-centered solutions.The conversation digs deep into how Direct Primary Care (DPC) and cash-pay consumerism can fix the broken way we pay for healthcare in America. Niko shares actionable strategies for companies looking to reclaim their healthcare data, including how to support a remote workforce and how to implement a phased, multi-year approach to self-funding. If you are tired of repeating the same broken benefit renewal cycle every year, this episode provides a clear, solution-oriented roadmap to building a transparent, high-quality health benefit from the ground up.More on Freedom Healthworks & FreedomDoc HealthSubscribe at https://healthcareamericana.com/More on Niko J. Caparisos & Community-Owned Health PlansFollow Healthcare Americana: Instagram & LinkedIN

In this episode,. Alan Condon, Editor-in-Chief at Becker's Healthcare, breaks down the latest financial performance and strategic shifts among major nonprofit health systems including CommonSpirit, Ascension, and Trinity Health. He also discusses the growing focus on ambulatory surgery centers, Providence's decision to wind down its health plan business, and the mounting pressures facing provider-sponsored insurance plans.

In this episode, Rakesh Mathew, MS, MBA, CPHIMS, Interoperability Leader at Jefferson Health Plans, joins the podcast to discuss the financial pressures facing payers and how sustained losses can reduce competition and lead to market consolidation. He shares perspectives on improving affordability and access, and outlines how organizations can prepare for success in 2027 through stronger interoperability and strategic planning.

In this episode, Rakesh Mathew, MS, MBA, CPHIMS, Interoperability Leader at Jefferson Health Plans, joins the podcast to discuss the financial pressures facing payers and how sustained losses can reduce competition and lead to market consolidation. He shares perspectives on improving affordability and access, and outlines how organizations can prepare for success in 2027 through stronger interoperability and strategic planning.

Why do so many healthcare innovation efforts stall after pilots? In this Bright Spots in Healthcare episode, host Eric Glazer sits down with leaders from Healthworx,  the investment and innovation arm of CareFirst, for a candid discussion on what actually allows innovation to scale inside complex healthcare organizations. As health plans invest heavily in AI, digital transformation, startup partnerships, and new care models, many still struggle to operationalize innovation in meaningful ways. This conversation explores why innovation often breaks down between idea and implementation,  and what organizations can do differently. Guests include: Emily Durfee, Director, Corporate Venture Capital, Healthworx Soo Jeon, Head, Healthworx Accelerator Mike Batista, Managing Partner, Healthworx Studio Together, they explore: Why health plan innovation efforts often fail to scale The operational barriers that prevent ideas from gaining traction Why healthcare struggles to move beyond pilots and experimentation What startups misunderstand about working with health plans Why incremental operational evolution often beats transformational change How Healthworx approaches innovation through investing, accelerating, and building What separates organizations that successfully scale innovation from those that don't This episode offers a practical look at the operational realities of healthcare innovation and what it takes to turn new ideas into measurable impact Panelist Bios: https://www.brightspotsinhealthcare.com/events/why-health-plan-innovation-fails-and-what-actually-scales-healthworx/ About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

In this episode, we break down the SAG-AFTRA Health Plan's $950,000 phishing settlement, Medtronic's nine-million-record breach, and the Inc Ransom attack on Sandhills Medical Foundation. We also highlight Henderson Behavioral Health's patient-centered approach and discuss practical takeaways for strengthening your organization's security posture through staff training, system patching, and incident response planning.

The Friday Five for May 15, 2026: Field Notes: Camp Ritter The “Spotify 20: Your Party of the Year(s)” TRICARE Transition from DS Logon to myAuth Scammers Using Meta to Target Seniors Introducing the Integrity Health Plan   Get Connected:

Not surprisingly healthcare affordability has risen to the top or #1 mid-term election campaign issue. Largely due to pricing failure, that costs Americans about $250 billion annually, pricing power is the consequence of an increasingly concentrated healthcare market. Think: Herfindahl-Hirschman Index scores. Hospital pricing/prices are particularly noteworthy or moreover surgical procedures and patented drugs that have risen at multiples of the annual inflation. This means those insured pay increasingly higher coverage (premiums, deductibles, copays) and are forced into medical debt or bankruptcy, forced to avoid necessary care and/or make financial trade offs. Insurance plans, here we're discussing self-insured employee plans, that capture roughly 65% of covered workers, face similarly challenging math. For example, recently reported news found the five largest managed care plans lost $226 billion in market value over the previous 12 months. As for solutions, federal price transparency laws, though well intended, have either gone un-headed and/or lack enforcement. Mr. Robert Andrews is the CEO of the Health Transformation Alliance (HTA), a cooperative of approximately 80 large self-insured employer health plans. HTA was founded in 2016 by four pioneering employers from American Express, Macy's, Verizon and Caterpillar. HTA member companies are collectively responsible for more than 5 US million lives and 8 million globally spending $450 billion annually in the US market. Mr. Andrews served NJ's 1st congressional district in the US House of Representatives from 1990 to 2014.Information on the Health Transformation Alliance is at: https://www.htahealth.com/about-us/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Summer is supposed to be easy breezy, right? But as women, we typically take on the burden of new schedules and circus-level logistics, all while trying to maintain our own health. In today's episode of the Joyful Health Show, I share my ideas for a stress-free summer for YOU, Christian women! Here's what I'll share: My story of burnout and what I did in response How to prioritize instead of agonize A 20-minute summer morning that will get you going I want you to walk away feeling light-hearted about the summer ahead, excited about what God has in store and equipped for whatever comes. "For everything there is a season, a time for every activity under heaven." Ecclesiastes 3:1 Helpful Timestamps: 00:13 Why Summer Feels Hard07:37 Let Go Of Expectations15:45 Keystone Health Habits26:18 The 20 Minute Morning

"I would rather take this risk because I will never give another dime to a fully-insured carrier as long as I live."In an era of double-digit medical trend and skyrocketing fully-insured renewals, is the traditional insurance broker obsolete?This week, my guest is John Kountz, a benefits consultant at Frost Insurance who believes that the days of the "renewal carousel" - shopping the big 4 carriers and accepting double-digit increases every year - are finally over. In this episode, John shares his journey from feeling completely helpless as a broker to discovering the power of true consulting.We discuss the critical differences between a "broker" and a "consultant," how he uncovered that an employer was secretly paying 45% of their entire $10 million pharmacy spend in rebates, and how taking a fully-insured client directly to Reference-Based Pricing (RBP) cut their $1,000/month employee-only premium completely in half. John also breaks down the emerging power of pharmacogenomics, why 2026 is poised to be an even more brutal renewal year, and why you must replace your traditional broker with a true consultant.If you are an employer tired of throwing away money on fully-insured premiums, or a broker wanting to make the jump to self-funding, this conversation is the push you need.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why the Benefits Consultant is Healthcare's Most Important Role (00:04:03) Staying Independent in an Era of Broker Consolidation (00:11:51) Getting Out of the "Renewal Carousel" (00:18:18) The Turning Point: Discovering 45% of Rx Spend Was Going to Rebates (00:20:41) Converting a Fully-Insured Group to Reference-Based Pricing (RBP) (00:30:11) The Real Definition of Self-Funding (The Chassis vs. The Car) (00:36:05) Finding the Root Cause: Diet, Inflammation & Autoimmune Disease (00:46:04) The Future of Prescribing: Pharmacogenomics (00:57:20) Why the 2026 Renewal Season Will Be a "Bloodbath" (01:02:00) Closing Thoughts: Stop Working With Traditional BrokersKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

S3E5: Bridging the Divide: How Provider Sponsored Health Plans Navigate Financial Pressure and More Host: Frank Cutitta Guest: Brad Hawkins, Vice President, MRO To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

In this Bright Spots in Healthcare episode, host Eric Glazer brings together payer and strategy leaders to explore a fundamental challenge in Medicare Advantage: why improving experience is not about measuring more, but managing better. This conversation focuses on where performance is actually being lost across the member journey, not within individual programs, but in the gaps between them. Plans continue to invest in outreach, pharmacy, provider engagement, and member services, yet still struggle to translate those efforts into consistent member action and measurable outcomes. This is a candid discussion for executives navigating rising expectations around experience, increasing pressure on Stars performance, and the need to deliver results through coordination, not just activity.   Our guests include: Dan Knecht, MD, Chief Medical Officer, EmblemHealth Stacey Friedman, Senior Director, Quality & HEDIS/Stars, Doctors HealthCare Plans Paula Jacobson, Director, Quality and Population Health, Security Health Plan Dave Burianek, Chief Strategy Officer, MedOrion    Together, they explore: Where member experience breaks down across the journey, especially in the moments immediately following enrollment Why campaign-based outreach is no longer sufficient to drive engagement or outcomes How leading plans are shifting from volume to sequencing, focusing on the next best action rather than multiple simultaneous asks What it takes to align pharmacy, quality, and member experience into a coordinated system How organizations are improving performance by reducing friction, increasing clarity, and guiding members toward action  This episode offers a practical look at how leading plans are rethinking CAHPS as a reflection of the full member journey, and what it takes to design that experience in a way that consistently drives performance.  Panelist Bios: https://www.brightspotsinhealthcare.com/events/beyond-the-survey-how-medicare-advantage-plans-are-rethinking-cahps-and-member-experience/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/April_16_Episode_Guide.docx.pdf Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/04-16-26-KIS-Beyond-the-Survey-Session.pdf Resources:  Report: Redesigning Experience: Why CAHPS Performance Is Won or Lost in the Member Journey This report examines why Medicare Advantage plans often see CAHPS results that don't reflect the effort they put in. The issue is not a lack of activity. It's that CAHPS reflects a year's worth of member experience, shaped by care access, coordination, navigation, and follow-through, not isolated interactions or last-minute interventions. Drawing on real-world examples, the report shows how improving underlying care events like annual wellness visits, redirecting care to the right setting, and strengthening member understanding directly influences CAHPS performance, and why results cannot be changed at the end of the measurement year. Inside, you'll find insights on: Why CAHPS questions act as proxies for clinical events like annual wellness visits and care coordination Where campaign-based engagement models fall short in shaping member experience How friction accumulates across touchpoints and impacts perception long before the survey is fielded What changes when plans shift from disconnected outreach to coordinated, journey-based design How aligning Stars, quality, and care delivery reduces fragmentation and improves outcomes Why understanding member barriers, including access, confusion, and behavioral factors, is critical to driving action The broader lesson is operational: plans that consistently perform on CAHPS are not doing more outreach. They are designing member journeys that reduce friction, coordinate care and communication, and naturally produce better experiences over time. To request your copy of the report, please contact show producer Jessica Tenzer at nroberts@brightspotsventures.com. Thank You to Our Episode Partner, MedOrion: MedOrion helps health plans move beyond static segmentation by using real-time clinical, situational, and behavioral signals to drive meaningful member action. By identifying who to engage, what barriers exist, and when to intervene, MedOrion enables more precise prioritization and coordination of outreach. This approach helps close care gaps, improve adherence, reduce avoidable utilization, and drive more consistent performance across cost, quality, and experience. Learn more at medorion.com.  Schedule a Meeting with a Senior Leader at MedOrion: To explore how MedOrion can support your organization in moving from campaign-based outreach to coordinated, signal-driven engagement, reach out to show producer Nicole Roberts at nroberts@brightspotsventures.com to schedule a conversation with a member of the MedOrion leadership team.    About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

In this episode, Suzanne Spradley and Chase Cannon discuss two recent circuit court decisions and their impact on employer-sponsored group health plans. Suzanne first discusses a Sixth Circuit decision involving a state law that attempts to regulate PBMs. Suzanne and Chase walk through Supreme Court precedent that appears to be driving states to enact PBM laws, and they explain how ERISA preemption is at the heart of it all. Suzanne concludes the podcast by outlining another federal decision relating to a fiduciary breach claim of an employer group health plan.

Did you know that if you have a high-deductible health plan, some services like immunizations and screenings are free (even if you haven't met your deductible)? Or that you might be able to invest the money in your HSA? This episode, KFF Health News reporter Jackie Fortiér shares tips on getting the most out of your HDHP.Have a question about navigating the health care system? Contact us here and you might be part of an upcoming episode of Health Care Helpline.Follow us on Instagram: @nprlifekitSign up for our newsletter here.Have an episode idea or feedback you want to share? Email us at lifekit@npr.orgSupport the show and listen to it sponsor-free by signing up for Life Kit+ at plus.npr.org/lifekitSee pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

Did you know that if you have a high-deductible health plan, some services like immunizations and screenings are free (even if you haven't met your deductible)? Or that you might be able to invest the money in your HSA? This episode, KFF Health News reporter Jackie Fortiér shares tips on getting the most out of your HDHP.Have a question about navigating the health care system? Contact us here and you might be part of an upcoming episode of Health Care Helpline.Follow us on Instagram: @nprlifekitSign up for our newsletter here.Have an episode idea or feedback you want to share? Email us at lifekit@npr.orgSupport the show and listen to it sponsor-free by signing up for Life Kit+ at plus.npr.org/lifekitSee pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

In this Bright Spots in Healthcare episode, host Eric Glazer brings together payer leaders to explore a fundamental challenge in Medicare Advantage: why strong strategies often fail to translate into sustained performance. This conversation focuses on the gap between intention and execution, where plans invest heavily in programs, outreach, and data, yet still struggle to drive the member actions that ultimately determine cost, quality, and experience. This is a candid discussion for executives navigating rising pressure on margins, increasing complexity in member populations, and the growing need to prove performance beyond activity alone. Our guests include: Mike Rapach, President & CEO, CareFirst Community Health Plan Maryland Joshua Meeks, Vice President, Medicare Advantage Individual Business, Blue Cross Blue Shield of Michigan Jen Cohen-Smith, SVP Medicare, Healthfirst Kathleen Faulk, Chief Strategy Officer, Drips Together, they explore: Where Medicare Advantage strategies break down, not in design, but in execution Why member engagement alone is no longer sufficient to drive outcomes How leading plans are shifting from outreach to activation by addressing barriers to action in real time What it takes to align product design, pharmacy strategy, and operational workflows to support long-term sustainability How organizations are translating insight into action to improve adherence, reduce avoidable utilization, and drive measurable ROI This episode offers a practical look at how leading plans are redefining performance in Medicare Advantage, and what it takes to ensure that strategy actually delivers results at scale. Panelist Bios: https://www.brightspotsinhealthcare.com/events/ma-strategy-session-what-actually-drives-long-term-viability/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide here: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/Episode-Guide-MA-Strategy-Session-04-09-26.docx.pdf  Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/04-09-26-KIS-MA-Strategy-Session_-What-Actually-Drives-Long-Term-Viability-Drips.docx.pdf  Resources:  Report: Stop Engaging, Start Activating; The New Architecture of Medicare Advantage Performance This companion report examines how health plans can close the gap between strategy and execution by focusing on what actually drives performance: whether members take action. Drawing on real-world implementation and emerging activation models, the report shows how identifying friction, understanding barriers, and guiding behavior in real time can improve adherence, reduce avoidable utilization, and strengthen outcomes across cost, quality, and experience. Inside, you'll find insights on: Identifying where outreach breaks down and why engagement alone fails to drive meaningful outcomes Understanding the root causes of non-adherence, including confusion, access barriers, competing priorities, and system design gaps Shifting from one-way communication to two-way, real-time conversations that surface and resolve barriers to action Designing activation models that guide members through next steps and increase completion of key actions Aligning engagement strategies with operational workflows to reduce friction and improve performance at scale Why moving from activity-based metrics to action-based outcomes is critical as financial pressure, regulatory changes, and member complexity increase The broader lesson is operational: the strongest Medicare Advantage models are not defined by how much outreach occurs, but by how effectively plans convert insight into action and ensure follow-through on the moments that matter most. To request your copy of the report, please contact show producer Jessica Tenzer at jtenzer@brightspotsventures.com. Thank You to Our Episode Partner, Drips: Drips helps health plans and providers drive meaningful member action through AI-powered, two-way communication at scale. By engaging members through familiar channels like text and phone, Drips enables real-time conversations that surface barriers, guide next steps, and improve adherence. Its approach shifts organizations from outreach to activation, helping close care gaps, reduce friction, and deliver more consistent performance across cost, quality, and experience. Learn more at drips.com. Schedule a Meeting with a Senior Leader at Drips: To explore how Drips can support your organization in moving from engagement to activation and improving member follow-through, reach out to show producer Jessica Tenzer at jtenzer@brightspotsventures.com to schedule a conversation with a member of the Drips leadership team.   About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

Brad Briner, North Carolina state treasurer, and Alex Mullineaux, Aledade regional market president, join Josh Israel, MD, and Sean Cavanaugh to discuss the state health plan's new preferred provider strategy. The goal of this approach is to improve patient health outcomes and reduce costs by connecting patients with clinicians that have a proven record of  high-quality, cost-effective care. Treasurer Briner and Alex share how this strategy came about, the benefits for patients and how North Carolina hopes to scale the plan in the future. In phase one, the state health plan approved partnerships with three networks to support this initiative, including Aledade.

Adjustable-rate mortgages (ARMs) are booming again, but Clark has a major warning: this "oldie but baddy" could be a financial time bomb. Clark breaks down why banks are pushing ARMs, who they actually work for (a narrow group indeed), and the "reset" risk that could cost you your home. Also, health insurance has become insanely expensive. Many Americans are skipping meals just to pay for healthcare. Clark discusses why catastrophic-only plans are a dangerous gamble and identifies the real culprit behind our skyrocketing medical bills.  Danger: Adjustable Rate Mortgages: Segment 1 Ask Clark: Segment 2 High Deductible Health Plans: Segment 3 Ask Clark: Segment 4 Mentioned on the show: Adjustable-Rate Mortgages Are Popular Again – Here's Why You Need To Be Careful NYTimes: A Third of Americans Have Cut Spending or Borrowed Money for Health Care NYTimes: New A.C.A. Plans Could Increase Family Deductibles to $31,000 What Is an HSA Account and How Does It Work? - Clark Howard How to Deal With Medical Debt - Clark Howard Will Mark Cuban's Prescription Company Really Save You Money? 10 Ways To Save on Prescription Drugs - Clark Howard Clark.com resources: Episode transcripts Community.Clark.com  /  Ask Clark Clark.com daily money newsletter Consumer Action Center Free Helpline: 636-492-5275 Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Gretchen Wagner, Associate Vice President - Risk Management, Humana, discusses how health plans are navigating cost pressures, workforce challenges, and rapid change by strengthening value-based partnerships and operational efficiency. She highlights the critical role of data interoperability, digital innovation, and analytics in improving member experience and long-term sustainability.

What would I actually do if I had to start over? No brand. No supplements to sell. No trends to chase. No social media theatrics. Just me, in 2026, building my health from the ground up. In this stripped-down solo episode, Darin lays out the foundational pillars he would implement immediately if he were starting fresh today. This is not about extremes. It's not about perfection. It's not about viral biohacks. It's about alignment. Infrastructure. Sovereignty. From water filtration and mineral balance to plant-dominant nutrition, strength training, sleep timing, nervous system regulation, purpose, and community, this is the grounded, research-backed roadmap to a Super Life. In This Episode Why reverse osmosis water filtration is step one The importance of remineralizing filtered water Eliminating PFAS, agrochemicals, and heavy metals from daily exposure Why non-toxic cookware is a non-negotiable A plant-dominant, whole-food strategy backed by longevity research Protein distribution and muscle protein synthesis science The truth about B12, the microbiome and supplementation Why algae-based omega-3s may be smarter than fish oil Resistance training as a longevity lever Why sleep timing consistency may matter more than duration Breathwork, meditation and nervous system training Community as biological medicine Limiting social media for mental health Purpose as a predictor of mortality risk Why you need a functional medical practitioner in your corner Nurturing creativity in a productivity-obsessed culture Chapters 00:00:00 – Welcome to SuperLife 00:00:33 – NAD supplement fraud & the importance of verification 00:02:23 – The question: If I started over in 2026, what would I do? 00:04:08 – No trends, no hype, just grounded science 00:05:15 – Step 1: Clean up your water 00:06:28 – PFAS, heavy metals & agrochemical contamination 00:07:59 – Reverse osmosis as the gold standard 00:08:35 – Re-mineralizing filtered water 00:09:40 – Mineral strategy & electrolyte balance 00:10:35 – Eliminating toxic cookware exposure 00:12:52 – Plant-dominant nutrition as foundational strategy 00:14:45 – Protein distribution & muscle protein synthesis 00:17:22 – Longevity Blue Zones & daily legumes 00:18:06 – B12 nuance & microbiome research 00:20:15 – Omega-3s: chia, flax & algae-based oils 00:22:39 – Strength training as the longevity switch 00:23:05 – Resistance training & reduced all-cause mortality 00:24:24 – Sleep timing consistency & mortality research 00:25:40 – Darkness, eye masks & sleep quality 00:26:20 – Nervous system regulation: meditation & somatic work 00:27:05 – Breathwork protocols & inflammation research 00:28:27 – Community as biological medicine 00:29:05 – Limiting social media & reducing depression risk 00:29:24 – Purpose & lower mortality association 00:30:12 – Functional medicine practitioners vs primary care 00:32:21 – Nurturing yourself in a productivity culture 00:34:22 – Closing: Build alignment, not perfection Thank You to Our Sponsors Our Place – Non-toxic cookware that keeps harmful chemicals out of your food. Get 10% off at fromourplace.com with code DARIN. Tru Niagen – Boost NAD+ levels for cellular health and longevity. Get 20% off with code Darin20 at truniagen.com. Key Takeaway If I were starting today, I wouldn't chase perfection. I would build alignment. Clean water. Plant-dominant nutrition. Strength. Sleep consistency. Nervous system regulation. Community. Purpose. And nurturing creativity. No hacks. No drama. Just infrastructure. That's how you build a Super Life. Bibliography/Sources British Journal of Sports Medicine. (2022). Muscle-strengthening activities and risk of cardiovascular disease, cancer, diabetes, and all-cause mortality: a systematic review and meta-analysis of prospective cohort studies. https://bjsm.bmj.com/content/56/13/757 Sleep. (2023). Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. https://academic.oup.com/sleep/article/47/2/zsad253/7280431 NIH Office of Dietary Supplements. (2024). Vitamin B12 Fact Sheet for Consumers. Provides guidance on necessary B12 sources for those on plant-based diets. https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/ Nutrients. (2019). Dietary Protein and Amino Acids in Vegetarian Diets—A Review. Authored by Mariotti and Gardner, examining protein adequacy in plant-based eating. https://www.mdpi.com/2072-6643/11/11/2661 Circulation. (2021). Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055656 Journal of Social and Clinical Psychology. (2018). No More FOMO: Limiting Social Media Decreases Loneliness and Depression. A randomized controlled trial on limiting social media use. https://guilfordjournals.com/doi/10.1521/jscp.2018.37.10.751 NHMRC. (2015). NHMRC Statement on Homeopathy. A comprehensive review of the evidence for the effectiveness of homeopathy. https://www.nhmrc.gov.au/about-us/publications/homeopathy