Podcasts about payers

Payers are increasingly using AI to scan claims, flag anomalies, and trigger denials or audits automatically—often without transparency and long before anyone on the hospital side understands what happened. As these systems accelerate, hospitals face growing exposure, especially when documentation, data flow, and internal AI tools aren't aligned with how payer models interpret clinical and financial information. This session unpacks the mechanics behind automated decision-making, why even accurate claims can be flagged, and how missing audit trails or inconsistent documentation can undermine appeals. 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 senior Medicaid health plan leaders to explore how organizations are rethinking communication strategies in response to redetermination and upcoming work requirements. The conversation dives into how plans are combining cultural competency, behavioral insights, and data-driven personalization to strengthen member connections, improve retention, and support equity-focused outcomes.  Real-world examples and best practices provide actionable guidance for health plans navigating these sweeping policy changes. Our guests include: Molly Whittle, Vice President, Medicaid Fiscal Strategy, WellSense Health Plan Terrie Hottle, Director of Product Implementation and Deployment, CareSource Abner Mason, Chief Strategy and Transformation Officer, GroundGame.Health Together, they explore: How Medicaid health plans are adapting communication priorities in response to redetermination and evolving work requirements. Innovative strategies to reach and retain hard-to-contact populations through culturally responsive and personalized engagement. How to transform compliance-driven outreach into trust-based, member-focused communication that supports long-term retention and health outcomes. Practical examples of leveraging behavioral insights, life coaching, and personalized messaging to improve engagement, close care gaps, and support members' social and health needs. Panelist Bios: https://www.brightspotsinhealthcare.com/events/medicaids-communication-wake-up-call-how-redetermination-and-work-requirements-are-forcing-a-new-member-engagement-playbook/ 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/2025/12/Episode_Guide_121125.docx.pdf Download the Key Insights Summary: Find key insights from the discussion: https://www.brightspotsinhealthcare.com/wp-content/uploads/2025/12/Key-Takeaways-Medicaids-Communication-Wake-Up-Call.docx.pdf  Resources:  HMA's new report on the CareSource JobConnect Program: https://www.healthmanagement.com/insights/briefs-reports/the-impact-of-the-caresource-jobconnect-program-a-benefit-cost-and-return-on-investment-roi-analysisthe-impact-of-the-caresource-jobconnect-program/   Report: How Medicaid Payers can Prepare for New Work Requirements Coming in Early 2027   The Reconciliation Act of 2025, signed on July 4th, introduces new Medicaid work requirements. Beginning in January 2027, states will be required to verify at both application and renewal that members of the Affordable Care Act (ACA) expansion group meet these requirements. A few highlights that stood out: The disruption will be significant: The CBO projects 10 million people could become uninsured by 2034 due to work requirements. Most losses aren't intentional: In Arkansas, 18,000 individuals lost coverage in seven months—largely because the reporting system was too complex to navigate. Waiting is the biggest risk: The report states plainly: "Payers need to act now… the biggest issue is waiting too long to engage." Five practical steps to start today: From identifying high-risk members early and communicating before the state does, to automating exemption processes and enabling consent-based data sharing. To request your copy, email show producer, Vekonda Luangaphay at vluangaphay@brightspotsventures.com Thank You to Our Episode Partner, GroundGame Health: GroundGame is a human impact company that helps Medicaid members stay covered and get care by removing the real-world barriers that stand in their way. They do this through human connection. Community-based engagement. Meeting members where they are and creating a culturally tailored experience at the level of the individual. Their Right Touch model blends personalized outreach with deep relationships across community organizations to close quality gaps, surface hidden needs, and actually solve them.  Learn more at https://www.groundgame.health/   Schedule a Meeting with Abner Mason, Chief Strategy & Transformation Officer at GroundGame.Health. To explore how GroundGame.Health can help your organization reduce churn, build trust, and keep Medicaid members connected to care through human-to-human, community-based engagement, reach out to show producer, Vekonda Luangaphay, vluangaphay@brightspotsventures.com to schedule a meeting with Abner Mason, Chief Strategy & Transformation Officer, GroundGame.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.  

This episode, from our November National Conference, explores one of healthcare's most persistent challenges: how hospitals and health plans can move from operating at cross-purposes to truly rowing in the same direction. Our guests are Danielle Lloyd, SVP of Private Market Innovations and Quality Initiatives, AHIP and Molly Smith, Group VP for Public Policy, American Hospital Association. Led by moderator Stephan Rubin from Optum, Danielle and Molly dig into the misconceptions that providers and payers often hold about each other and discuss how better data transparency, shared incentives, and policy alignment — including recent CMS rules such as 0057F — can help bridge long-standing divides. The 3 examine the future of prior authorization, the promise and limits of interoperability initiatives like TEFCA and the CMS Aligned Network, and why value-based care still struggles to scale despite years of policy focus. Finally, they look ahead to the role of AI, automation, and emerging data standards in reshaping care delivery and payment, and ask what real payer-provider collaboration must look like to deliver a more seamless, efficient, and patient-centered healthcare system.

David Busch dissects Powell's comments at the post-rate-decision press conference and looks at how the Fed's makeup could change with a new Chair. Looking at tech, he says lower rates will be a tailwind for the sector, and he's still a “firm believer.” He would stay invested in large-caps, but says to offset it with dividend payers.======== Schwab Network ========Empowering every investor and trader, every market day.Options involve risks and are not suitable for all investors. Before trading, read the Options Disclosure Document. http://bit.ly/2v9tH6DSubscribe to the Market Minute newsletter - https://schwabnetwork.com/subscribeDownload the iOS app - https://apps.apple.com/us/app/schwab-network/id1460719185Download the Amazon Fire Tv App - https://www.amazon.com/TD-Ameritrade-Network/dp/B07KRD76C7Watch on Sling - https://watch.sling.com/1/asset/191928615bd8d47686f94682aefaa007/watchWatch on Vizio - https://www.vizio.com/en/watchfreeplus-exploreWatch on DistroTV - https://www.distro.tv/live/schwab-network/Follow us on X – https://twitter.com/schwabnetworkFollow us on Facebook – https://www.facebook.com/schwabnetworkFollow us on LinkedIn - https://www.linkedin.com/company/schwab-network/About Schwab Network - https://schwabnetwork.com/about

Payer algorithms now drive denials, audits, and prior authorization decisions before a human ever reviews the case. This episode breaks down how automated payer models impact hospital revenue—and what leaders must do to strengthen oversight, governance, and defensibility.Brought to you by www.infinx.com

In this episode, host Sandy Vance sits down with someone who has been shaping the future of digital health long before AI became the headline Mike Serbinis, Founder and CEO of League.League was built on a simple but ambitious idea: if companies like Netflix can instantly understand what we need next, why can't healthcare do the same? Now, more than a decade into transforming the way people access and experience care, Mike joins Sandy to talk about how his team is helping organizations deliver truly personalized healthcare at scale.Together, they explore Mike's path into the world of AI, the early sparks that led to League's creation, and the lessons learned from 11 years of reimagining patient and member journeys. They delve into how League works alongside existing EHRs and health systems, not replacing anything, but weaving intelligence and interoperability through the cracks that slow down care.It's a thoughtful, future-forward discussion with one of the industry's most seasoned innovators—and a must-listen for anyone curious about where healthcare AI is truly headed.In this episode, they talk about:Mike's journey into AI and the origin story of LeagueHow League integrates with EHRs and other core health technologiesLessons from 11 years in healthcare—and why speed and scale matter more than everIf Netflix can recommend your next show, why can't healthcare do the sameReducing AI hallucinations and improving reliability for healthcare organizationsHow League delivers coverage, oversight, service, and increased productivityWhat different countries can teach us about healthcare modelsWhy we're entering “pilot season” for AI in healthcareA Little About Mike:Mike Serbinis is widely recognized as an innovative leader and serial entrepreneur who has built transformative technology platforms across many industries. Serbinis founded and helped build Kobo, Critical Path, DocSpace, and now League. Founded in 2014, League is a platform technology company powering next-generation healthcare consumer experiences (CX). Payers, providers and consumer health partners build on the League platform to accelerate their digital transformation and deliver high-engagement, personalized healthcare experiences. Millions of people use and love solutions powered by League to access, navigate and pay for care.Serbinis is also Chair of the Board of Directors for the Perimeter Institute for Theoretical Physics, the world's leading center for scientific research in foundational theoretical physics. He is a founding board member of the Vector Institute for Artificial Intelligence, an institution co-founded by Nobel Prize winner Geoffrey Hinton.

Kathy Roe, Managing Attorney, Health Law Consultancy, speaks with Dorothy DeAngelis, Senior Managing Director, Ankura Consulting, and Richelle Marting, Attorney, Marting Law, about the latest trends and developments related to prior authorization, from both the payer and provider angles. They discuss what prior authorization is and why it engenders scrutiny, approaches to easing prior authorization's administrative burden, the responsible use of artificial intelligence, the impact of the new WISeR Model, and what to expect in 2026. From AHLA's Payers, Plans, and Managed Care Practice Group.Watch this episode: https://www.youtube.com/watch?v=k2Oi2HnXZOELearn more about AHLA's Payers, Plans, and Managed Care Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/payers-plans-and-managed-care Learn more about AHLA's January 8, 2026 webinar on prior authorization: https://educate.americanhealthlaw.org/local/catalog/view/product.php?productid=1705Essential Legal Updates, Now in Audio AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Premium members. Get all your health law news from the major media outlets on this podcast! To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org/dailypodcast. Stay At the Forefront of Health Legal Education Learn more about AHLA and the educational resources available to the health law community at https://www.americanhealthlaw.org/.

For many of us, payer negotiations feel distant—something handled “somewhere up the chain,” far removed from the day-to-day work of helping patients. But here's the truth: nothing shapes our practice more than the reimbursement rates and contracts negotiated on our behalf.Reimbursement determines who we can serve, how much time we can spend with them, what services we can sustainably provide, and ultimately whether our practice can survive/thrive. And while therapists may assume this is a job for billing or leadership, every OT and PT needs a foundational understanding of how payer negotiations work.In this one-hour webinar, we're joined by two leaders with deep, real-world expertise:John Hutchinson, MBA — Co-founder of CARE Counseling (with his wife, Dr. Andrea Hutchinson), a practice acquired by UnitedHealth in 2024. John brings firsthand experience navigating growth, payer relationships, and the business realities that shape modern care.Chad Herzog — VP of Operations at Aroris, an organization whose mission is simple and powerful: help healthcare providers get paid what they're worth so they can focus on what matters most—helping people and improving patients' lives.Together, they'll break down what every clinician should know about payer negotiations, how reimbursement impacts clinical practice, and what therapists can do to advocate for sustainable care models.See full course details here: https://otpotential.com/ceu-podcast-courses/negotiating-with-payersSee all OT CEU courses here: https://otpotential.com/ceu-podcast-coursesSupport the show by using the OTPOTENTIAL Medbridge Code: https://otpotential.com/blog/promo-code-for-medbridgeLearn about Aroris and payer contract negotiation: https://www.arorishealth.com/contract-negotiation/Try 2 free OT Potential courses here: https://otpotential.com/free-ot-ceusSupport the show

About Ben Forrest:Ben Forrest is the CEO of Olio, a care coordination technology company focused on improving collaboration among payers, health systems, and post-acute providers for the most complex patients. With a 14-year background in the medical device industry, Ben saw firsthand how fragmented workflows and siloed care settings created barriers to quality and efficiency—an insight that led him to build Olio. Under his leadership, the platform now enables real-time engagement across hundreds of care sites, helping organizations reduce administrative burden, improve outcomes, and better manage medical spend. Ben is dedicated to bringing modern software, thoughtful workflows, and emerging AI capabilities to one of healthcare's most persistent challenges: truly connected care.Things You'll Learn:Care coordination is deeply fragmented, especially for complex patients moving across hospitals, skilled nursing, home health, behavioral health, and other community settings.Olio's platform connects payers, health systems, and post-acute providers in one shared workflow, enabling daily engagement and reducing administrative burden.Better downstream provider engagement directly improves outcomes and lowers costs, especially in Medicare Advantage, Medicaid, ACO, and bundled payment environments.Scaling coordination statewide requires more than EMRs; it requires workflow technology that ensures transparency, accountability, and consistent communication across 100+ care sites.Economics drive engagement: care coordination intensity increases where organizations hold risk or face pressure to manage total medical spend.The future of AI in care coordination is still emerging, and smart companies will focus on doing one operational problem exceptionally well before expanding.Payers will face mounting pressure to reduce medical spend, making true care coordination, not just better authorization practices, a strategic necessity.Olio was born from the realization that healthcare excels at delivering care in silos but struggles when patients move between settings, especially under value-based models.Resources:Connect with and follow Ben Forrest on LinkedIn.Follow Olio on LinkedIn and discover their website. 

In this episode of Disruption/Interruption, host KJ interviews Matt Seefeld, CEO at MedEvolve, about the chaos and inefficiencies in the US healthcare revenue cycle. Matt shares how generative AI and a focus on human accountability can help providers achieve "zero touch" claims, reduce waste, and improve access to care, especially for small and rural hospitals. Four Key Takeaways: The Real Cost of Healthcare is Obscured (3:00)The US healthcare system lacks alignment between consumers, providers, and payers, making it nearly impossible to know the true cost of care. Administrative Waste is a Billion-Dollar Problem (04:01)Most providers touch claims multiple times, with 63% of those touches being wasted effort due to system inefficiencies and payer games. AI is a Tool, Not a Cure-All (31:50)While AI can automate and improve processes, more than half of claim errors still require human intervention, and technology alone won't solve systemic issues. Access to Care is Shrinking for Many Americans (24:00, 27:00)As costs rise and reimbursements fall, small and rural hospitals are closing, and more Americans are forced to seek care through emergency services or go without. Quote of the Show (31:50):"More than half—53%—of the errors that we see that humans have to get involved with come from AI solutions, so they're not smart enough yet." - Matt Seefeld Join our Anti-PR newsletter where we’re keeping a watchful and clever eye on PR trends, PR fails, and interesting news in tech so you don't have to. You're welcome. Want PR that actually matters? Get 30 minutes of expert advice in a fast-paced, zero-nonsense session from Karla Jo Helms, a veteran Crisis PR and Anti-PR Strategist who knows how to tell your story in the best possible light and get the exposure you need to disrupt your industry. Click here to book your call: https://info.jotopr.com/free-anti-pr-eval Ways to connect with Matt Seefeld: LinkedIn: https://www.linkedin.com/in/matt-seefeld-521319/ Company Website: https://medevolve.com How to get more Disruption/Interruption: Amazon Music - https://music.amazon.com/podcasts/eccda84d-4d5b-4c52-ba54-7fd8af3cbe87/disruption-interruption Apple Podcast - https://podcasts.apple.com/us/podcast/disruption-interruption/id1581985755 Spotify - https://open.spotify.com/show/6yGSwcSp8J354awJkCmJlDSee omnystudio.com/listener for privacy information.

In this episode, Rick Harbit of Blue Cross Blue Shield of North Carolina and Bob Tavernier of Quest Analytics discuss how payers are navigating financial pressures, advancing network adequacy 2.0, and using data and network intelligence to drive long-term success. This episode is sponsored by Quest Analytics.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the complexities surrounding Additional Documentation Requests (ADRs) from Medicare Advantage plans. They emphasize the importance of compliance, the legal obligations of providers, and the potential consequences of ignoring these requests. The conversation also touches on the ongoing investigations into Medicare Advantage fraud and the need for providers to navigate these challenges carefully while maintaining good relationships with payers.TakeawaysResponding to ADRs is a legal obligation for providers.Ignoring ADRs can lead to serious consequences.Providers should negotiate terms if requests are unreasonable.HIPAA allows disclosures for payment-related activities.Payers are permitted to request specific documentation for audits.Maintaining a good relationship with payers is crucial.Providers can ask for clarification on ADR requests.Documentation requests should be fulfilled within narrow parameters.The OIG investigates Medicare Advantage plans for fraud.Providers should utilize electronic means for submitting documentation.

Kathy Roe, Managing Attorney, Health Law Consultancy, speaks with Annie Shieh and Judith Waltz, Partner, Foley & Lardner, about the impact of recent changes to Medicare Advantage (MA) compliance on plans and providers. They discuss what plans and providers are responsible for when it comes to MA compliance, the current MA landscape, MA compliance changes from a plans perspective (including the current Administration and the 2026 Final Rule), MA compliance changes from a provider perspective (including the 60-day refund rule and recent litigation), and administrative enforcement actions. Annie and Judith spoke about this topic at AHLA's 2025 Annual Meeting in San Diego, CA. From AHLA's Payers, Plans, and Managed Care Practice Group.Watch this episode: https://www.youtube.com/watch?v=vjRzb0UiNuYLearn more about the AHLA 2025 Annual Meeting that took place in San Diego, CA: https://www.americanhealthlaw.org/annualmeeting Learn more about AHLA's 2025 Annual Meeting eProgram: https://educate.americanhealthlaw.org/local/catalog/view/product.php?productid=1472 Learn more about AHLA's Payers, Plans, and Managed Care Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/payers-plans-and-managed-careEssential Legal Updates, Now in Audio AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Premium members. Get all your health law news from the major media outlets on this podcast! To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org/dailypodcast. Stay At the Forefront of Health Legal Education Learn more about AHLA and the educational resources available to the health law community at https://www.americanhealthlaw.org/.

In this episode, hosts Payal Nanavati and Megan Beaver speak with Linda Malek and Matthew F. Ferraro about the latest federal and state developments in artificial intelligence (AI) policy affecting health care. The conversation covers the Trump administration's AI action plan and Executive Orders on AI, new industry-specific and comprehensive state laws, and enforcement trends, with a focus on how these changes impact the health care industry. This podcast episode features the following speakers: Linda Malek is a partner in Crowell & Moring's New York office, and is a member of our Health Care, Privacy & Cybersecurity, and Life Sciences practices. She advises a broad array of health care and life sciences clients on compliance with federal, state, and international law governing clinical research, data privacy, cybersecurity, and fraud and abuse. Linda also counsels digital health and biotech companies developing AI tools. She navigates the complex and evolving federal and state regulatory landscape, balancing the priorities of oversight authorities with issues related to data privacy and security as well as business goals. Matthew F. Ferraro is a partner in Crowell & Moring's Washington, D.C. office and is a member of our Privacy and Cybersecurity Group, where he advises leading organizations on high-impact matters involving artificial intelligence (AI), cybersecurity, and emerging technologies. He previously served as Senior Counselor for Cybersecurity and Emerging Technology to the Secretary of Homeland Security, helping shape national AI and cyber policy and helping to establish and run the Artificial Intelligence Safety and Security Board. Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

In this podcast, Vishal Iyengar, Principal at Deloitte, and Mike Stimpson, CTO at enGen, discuss the strategic value that AI Agents can unlock to transform healthcare outcomes, operations, and stakeholder experience. They explore the practical use of Agents to answer foundational questions and address requests for information from members and providers that routinely cause abrasion, confusion, and administrative overhead. Vishal and Mike also highlight what is needed for these Agentic solutions to be deployed and adopted for organizations to achieve the expected results – data integrity, cyber security, governance and compliance, and targeted talent. In this episode, they talk about:How AI has grown from traditional machine learning to GenAI to today's Agentic capabilitiesA simple 3-layer setup: domain agents (specialists), reasoning agents (the organizer), and an enterprise model (the professor)Real-life use cases, like “Is this service covered?” or “Why was my claim denied?”What enGen focuses on to succeed: fresh thinking, outside perspectives, curiosity, a willingness to rebuild, and the right teamenGen's vision is transforming healthcare by supporting members on their whole health journey and creating seamless experiencesSmarter data with AI-enabled APIs that make information easy to use across different needsWhy speed matters but not at the cost of security and trustA Little About Vishal and Mike:Vishal brings over 2 decades of technology and business transformation experience in the Health Care industry. He specializes in the infusion and adoption of new-age technologies into today's complex ecosystem that enables Payers and Providers to manage, deliver, and reimburse for care. Most recently, he has focused on real-world use of AI to augment technologists, operators, and business experts to meaningfully change how Health Care systems support their stakeholders. Mike comes to enGen with over 25 years of experience in technology and operations within both the health care and financial services industries. For the past 20 years, he consulted with health care organizations in transforming their businesses through technology-enabled solutions and large-scale business transformations specifically focused in core administration and service transformation . Mike leads enGen's person-centric solutions focused on digital, clinical and provider transformation that puts the member and patient at the center of their healthcare journey.

Hour 4 of the Monday Bob Rose Show on the federal government shutdown's impact on Florida and the military, and a critical get-out-the-vote campaign to protect Gainesville Regional Utilities customers from raiding by the radical left Gainesville City Commission. Plus the morning's biggest stories for 10-06-25.

In the second of a two part series on the impact of administrative law in the health care industry, hosts Payal Nanavati and Savanna Williams talk to Dan Wolff about the practicalities of seeking judicial review to challenge agency actions, the impact of Loper Bright, and the major questions doctrine. This podcast episode features the following speakers: Dan Wolff is a partner in Crowell & Moring's Washington, D.C. office and leads the firm's administrative law litigation practice. Dan's practice encompasses litigation arising under the Administrative Procedure Act or as a result of government enforcement actions or commercial disputes. He regularly appears in federal district and appellate courts around the country and before a host of agency tribunals, and counsels clients on their rights and obligations under a number of federal regulatory programs. Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

In this episode, Scott Becker reviews year-to-date stock performance for major payers.

In this episode, Scott Becker reviews year-to-date stock performance for major payers.

In this episode, Scott Becker reviews year-to-date stock performance for major payers.

In the first of a two part series on the impact of administrative law in the health care industry, hosts Payal Nanavati and Savanna Williams talk to Dan Wolff about how administrative law manifests itself on a day-to-day basis and how to interact with agency officials in a heavily regulated industry. This podcast episode features the following speakers: Dan Wolff is a partner in Crowell & Moring's Washington, D.C. office and leads the firm's administrative law litigation practice. Dan's practice encompasses litigation arising under the Administrative Procedure Act or as a result of government enforcement actions or commercial disputes. He regularly appears in federal district and appellate courts around the country and before a host of agency tribunals, and counsels clients on their rights and obligations under a number of federal regulatory programs. Payers, Providers, and Patients – Oh My! is Crowell & Moring's health care podcast, discussing legal and regulatory issues that affect health care entities' in-house counsel, executives, and investors.

Learn how AI is already working to close the member engagement gap, transforming intent into impact, personalizing care at scale, and creating the connected experiences members now expect. Leaders from Highmark Health, Ovatient, Cigna, and League share proven strategies, bright spots, and lessons learned in applying AI to drive measurable outcomes, lower costs, and improve the member experience. In this episode, you'll learn: How AI is turning digital intent into meaningful health actions Real-world examples of personalized engagement that improved outcomes and savings Why the future of digital health is shifting from mobile-first to AI-first What it takes to build a scalable, purpose-built AI platform for healthcare How payers and providers can unite around the member with AI-powered engagement Panelists: Ian Blunt, VP Advanced Analytics, Highmark Health Michael Dalton, Founder & CEO, Ovatient Charles DeShazer, MD, Former Chief Quality Officer, The Cigna Group         Andrew Dubowec, Chief Growth Officer, League       Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download here. Resources Here's the podcast Eric Glazer referenced during the show: Acquired/ACQ2 Episode: How is AI Different Than Other Technology Waves? (With Bret Taylor and Clay Bavor), August 18, 2025 Thank you to League for supporting this episode. League is the leading healthcare consumer experience platform, reaching more than 40 million people around the world and delivering the highest level of personalization in the industry. Payers, providers, and consumer health partners build on League's platform to deliver high-engagement healthcare solutions proven to improve health outcomes. Learn more at www.league.com. How to Engage: Chat with Us: Share your thoughts with Producer Jessica Tenzer at jtenzer@brightspotsventures.com  

In anticipation of the 2025 ASHP Conference for Pharmacy Leaders, ASHP is hosting a series of podcast episodes. Join our host, Cynthia Von Heeringen, senior education director at ASHP, as she interviews Venessa Goodnow, assistant vice president and chief pharmacy officer at Jackson Health System, as she discusses her upcoming sessions, Tackling the Revenue Cycle Challenge: Processes, Politics, Payers, and Patients.  The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Payers have committed to streamlining the prior authorization process, but will this make a difference in the revenue cycle? 

This season on Current Trends for Payers, we're highlighting guest experts in emerging technologies and operational strategies that health plans need to stay agile and competitive.We'll dig into what's working and what's coming next, with candid conversations from executives, product, and business leaders.Whether you're focused on risk adjustment, member engagement, or core admin, this season offers a clear look at how forward-thinking health plans are staying ahead.Subscribe to Current Trends for Payers on Apple, Spotify, and all major podcast apps to be the first to know when the next episode drops. 

Learn more about the Sequoia Project's CMS0057F Implementation checklist here- https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/  Michael welcomes back (Episode 174, Oct 2024) the co-chairs of the Sequoia Project's Payer to Payer API Implementation Workgroup, Nancy Beavin (Medica) and Bob Oakley (Evernorth), to discuss their new work product, a downloadable tool designed to help payers assess their readiness for compliance with the payer-to-payer components of CMS-0057-F. Along with the workgroup's project manager, Jim Adamson (Point of Care Partners), Nancy and Bob offer updates on the workgroup meetings, the origin of the checklist, and their plans for the future.   

Sponsored by Eyecon by RxSafe Guests: Joe Moose, PharmD (Moose Pharmacy) & Joe Williams, RPh (APEX Pharmacy Consulting) Podcast Series: LTC Pharmacy at Home: Redefining Independent Pharmacy Growth Episode Summary: In Part 3 of our Eyecon by RxSafe-sponsored series, we dive deep into how independently owned pharmacies can scale their business and impact patient lives by expanding into Long-Term Care at Home (LTC-at-Home). Joined by industry leaders Joe Moose of Moose Pharmacy and Joe Williams of APEX Pharmacy Consulting, we break down the Top 5 ways community pharmacies can lead the LTC-at-Home movement — offering actionable strategies to support medically complex patients, differentiate services, and integrate more deeply into the care team. This episode delivers a blueprint for pharmacies ready to go beyond traditional retail and build recurring revenue with purpose-driven patient care.

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We keep saying we want value-based care. But why do most models still fall short?In this episode, I sat down with Hamad Husainy, a clinician-turned-HealthTech leader at PointClickCare, to explore the hidden reasons value-based systems collapse—and what it actually takes to build one that works.We unpacked why data timing, team collaboration, and cultural transformation—not just more tech—are essential to seamless care. Hamad brought real stories from the field and shared where most leaders miss the mark when scaling their care ecosystems.The question isn't: do you have the data? It's: are you using it at the right time, in the right hands, to prevent the wrong outcomes?If you've ever felt like your solution should drive better results but doesn't get traction, this is your inside look at what investors, payers, and care leaders want next.

Hour of destiny daily devotional is a daily spiritual food for inspiration, impartation, guidance, and nourishment for Gods children. It is one of Gods ways of speaking to His children daily about their lives, family, and job.Host - Rev Mike EniolaConnect with us on our official channels.https://www.instagram.com/hourofdestinyTiktok- tiktok.com/@hour.of.destinyTelegram - https://t.me/hourofdestiny_dailyYouTube - https://youtube.com/@greenculturemediaSpotify Subscription https://podcasters.spotify.com/pod/show/hourofdestiny/subscribePLEASE LIKE, COMMENT, AND SHARE WITH YOUR FRIENDS AND FAMILY, GOD BLESS YOU.

Hour of destiny daily devotional is a daily spiritual food for inspiration, impartation, guidance, and nourishment for Gods children. It is one of Gods ways of speaking to His children daily about their lives, family, and job.Host - Rev Mike EniolaConnect with us on our official channels.https://www.instagram.com/hourofdestinyTiktok- tiktok.com/@hour.of.destinyTelegram - https://t.me/hourofdestiny_dailyYouTube - https://youtube.com/@greenculturemediaSpotify Subscription https://podcasters.spotify.com/pod/show/hourofdestiny/subscribePLEASE LIKE, COMMENT, AND SHARE WITH YOUR FRIENDS AND FAMILY, GOD BLESS YOU.

A question I'm often asked is, “Why do physicians charge so much?” There's no easy answer, as there isn't a fixed price list for medical services. Due to the healthcare system's complexity and the absence of set prices, providers are largely free to charge what the market will bear. However, can there be consequences for […] The post Can physicians charge whatever they want to Insurance Payers? appeared first on Terry Fletcher Consulting, Inc..

A question I'm often asked is, “Why do physicians charge so much?” There's no easy answer, as there isn't a fixed price list for medical services. Due to the healthcare system's complexity and the absence of set prices, providers are largely free to charge what the market will bear. However, can there be consequences for […] The post Can physicians charge whatever they want to Insurance Payers? appeared first on Terry Fletcher Consulting, Inc..

Elizabeth New (Hovde) of the Washington Policy Center says Washington's efforts to expand public health care are backfiring. She criticizes SB 5083 and HB 1392 for shifting costs to private payers and argues for a more competitive, multi-payer system. https://www.clarkcountytoday.com/opinion/opinion-more-payers-not-fewer-needed-in-health-care/ #Opinion #HealthCareCosts #ElizabethNew #ElizabethHovde #WashingtonPolicyCenter #SB5083 #HB1392 #InsurancePremiums #Medicaid #UniversalCare #CostShifting

In this episode of Quality Matters, Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, joins host Andy Reynolds to explore the rise of—and the relationship between—two trends in behavioral health: measurement-informed care and peer support. Julie breaks down how these strategies improve outcomes, engage patients and close gaps in access and accountability.Listen to this episode to discover: How Measurement-Informed Care Engages Patients: Learn how measurement-informed care supports patient engagement and treatment adjustments in behavioral health. We explore the importance of ongoing assessment, tracking symptoms and outcomes and empowering patients to understand their journey. Friction and Fuel for New Approaches: We unpack historical challenges to measurement-informed care. These include the omission of behavioral health from key legislation and the costs of EHR integration. We also discuss how NCQA depression measures and person-centered outcome measures relate to measurement-informed care.Benefitting From Peers' Lived Experience: We discuss how people who have been through mental health or substance use treatment can provide non-clinical support to help others navigate the system, subvert stigma and fill care gaps.This discussion is a valuable resource for providers, policy leaders and others who care about improving access, engagement and outcomes in behavioral health.Key Quote:"Measurement-based care has been around for a long time and only 20% of behavioral health providers adopted it.Traditionally, these are trained clinicians. And in the course of a session with a patient, probably in the back of their mind, they're evaluating whether an individual is improving or has worsening function.Payers would like some numerical or standardized way of seeing the clinician's clinical judgment. Measurement-informed care offers that."Julie SeibertTime Stamps:(03:04) Who's Behind Measurement-Informed Care(05:08) HEDIS and Measurement-Informed Care(08:13) Person-Centered Outcome Measures in Behavioral Health(09:58) The Power of Peer Support Specialists(11:57) Addressing Workforce Shortages(15:37) Why States Support Peer Support(16:32) Peer Support's Connection to Measurement-Informed CareDive Deeper:Blog: How Peer Support Can Help Close the Gaps in Behavioral HealthcareBlog: Measurement-Based Care in Behavioral HealthQuality Matters Episode 13: Getting Clear About Behavioral HealthConnect with Julie Seibert

Who is responsible for paying hospital bills?  Travis Gentry, CEO of Hyve Health joined me to discuss who the payers are and the concerns with holding payers accountable.

Show Notes: Ami Parekh discusses the business model and services of Included Health, a company that provides personalized healthcare. Included Health partners with self-insured employers and health plans to improve the way working Americans and their families receive healthcare.  Included Health Services  About a third of Fortune, 100 companies, and 10 million Americans have access to Included Health's services. The company focuses on providing access answers and advocacy as people engage in the healthcare system. The company has nearly 3000 people, including 1000 clinicians across the country, including primary care doctors, specialists, nurse practitioners, and therapists. Additionally, hundreds of care advocates help patients understand the ins and outs of the healthcare system. Many patients come to Included Health because they can't get access to primary care and behavioral health, which can take one to two months across most of the country. The company aims to address this supply problem. Navigating the Healthcare System Ami talks about the role of Included Health in helping patients navigate the healthcare system, focusing on personalized and best-for-the-patient approach. She explains how it can help patients navigate their insurance and coverage options. She also covers the use of data and data science to match patients with the highest quality healthcare professionals for specific requirements, such as orthopedic surgeons or specialists. Ami emphasizes that Included Health are not plans or payers, but providers who work with a wide field of providers, and their job is to help patients achieve the best outcomes within the current healthcare system. Accessing Quality Data in Healthcare The conversation turns to the concept of quality data in healthcare, how it is crucial to consider the quality of care and the likelihood of repeat surgeries, and the issue of inappropriate prescribing behavior, such as the use of opiates and benzodiazepines, which can be addictive. Ami explains how Included Health accesses and uses data, and how collected sanctioned data can help determine if a provider is safe for family members to see. Ami emphasizes that data is never perfect, and in the worst case scenario, patients can consult with clinicians to find the right doctor. The data can help inform conversations about who to see, and Included Health offers support in finding publicly available data sources and the right practitioner. She highlights the need for better data and collaboration between healthcare providers and patients to improve patient outcomes and overall healthcare quality. Improving Healthcare Pricing and Cost Employers typically pay for Included Health as a layer on top of their health plan, as they want their employees to be healthy, productive, and engaged members of their workforce. They also want healthcare costs to remain low so that they can pay their employees a living wage and invest in other benefits. Healthcare is often the number two cost after supplies in America, and employers want their employees to be healthy, productive, and engaged. Included Health offers a way to give healthy days back to employees by reducing the number of days they are unable to be healthy due to mental or physical health reasons. This results in increased productivity, better work performance, and overall cost savings. There are two dimensions to using included health services: first-time care and saving time. First, employees get the right care the first time, which can lead to cost savings. Second, health plans are incentivized to offer support to their patient population, as they are paying for it. Third, Included Health helps find providers quickly, saving employees time and freeing them up to focus on the healing process and family. Furthermore, Included Health provides access to primary care doctors, which is crucial for long-term cost savings and better health. How Included Health Works Included Health has about 1500 clinicians available for virtual appointments, including behavioral health providers. The app allows users to schedule appointments within a week, ensuring choice and quick access to healthcare services. Technology has brought about broader trends in the industry, such as value-based care and making things easier to access. The cost of healthcare is increasing by seven to 10% year over year, making it unsustainable for the American population. Employers, who are often the purchasers of healthcare, are seeking better solutions to control healthcare costs. They are trying to do this through products and services, creating new networks, and focusing on wellness. The trend is driven by employers and the government, as well as insurance companies. Included Health fits into this trend by reducing total care costs and prioritizing the member experience. By being a one-stop shop for patients and members, employers can experiment with different services without disrupting the member experience. This allows them to work with the growing trend of cost-cutting and value-based care in the healthcare industry. Included Health's Clients and Pricing Structure  The pricing structure for the company is custom, client-by-client, and depends on the population being served. The company does not have a per-head pricing structure, but rather on a population level. Performance guarantees are part of the pricing model, which includes up-operation and delivery of savings.The company has started participating in shared savings models with CalPERS, which allows California employees and their dependents access to their services. Payers see the company as a provider for their members, and they believe that these models are helping them achieve better outcomes for patients. Included Health mostly focuses on larger enterprise and jumbo clients, with 33 of the Fortune 100 companies being clients. Smaller clients also receive good results from the company. The Role of AI in Healthcare Ami discusses the use of Telehealth in healthcare. She mentions her parents as an example of how they could do more virtually than they are today. Ami also discusses the role of AI in healthcare, stating that, by providing tools that can help healthcare workers it is a beneficial tool.  AI has been used in healthcare for therapy, diagnosis, and diagnosis, with 20% of conversations being healthcare-related. She is excited about the potential of AI in healthcare. Member-facing AI can answer basic health insurance questions and provide guidance on insurance deductibles and costs. Included Health ensures all of their AI services are supported by humans, whether on the clinical side or on the care team side, to ensure a human is available to the customer when needed.  Ami believes that AI will be a tool that supports the human workforce in healthcare, making their jobs easier and allowing them to do more for the members. Over the next year or two, AI will play a significant role in healthcare, with AI helping navigate systems, schedule calls, and provide better access to care for patients. Timestamps: 01:22 Included Health's Services and Impact 03:22: Navigating the Healthcare System  07:20: Challenges and Solutions in Healthcare Data  14:29: Employer and Health Plan Perspectives  21:33: Value-Based Care and Pricing Structure  27:21: Health Plan and TPA Relationships  32:41: Role of AI in Healthcare  Link:  https://includedhealth.com/   Unleashed is produced by Umbrex, which has a mission of connecting independent management consultants with one another, creating opportunities for members to meet, build relationships, and share lessons learned. Learn more at www.umbrex.com.

Medicare Advantage (MA) is one of the most popular insurance programs for the Medicare-eligible population, however it faces significant headwinds from both payer and provider organizations. Alan Lassiter, Principal, ECG Management Consultants, speaks with Christine Worthen, Member, Epstein Becker & Green PC, and Joe Mangrum, Partner, ECG Management Consultants, about the current state of MA, the complex issues confronting both payers and providers, and strategies for successfully navigating these uncertain times. They discuss issues related to provider-sponsored plans, structuring value-based arrangements with MA plans, how MA plans can maintain margin, CMS' recent final rule, sustainable MA plan reimbursement, network design and supplemental benefits, and the value drivers of data. From AHLA's Payers, Plans, and Managed Care Practice Group.AHLA's Health Law Daily Podcast Is Here! AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Premium members. Get all your health law news from the major media outlets on this new podcast! To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org/dailypodcast.

No one is better equipped to support patients than providers. But do health systems have the power required to improve the healthcare system?  In this episode of Healthcare Insider, Premier Inc. President and CEO Mike Alkire explains why a provider-led model—not one led by payers or legacy tech vendors—is the only viable path forward. He outlines how hospitals can take back control and lead transformation by focusing on high-value partnerships, smarter use of data and AI-driven solutions. Listen to learn how health systems can: Shift power from payers to providers through strategic partnerships Leverage data and AI to reduce costs and improve outcomes Incentivize innovation to build a more sustainable system

Payers are seeking new ways to enhance member engagement and drive long-term retention. This podcast explores a powerful new-to-market strategy for transforming how health plans design member journeys to create a seamless experience in a combination of offline and online environments. Don't miss the insights in this episode that will redefine how your plan approaches member engagement.About Our Guest: Barb Ody is a payer consultant and expert in member experience solutions, technology and process implementations, clinical business informatics, data modeling and analysis.

In this episode of the High Performing Dental Team podcast, Dayna Johnson interviews Dr. Ryan Hungate at the International Dental Show in Cologne, Germany. They discuss the collaboration between FDI and Henry Schein on integrating electronic health records in dentistry, the importance of universal data platforms, and the potential for reimbursement changes in dental practices. The conversation highlights the need for seamless communication between dental and medical professionals to improve patient care. Takeaways ➡The International Dental Show is a significant event for dental professionals. ➡Dr. Ryan Hungate has transitioned from practicing orthodontics to focusing on strategic roles in dental technology. ➡The collaboration between FDI and Henry Schein aims to integrate health records across dental and medical fields. ➡Eight core health indicators are being developed to enhance patient care. ➡The Universal Data Platform allows for better data sharing between dental practices and medical professionals. ➡Payers may reimburse for new health indicators and tests that improve patient outcomes. ➡Integrating health records can streamline workflows in dental practices. ➡Dental professionals are encouraged to adapt to new technologies without extensive retraining. ➡The importance of collaboration in the dental industry is emphasized. ➡Innovative solutions are needed to incorporate health screenings into regular dental visits. Chapters 00:00 Introduction to the High Performing Dental Team Podcast 04:48 The Collaboration Between FDI and Henry Schein 09:51 Integrating Health Records in Dentistry 13:43 The Role of Universal Data Platform Click here to download the Consensus Statement: https://fdiworlddental.org/consensus-statement-integrated-electronic-health-records Please rate, review and share this episode with your colleagues. Book a call with Dayna: https://calendly.com/dayna-johnson/discovery-call

On this episode of DGTL Voices, Ed interviews Bruce Lee, a seasoned technology leader with a rich background in financial services and healthcare. Bruce shares his journey from a small village in England to becoming the CTO of Centene. We discuss his passion for music, the importance of curiosity and people in technology, and his insights on bridging the gap between payers and providers in healthcare. He emphasizes the need for kindness in personal relationships and the importance of engaging with the evolving landscape of AI and technology.

Jacob and Nikhil sit down with Frank Wu, the Co-Founder and CEO of Taro Health. Taro Health is a health insurance plan currently live in Maine and Oklahoma that offers unlimited primary care and mental health visits. The company has raised over $18m from investors like Hummingbird Ventures, Quiet Capital, and FPV Ventures. They discuss creating value in InsurTech, building a health plan for Direct Primary Care providers, what's next for health insurance, and more. [0:00] Intro[0:18] Frank's Background and Journey[1:17] Introduction to Taro Health[2:50] Challenges and Strategies in Health Insurance[7:24] Direct Primary Care Model[13:01] Patient and Doctor Archetypes in DPC[17:01] Enrollment and Market Strategies[28:56] Generative AI in Health Insurance[35:31] Quickfire Out-Of-Pocket: https://www.outofpocket.health/

Highmark Health, Mass General Brigham Health Plan, SCAN, and TytoCare leaders discuss strategies for creating innovative, high-impact healthcare products.    Tune in to learn:   How traditional health plans are rethinking product design in the face of growing competition from direct-to-consumer models Strategies for creating more personalized, flexible, and transparent offerings that resonate with today's healthcare consumers The role of data, technology, and innovation in modernizing health insurance products Real-world success stories from leading organizations who are successfully navigating this evolving market Panelists:  Maria Baker, VP, Health Strategy & Delivery, Highmark Health Lena Perelman, VP, Medicare Product Operations, SCAN Health Plan Roni Mansur, Vice President of Product Management, Mass General Brigham Health Plan Suzi Pigg, Vice President, Payers, TytoCare https://www.brightspotsinhealthcare.com/events/innovating-product-design-for-growth-and-member-engagement/   This episode is sponsored by TytoCare: TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are six times higher than traditional telehealth services; reduces the total cost of care by an average of five percent; diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for the successful deployment and adoption of the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 250 major health systems and health plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.   Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

Health plan leaders from Cambia Health Solutions, Highmark Health and League share strategies for driving consumer engagement, improving health outcomes, and optimizing payer-provider relationships. Learn how health plans can shift from broad segmentation strategies to truly personalized, member-centric healthcare by harnessing data, AI, and digital transformation.     Learn how health plans are using AI-driven insights to deliver tailored interventions.

  The Friday Five for February 14, 2024: Apple iOS 18.3.1 Updates Trend Alert: Smart Ankle Watch? Egg Substitutions for Baking & Protein Healthcare Regulatory Update (of sorts) The Postseason Game Plan   Download Your FREE Copy of The Postseason Game Plan Now!   Apple iOS 18.3.1 Updates: Adorno, José. “IOS 18.3.1 Now Available Ahead of Big Ios 18.4 Upgrade.” Bgr.Com, BGR, 10 Feb. 2025, bgr.com/tech/ios-18-3-1-now-available-ahead-of-big-ios-18-4-upgrade/. Disotto, John-Anthony. “iOS 18.4 Could Be the Biggest iPhone Upgrade Ever – Here's Why.” TechRadar.Com, TechRadar, 11 Feb. 2025, www.techradar.com/phones/iphone/ios-18-4-could-be-the-biggest-iphone-upgrade-ever-heres-why. Phelan, David. “Apple iOS 18.4 Release Date: The Major iPhone Update Is On Its Way.” Forbes.Com, Forbes Magazine, 8 Feb. 2025, www.forbes.com/sites/davidphelan/2025/02/08/apple-ios-184-release-date-the-major-free-iphone-update-is-on-its-way/. Rossignol, Joe. “iOS 18.4 Will Include These New Features for Your iPhone.” MacRumors.Com, MacRumors, 5 Feb. 2025, www.macrumors.com/2025/02/05/ios-18-4-expected-features/.   Trend Alert: Smart Ankle Watch? Lovejoy, Ben. “The Five Reasons Some People Wear Their Apple Watch on Their Ankle.” 9to5Mac.Com, 9to5Mac, 10 Feb. 2025, 9to5mac.com/2025/02/10/the-five-reasons-some-people-wear-their-apple-watch-on-their-ankle/. Skwarecki, Beth. “Why (and How) to Wear Your Apple Watch on Your Ankle.” Lifehacker.Com, Lifehacker, 11 Feb. 2025, lifehacker.com/health/why-and-how-to-wear-an-apple-watch-on-your-ankle. Heater, Brian. “Tiktok Influencers Are Wearing Apple Watches on Their Ankles.” Techcrunch.Com, TechCrunch, 10 Feb. 2025, techcrunch.com/2025/02/10/tiktok-influencers-are-wearing-apple-watches-on-their-ankles/.   Egg Substitutes for Baking & Protein: David, Lauren. “8 Egg Substitutes for Cooking and Baking.” Aarp.Org, AARP, 10 Feb. 2025, www.aarp.org/home-family/your-home/info-2025/egg-substitutes-cooking-baking.html. Valente, Lisa. “10 Foods with More Protein Than an Egg.” Eatingwell.Com, EatingWell, 18 Nov. 2024, www.eatingwell.com/article/291485/10-foods-with-more-protein-than-an-egg/. McDonell, Kayla. “13 Effective Substitutes for Eggs.” Healthline.Com, Healthline Media, 7 Feb. 2024, www.healthline.com/nutrition/egg-substitutes. Phaneuf, Taryn. “Egg Prices Are Rising Again. Here's Why They're So High.” Edited by Laura McMullen, Nerdwallet.Com, NerdWallet, 11 Feb. 2025, www.nerdwallet.com/article/finance/why-are-eggs-so-expensive. Lannon, KJ. “Egg Prices Got You Scrambling? Here's 3 Substitutes to Use in Your Cake Mix.” Tastingtable.Com, Tasting Table, 10 Feb. 2025, www.tastingtable.com/1780478/egg-substitutes-boxed-cake-mix/.   Healthcare Regulatory Update (of sorts) Bell, Allison. “10 House GOP Health Program and Tax Change Ideas.” Thinkadvisor.Com, ThinkAdvisor, 24 Jan. 2025, www.thinkadvisor.com/2025/01/24/10-house-gop-health-program-and-tax-change-ideas/. Muoio, Dave. “Consumer Financial Protection Bureau Shake-up Leaves Medical Debt Reform in Limbo.” Fiercehealthcare.Com, Fierce Healthcare, 6 Feb. 2025, www.fiercehealthcare.com/regulatory/consumer-financial-protection-bureau-shakeup-leaves-medical-debt-reform-limbo. Muoio, Dave, et al. “Healthcare Lobbying 2025: Here Are the Top Policy Issues for Hospitals, Payers, Docs and Tech.” Fiercehealthcare.Com, Fierce Healthcare, 12 Feb. 2025, www.fiercehealthcare.com/regulatory/healthcare-lobbying-2025-here-are-top-policy-issues-hospitals-payers-docs-and-tech.   The Postseason Game Plan: https://postseasongameplan.com/   Resources: 5 Types of Content to Share on Social Media: https://lnk.to/asgf20250131 Best Apps for Sports Fans: https://lnk.to/asga78 Guidelines for Sharing Personal Beneficiary Data with Other TPMOs: https://lnk.to/asg647 MedicareCENTER FAQs: https://lnk.to/asg645 PlanEnroll FAQs: https://lnk.to/asg646   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://twitter.com/RitterIM and Youtube, https://www.youtube.com/user/RitterInsurance     Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail. Not affiliated with or endorsed by Medicare or any government agency.

 In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down key developments in the payer world. They discuss CVS Health's stock surge, the impact of Medicaid policy changes, and UnitedHealth's aggressive reputation management.

Michael Serbinis, CEO and Founder of League, sits down with Eric to for a compelling discussion on how digital innovation is reshaping healthcare. Discover how League's platform empowers health plans like Highmark to deliver personalized, data-driven experiences that simplify navigation, improve engagement, and enhance member satisfaction. Mike shares fascinating insights on: The power of a unified digital front door for healthcare consumers  Real-world examples of how League amplifies care access and reduces costs  The role of personalization in creating Amazon-like experiences for healthcare  Mike also reflects on lessons from his entrepreneurial journey, including his time working with Elon Musk and how it inspired his vision to transform healthcare. Listen in for actionable strategies on leveraging technology to meet evolving consumer expectations and drive better outcomes. About Mike Michael Serbinis founded League in 2014. League accelerates the digital transformation of the healthcare consumer experience (CX). Serbinis has led the company since its inception, raising over $235 million in funding and driving exponential growth as League powers healthcare's biggest brands.    Mike has had a long and distinguished career as a serial entrepreneur, rocket scientist, engineer and investor. Most recently, Serbinis was the founder and CEO of Kobo, a digital reading company that rivals Amazon's Kindle worldwide. Before that, he founded cloud storage pioneer DocSpace and then built Critical Path, a messaging service that handled one-third of the world's email. Serbinis is also Chair of the Board of Directors for the Perimeter Institute, the world's leading center for scientific research in theoretical physics.    Now, as the CEO of League, Serbinis is focused on healthcare transformation. Payers, providers and pharmacy retailers build on the League platform to accelerate digital transformation and deliver high-engagement, personalized digital experiences. Millions worldwide use and love solutions powered by League to access, navigate and pay for care.   About League  Founded in 2014, League is the leading healthcare consumer experience platform, reaching more than 20 million people around the world and delivering the highest level of personalization in the industry. Payers, providers, and consumer health partners build on League's platform to deliver high-engagement healthcare solutions that improve health outcomes. To date, League has raised $235 million in venture capital funding, powering the digital experiences for some of healthcare's most trusted brands, including Highmark Health, Manulife, Medibank, and Shoppers Drug Mart.   Bright Spots in Healthcare is produced by Bright Spots Ventures Bright Spots Ventures brings healthcare leaders together to share working solution or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime. Visit our website at www.brightspotsinhealthcare.com

In this replay/compilation episode, we explore the drastic changes in healthcare costs since the government's increased involvement, particularly focusing on the shift from individual out-of-pocket expenses to public health insurance covering a significant portion of costs. We discuss the economic impacts of these changes, such as rising premiums, claim denials, and the restrictions placed on insurance companies by laws like the Affordable Care Act. The episode emphasizes the need for a free market system to make healthcare more affordable and critiques how government policies have led to inefficiencies and higher costs. (00:00) The Impact of Government on Healthcare Costs (00:35) Historical Healthcare Expenditures: A Closer Look (02:17) Out-of-Pocket Costs and Public Health Insurance (03:21) The Role of Private Health Insurance (04:58) The Free Market Solution to Healthcare (05:19) Affordable Care Act: Challenges and Consequences (06:17) Insurance Mandates and Market Dynamics (07:48) The Economics of Health Insurance (13:25) Conclusion: Addressing the Real Problems in Healthcare