Podcasts about health plans

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/

"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

This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Howard Weiss, Vice President, Government Relations, EmblemHealth, discussing how payers are addressing trust in healthcare, balancing cost with member experience, and using AI to enhance care management, outreach, and workforce support without replacing human roles.In collaboration with Hippocratic AI.

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 episode, Sundar Srinivasan, President – Health Plan & Life Sciences, NTT DATA, discusses how payer organizations are moving from AI pilots to scaled deployments, focusing on high impact use cases, operational transformation, and the importance of trust, governance, and measurable ROI.This episode is sponsored by NTT DATA.

In this episode, Rob Duffy, Chief Technology Officer at HealthEdge, explores how modern cloud infrastructure and deeply integrated AI can help health plans manage rising complexity, reduce administrative costs, and scale operations. He shares why platform consolidation and embedded AI are critical to staying competitive and sustaining performance in a rapidly evolving healthcare landscape.This episode is sponsored by HealthEdge.

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.

Health Affairs Publishing's Jeff Byers welcomes Jeanne Lambrew of The Century Foundation to discuss her recent Forefront article exploring whether high deductibles and health spending accounts achieve their intended goals and how alternative approaches could improve healthcare affordability and access. On April 20th, join us for our upcoming Insider exclusive event exploring the evolution of the Medicare Advantage market featuring Sachin Jain, David Meyers, and Grace Mackleby.Also, check out our newest trend report focusing on the current state of prior authorization.Become an Insider today.Related Articles:Abandon—Don't Expand—High-Deductible Plans Linked To Spending Accounts (Health Affairs Forefront)

Send us Fan MailFood as medicine is moving from buzzword to real healthcare strategy.In this CareTalk episode, Spencer Pratt, Chief Growth Officer of NourishedRx, explains why nutrition is finally getting the policy, payer, and consumer support needed to impact chronic disease at scale.

Thomas Friedman, Executive Administrator of the State Health Plan, joins The SEANC View podcast to explain the Lantern program, a new preferred-provider and tiered-access model designed to lower costs for members while improving quality and access. We also discuss the recently approved preferred tiers by the State Health Plan Board of Trustees, efforts to protect rural access, early program results, and plans to negotiate better pricing with providers. The conversation also touches on contract changes, the push for transparency and competition, and how these steps aim to reduce premiums and preserve funds for employee raises and retiree benefits, while keeping participation voluntary and focused on member choice.

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 of Healthcare Americana, Christopher Habig talks with Colton Storla about why employer health plans keep getting more expensive and why most companies never get clear answers. Colton explains how the renewal process works and how hidden incentives, lack of transparency, and multiple middlemen continue to drive costs higher without improving care. The discussion also explores a better path forward, highlighting how employers can take control by using clear data, building direct relationships with providers, and adding options like direct primary care. This episode challenges business leaders to rethink how they buy healthcare, and shows how a simpler and more intentional approach can lower costs and improve care for employees.More on Freedom Healthworks & FreedomDoc HealthSubscribe at https://healthcareamericana.com/More on Colton Storla & North Risk PartnersFollow Healthcare Americana: Instagram & LinkedIN

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.

On this week's Empowering Plans Podcast, Attorneys Jen McCormick and Nick Bonds talk through a federal district court case out of Massachusetts that has put a preliminary pause on vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP) – and why the case has broader potential implications than it may initially appear. They break down what happened, why the court intervened, and what this means for self-funded health plans' obligations under the ACA's preventive care mandate.

Advocate Health plans to launch drone delivery service full 41 Thu, 26 Mar 2026 20:46:29 +0000 LDsu7tSeQ4Lh3wWbOVjIJddVcBVdccCE news Chicago All Local news Advocate Health plans to launch drone delivery service A dive into the top headlines in Chicago, delivering the news you need in 10 minutes or less multiple times a day from WBBM Newsradio. 2024 © 2021 Audacy, Inc. News False https://player.amperwavepodcasting.com

Advocate Health plans to launch drone delivery service full 41 Thu, 26 Mar 2026 20:46:29 +0000 LDsu7tSeQ4Lh3wWbOVjIJddVcBVdccCE news Chicago All Local news Advocate Health plans to launch drone delivery service A dive into the top headlines in Chicago, delivering the news you need in 10 minutes or less multiple times a day from WBBM Newsradio. 2024 © 2021 Audacy, Inc. News False https://player.amperwavepodcasting.com

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.

Raised in the high Himalayas, educated across 22 homes in multiple countries, and fluent in five languages , Simmi Singh was never going to follow a conventional path. She started out wanting to be a UN translator. A mentor stopped her and said: you have a voice of your own. That single conversation redirected her toward management consulting at Booz Allen and Ernst and Young, then entrepreneurship, then scaling the health vertical at Cognizant from a $10M fledgling unit into one of the company's most significant growth stories, then 15 years as a partner and global practice leader at Egon Zehnder placing boards and entire management teams for some of the most transformational companies in the world, then a secondment as Senior Advisor on Health Innovation to the U.S. Secretary of Health and Human Services, and most recently joining Blue Cross Blue Shield of Massachusetts as Chief People Officer and Executive Vice President. In this episode of Inspiring Women, host Laurie McGraw sits down with Simmi Singh to trace the through line of a brilliantly discontinuous career and pull out the lessons that only come from decades of doing it at the highest levels. They discuss: Growing up in the Himalayas surrounded by brilliant women with broken dreams, and how that shaped her hunger for agency at a time when no recipe existed for women like her Being one of 12 women in a college of 3,000 men and becoming the first female valedictorian in the institution's 100 year history What she learned scaling Cognizant's health vertical by giving away power before she had any, and why that was the most strategic move she made How she decoded great leadership by surrounding herself with human textbooks, including mentors under 30, even at 62 Why she believes women need sponsors far more than mentors, and what it actually means to be worthy of one The mistake she sees leaders making in healthcare AI right now, and the more audacious problems she believes women should be solving Simmi Singh is proof that intellectual homelessness, the restless feeling of living on the bridges between worlds, is not a liability. It is the rarest kind of preparation.

As health plans drop GLP-1s, what's next for patients?

The Cybercrime Wire, hosted by Scott Schober, provides boardroom and C-suite executives, CIOs, CSOs, CISOs, IT executives and cybersecurity professionals with a breaking news story we're following. If there's a cyberattack, hack, or data breach you should know about, then we're on it. Listen to the podcast daily and hear it every hour on WCYB. The Cybercrime Wire is brought to you Cybercrime Magazine, Page ONE for Cybersecurity at https://cybercrimemagazine.com. • For more breaking news, visit https://cybercrimewire.com

From HIMSS in Las Vegas, Michael chats with Dan McDonald, Co-Founder and CEO of 86Borders. Together, they discuss the impetus for starting 86Borders, what actually drives meaningful engagement with health plans, why members often struggle to connect with health plans, why human connection is important amid the automated outreach landscape, how Dan measures success for members and health plans, and much more.  Learn more about 86Borders at www.86borders.com. 

"I've got a patient in Washington state. He's traveling 100 miles every other week to receive an infusion. We moved this patient into the home and saved the plan $700,000 on this one patient...on gout treatment."Why are infusion drugs quietly destroying your health plan's budget?This week, my guest is Rob LaHayne, Co-Founder of Leap Health. We pull back the curtain on one of the most overlooked and expensive categories in healthcare: Specialty Infusion Care. Because these drugs are administered by a medical professional, they are billed through the medical plan under "J&Q Codes" - subjecting them to massive hospital markups and "buy-and-bill" margin games.In this episode, Rob explains how Leap Health is solving this by taking over the supply chain, procuring the drugs transparently without margin, and redirecting patients to their own homes or convenient infusion centers. We discuss how these J&Q codes are often the hidden culprit behind breached stop-loss deductibles and skyrocketing renewals, and why shifting the site of care is a win for both the employer's budget and the patient's quality of life.If you're a benefits consultant trying to figure out why your client's medical spend is out of control, or an employer tired of paying massive hospital markups for necessary medications, you need to understand J&Q codes.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 ParetoHealth.com/Spencer 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: The Hidden Problem of J&Q Codes (00:04:13) Rob's Background & The Genesis of Leap Health (00:08:24) Why Hospital "Buy-and-Bill" Margins Drive Up Costs (00:13:22) How Leap Health Provides Transparent, Zero-Margin Pricing (00:16:31) Shifting Site of Care: The Power of Home Infusions (00:23:44) Overcoming Headwinds: Patient Engagement & Plan Design (00:27:01) Taking Over the Supply Chain to Bypass the "BUCA" PBMs (00:32:51) Stop-Loss Renewals: Why Identifying J&Q Codes is Critical (00:37:04) Saving $700,000 on a Single Gout Patient (00:41:39) The Future: Unbundling the Health Plan & "Point Solution Fatigue" (00:45:41) Closing Thoughts: Why Consultants Must Request J&Q Code DataKey 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/

In this episode, Dawn Maroney, President of Alignment Health and CEO of Alignment Health Plan, joins the podcast to discuss how payer–provider relationships are evolving amid cost pressures and workforce shortages. She explores common gaps between strategy and execution, the importance of disciplined operational follow-through, and why healthy competition remains essential to driving innovation, value, and improved outcomes across the healthcare landscape.

Loneliness isn't just uncomfortable - it's costly. And the scariest part? Most of us are living it without calling it what it is.Dr. Jody talks with Ken Stern (*Healthy to 100*, *Century Lives*) about the loneliness epidemic and the link between social isolation and mortality risk - plus the practical shift that changes everything: building your social life with the same intention you'd bring to nutrition or exercise.They get into what “lonely” actually looks like in real life, why we're spending less time with friends than we did a generation ago, and how proximity, community design, and technology have quietly pulled us apart.This is a call back to connection - with a plan, not just a wish.Links & Resources:ABOUT CENTURY LIVES The Longevity Project: https://www.longevity-project.com/centurylivesHealthy to 100: Secrets from Countries Where Retirees Age Best: https://www.kiplinger.com/retirement/happy-retirement/healthy-to-100-secrets-from-countries-where-retirees-age-bestSocial Relationships and Mortality Risk: A Meta-analytic Review (PLoS Medicine, 2010): https://pmc.ncbi.nlm.nih.gov/articles/PMC2910600/Our Epidemic of Loneliness and Isolation: The U.S. Surgeon Generals Advisory (May 3, 2023): https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf Hosted on Acast. See acast.com/privacy for more information.

In this episode, Karen Walker Johnson, Chief Executive Officer of Clever Care Health Plan, discusses how culturally competent, value based care is reshaping Medicare Advantage. She shares insights on strengthening provider trust, investing in community based engagement, and advocating for quality metrics that recognize cultural competence to improve outcomes and affordability.

In this episode, Jeff Bak, President and Chief Executive Officer of Imagine360, shares how alternative health plan models and reference based pricing can lower employer costs while improving the member experience. He discusses narrowing networks, building provider trust, correcting broker misconceptions, and delivering guaranteed savings in a high pressure cost environment.

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

If you're a physician with at least 5 years of experience looking for a flexible, non-clinical, part-time medical-legal consulting role… ...Dr. Armin Feldman's Medical Legal Coaching program will guarantee to add $100K in additional income within 12 months without doing any expert witness work. Any doctor in any specialty can do this work. And if you don't reach that number, he'll work with you for free until you do, guaranteed. How can he make such a bold claim? It's simple, he gets results…  Dr. David exceeded his clinical income without sacrificing time in his full-time position. Dr. Anke retired from her practice while generating the same monthly consulting income.  And Dr. Elliott added meaningful consulting work without lowering his clinical income or job satisfaction. So, if you're a physician with 5+ years of experience and you want to find out exactly how to add $100K in additional consulting income in just 12 months, go to arminfeldman.com.                                                          =============== Get the FREE GUIDE to 10 Nonclinical Careers at nonclinicalphysicians.com/freeguide. Get a list of 70 nontraditional jobs at nonclinicalphysicians.com/70jobs.                                                                                                 =============== Pediatrician and former Navy physician Dr. Laura Clapper shares how a lifelong interest in data, AI, and systems thinking led her from clinical practice into senior leadership roles at major health plans and large self-insured employers. In this classic replay from 2022, she pulls back the curtain on the "black box" of payers and national accounts, explaining what medical directors and CMOs actually do inside insurers, employer health benefits teams, ACOs, and value-based care organizations. She walks through day-to-day work in utilization management, quality, pharmacy, innovation, and employer-facing roles, as well as the credentials and experience you need to be considered for these positions. Dr. Clapper also looks ahead to emerging opportunities in telehealth, data and EHR optimization, startups, women's health, and executive coaching. You'll find links mentioned in the episode at nonclinicalphysicians.com/health-plans-need-a-cmo/

In this episode, Rob Andrews, Chief Executive Officer of the Health Transformation Alliance, discusses how employers and providers can work more closely to improve value, reduce middleman costs, and drive better outcomes. He shares perspectives on payer competition, transparency, GLP 1 cost pressures, and how technology and personalized medicine may reshape health plans in the years ahead.

In this episode, Patrick Gilligan, President and CEO of Point32Health, shares how the New England based nonprofit is confronting rising medical and pharmacy costs while staying focused on members and employers as its true shareholders. He discusses the affordability crisis, aligning incentives with providers, and why redesigning care around the patient experience is essential to lowering costs and improving outcomes.