Podcasts about payers

Dive into the latest episode of Pharmacy Friends for a discussion of the FDA Commissioner's National Priority Voucher pilot. While accelerated approvals may improve access to innovative therapies, what could a compressed decision-making window mean for evidence review, affordability assessment and implementation planning? Prime experts Angela Sutton and Bob Greer explore the important roles clinical confidence and operational readiness will play in making solid coverage decisions. Hear what they're most focused on, including:Managing drug spendAssessing coverage strategiesDetermining policy risk00:00 Introduction02:10 What's generating all the questions now?04:35 FDA Hearing05:50 Pro's and con's of accelerated drug approvals11:05 Policy uncertainty and impact to payers11:54 Impact of FDA leadership changes12:24 Meeting the moment15:26 Using data to make better decisions that need to be fast18:39 What we would tell the acting FDA leadership that matters23:15 Closing

As healthcare costs continue to rise, more patients are finding themselves navigating not just illness, but the growing complexity of paying for treatment. Specialty pharmacy sits right at the center of that challenge—often out of sight, but increasingly essential to how modern care actually works. These high-cost, high-touch therapies now make up more than half of total U.S. drug spending, despite representing only a small share of prescriptions, a shift that's reshaping how patients access and stay on treatment.Why has specialty pharmacy become the linchpin between access, affordability, and outcomes in modern healthcare?On this episode of I Don't Care, host Dr. Kevin Stevenson sits down with Grant Knowles, SVP of Clinical Services and Payer Strategy at Senderra Specialty Pharmacy, to unpack the evolving role of specialty pharmacy in improving patient outcomes. Together, they explore how clinical oversight, financial navigation, and emerging technologies are reshaping how patients access and adhere to life-changing therapies.Top insights from the talk…Specialty pharmacy goes beyond dispensing medication, serving as a central coordinator across fragmented healthcare stakeholders to manage complex therapies and patient needs.Financial toxicity remains one of the biggest barriers to adherence, with 23–25% of patients delaying or abandoning treatment due to cost pressures.Technology and AI are transforming patient engagement, shifting communication from phone calls to digital-first experiences while maintaining critical human touchpoints.Grant Knowles is a healthcare executive with over 15 years of experience across specialty pharmacy, managed care, and pharmaceutical operations, with expertise in business development, contracting, and supply chain strategy. He has held senior leadership roles, including SVP of Clinical Services and Payer Strategy at Senderra Specialty Pharmacy and executive positions at Ardon Health, where he led growth, operations, and industry partnerships. A managed care residency-trained pharmacist, Knowles is recognized for driving innovation, improving patient experience, and delivering sustainable growth in highly competitive healthcare markets.

VBC Insights: The Shift to Value: How Payers Are Adapting to Rising Costs by Healthcare NOW Radio and Podcast Network - Radio and Podcasts for the Healthcare Industry

As financial pressures intensify across healthcare, payers are rethinking traditional strategies and accelerating their transition to value-based care. In this episode of Value-Based Care Insights, host Daniel Marino speaks with Joe Mangrum, Partner at ECG Management Consultants, about how payers are adapting to rising medical costs, tightening Medicare Advantage margins, and increasing regulatory demands. Together, they unpack how payer strategies are shifting from broad network expansion to more selective, high-performing partnerships, with a growing emphasis on disciplined, data-driven decision-making. The discussion highlights the critical role of payer-provider collaboration in managing total cost of care, along with the increasing importance of data sharing, risk stratification, and more mature value-based arrangements. The episode offers practical insights into aligning incentives, strengthening partnerships, and building sustainable care models for the future.

A couple weeks ago, Michał Nedoszytko placed third globally at Anthropic's hackathon out of 13,000 participants. He was the head of cardiology at a hospital in Brussels at the time. Now he is Clinical Scientist at Abridge. On this episode of Vital Signs, Nikhil and I sat down with Abridge's CEO Shiv Rao and Michal to chat about how the hire came together, what changed with Opus 4.6 that let a cardiologist ship a working MVP in 40 minutes, and where they both think clinical AI goes next.   (0:00) Intro (0:19) Hackathon Fame (3:52) Shiv Recruits Mahal (6:30) Doctors Who Code (9:07) Prototypes vs Production (10:26) Regulation and Partnerships (13:00) Customization vs Reliability (15:59) AI Native Company Ops (19:29) Healthcare in 10 Years (21:08) Admin vs Clinical AI (24:47) Payers and Prior Auth (29:48) Training Doctors for AI (35:19) Context, Autonomy, and Demand (40:40) Pre-visit Workflows and Triage   Out-Of-Pocket: https://www.outofpocket.health/

In this episode, Dr. Lisa Shah, Executive Vice President and Chief Medical Officer of Twin Health, discusses how AI-powered digital twin technology is transforming care for chronic conditions and enabling personalized, real-time interventions. She also shares insights on payer trends, outcomes-based models, and new approaches to reducing reliance on medications while improving long-term health outcomes.This episode is sponsored by Twin Health.

Compliance works better when documentation supports care in real time instead of becoming a burden after the fact. In this episode, Paige Dustmann and Derek Staub discuss how fraud, waste, and abuse pressures are reshaping behavioral health compliance for providers, payers, and managed care organizations. Paige explains how Monolith Health helps teams capture services, assessments, and treatment planning in real time, reducing paperwork and improving audit readiness. Derek highlights how changing regulations, random audits, and documentation gaps can put even well-intentioned providers at risk, emphasizing the need for stronger systems and clearer communication with MCOs. Together, they explore how better workflows, state-aligned lesson plans, and proactive compliance tools can protect organizations while ensuring clients receive care that meets their real needs. Tune in and learn how better documentation, stronger compliance systems, and clearer payer-provider communication can reduce risk and improve behavioral health care delivery! Resources: Learn more about Monolith Health on their LinkedIn and visit their website here.

Payers are taking a closer look at E&M claims, and providers are feeling the impact. This session explores what is changing, why it matters, and what organizations can do to respond.Brought to you by www.infinx.com

Rural health systems are underfunded, understaffed, and buried in fax machines. Meanwhile, large insurance payers are using automation and AI to deny claims faster than ever — and rural providers often don't have the time or staff to appeal before the deadline passes. The result is money quietly bleeding out of systems that can least afford to lose it.In this episode of Health Reimagined, host Jon Myer (Myer Media, powered by Ingram Micro) sits down with Dan from InfoCap to talk about intelligent document processing, human-centric automation, and why the very fact that rural hospitals are behind on technology might actually put them in the best position to leapfrog the legacy mess that is slowing everyone else down.

Rural health systems are underfunded, understaffed, and buried in fax machines. Meanwhile, large insurance payers are using automation and AI to deny claims faster than ever — and rural providers often don't have the time or staff to appeal before the deadline passes. The result is money quietly bleeding out of systems that can least afford to lose it.In this episode of Health Reimagined, host Jon Myer (Myer Media, powered by Ingram Micro) sits down with Dan from InfoCap to talk about intelligent document processing, human-centric automation, and why the very fact that rural hospitals are behind on technology might actually put them in the best position to leapfrog the legacy mess that is slowing everyone else down.

Welcome to a special episode of HME News in 10, sponsored by Tactical Back Office.   Today's guest is Lauren Barranti, payor relations with Tactical Back Office. Long-term price compression, closed payer networks and third-party administrator models create burdens for smaller HME providers, who may not have the resources to juggle everything from credentialing and contracting to managed care strategy in a competitive market, Barranti says. That can be costly. “Payers and customers will get mixed signals,” she said. “It will be obvious that things are not organized and flow will be affected. Ultimately, what happens is trust erodes. And that's probably the worst thing that can happen.” What's the path forward for these providers? Ensuring that back-office people, processes and technology are intentionally integrated, Barranti says. Hosts:   Liz Beaulieu Theresa Flaherty   Guest:  Lauren Barranti

Payers are operating at the center of converging pressures: rising costs, accelerating utilization, heightened public scrutiny, and a wave of CMS reforms that are reshaping expectations around transparency, interoperability, prior authorization, and accountability. Medicare Advantage has become the front line for these shifts—exposing tensions between regulatory oversight, margin compression, and growing demands for better member and provider experiences. Against this backdrop, health plans are being asked to do more with less—while proving real value through measurable outcomes, trust, and access. In this episode, recorded in February at the ViVE digital health and healthcare innovation conference, Rae Woods moderates a conversation with payer and technology leaders on how AI and data are being used to reduce payer–provider friction, rethink prior authorization, and improve the member experience—without losing sight of accountability or return on investment. Panelists include: Ali Khan, MD, Chief Medical Officer, Medicare at Aetna (a CVS company) Kay Judge, MD, Chief Medical Officer, Medicare at Blue Shield of California Syed Mohiuddin, MD, Head of Healthcare, Anthropic We're here to help: Podcast | 276: The AI gold rush is changing how humans (and clinicians) make decisions Research | How to succeed using AI: Lessons from 4 leading organizations Expert Insight | Inside CMS' final rule changes for 2026 Learn more about the ViVE conference Register today for the 2026 Advisory Board Summit in Washington, D.C. Updating COVID-19 management protocols may help address long-term impacts A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

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SummaryIn this episode, Sean and Terry Fletcher discuss the latest issues in healthcare compliance, focusing on problematic billing practices, the risks of retrospective diagnosis coding, and the influence of third-party payers like Optum. They explore how these practices threaten provider integrity and patient care, offering insights and advice for healthcare professionals navigating these challenges.Key TopicsHealthcare billing and coding practicesRisks of retrospective diagnosis coding and claims manipulationImpact of third-party payers on provider integrityUncovering the Truth Behind Healthcare Billing FraudHow Payers Like Optum Are Influencing Medical Coding

In this episode of the AI at Health series on The Beat Podcast, host Sandy Vance sits down with Vadiraj Guttal, VP and Business Head for Infosys Helix, for a thoughtful and candid conversation about why health plans are still stuck in batch processing, what it actually means to be cloud native versus just cloud hosted, and how a platform-centric approach is delivering two to three times the improvement that incremental fixes never could. With Helix now six-plus years in the making, Vadiraj brings a grounded, practitioner's perspective to one of the most complex transformation challenges in healthcare today. If you are a health plan executive trying to reduce administrative costs, modernize operations, and prepare for an AI-driven future, this episode is essential listening. In this episode, they talk about: Most health plans moved to the cloud without actually taking advantage of what the cloud can do Batch processing is still the norm in healthcare, and it is the root cause of most administrative delays Platform-centric thinking means cloud-native architecture, reusable data, event-driven workflows, and composability Provider credentialing that takes two to three months today could be reduced to one week with the right platform Helix targets a 40% reduction in IT operations costs and a 50 to 60% reduction in workflow fallouts True digital-native health plans do not exist yet, and that is exactly the gap Helix is built to close Tier two and tier three health plans without large digital transformation budgets are the ideal Helix candidates The next big challenge is using AI at scale in production while keeping outcomes deterministic, not probabilistic A Little About Vadiraj: Senior Health-tech and IT Consulting professional with 23+ years of experience in software development, project management, sales, and delivery of strategic consulting engagements, product and solution development for the payer segment of US healthcare. He partners with senior executives to address their business and technology needs through innovative solutions, resulting in IT efficiencies and business outcomes. As Business Head of Platforms at Infosys Healthcare, he is responsible for ideating and developing digital-native, AI- and cloud-run business applications. In this role, he also partners with other healthcare start-ups and academic institutions to industrialize their research and solve problems for large healthcare payers.

Payers are constantly shifting tactics to find new and creative ways to do their favorite thing: Not pay claims. And if you can't deny? Downgrade! We're seeing a lot of new patterns and tactics on this front, especially on the Medicare Advantage/private payer side of the house. And so it was time to take a look at where we are on the state of denials, with just the right person: Richelle Marting of Marting Law, LLC. Richelle has guested on OTR twice previously, the last time in January 2025. I'm bringing her back for the trifecta to discuss: What's new in the life of Richelle Marting—and at the law firm? Many few faces in the last 12 months... The denials landscape, including the tactical shift from hard denials to softer downgrades. Specific examples including Aetna Level of Severity Policy, Blue Cross and Cigna E/M downgrades Short-stay and readmission audits from MA plans: Does the 2-Midnight Rule apply to Medicare Advantage and one critical difference you need to know about. Other trends Richelle is seeing including sepsis, respiratory failure, and the use of artificial intelligence Successful appeals and prevention strategies Life on the speaking circuit, Richelle's OTR Spotify playlist selection, and Guns N' Roses “My Michelle” serendipity... 

Healthcare technology should quietly remove friction and reduce burden so clinicians can focus on what matters most: caring for patients in a more human way. In this episode, Lisa Gulker, Chief Nursing Officer at Oracle Health and Life Sciences, discusses how Oracle is rethinking healthcare technology by building AI directly into the foundation of its systems rather than layering it on as an afterthought. She explains how this approach can help clinicians spend less time in the chart, reduce workflow fragmentation, and make technology feel more seamless in the care experience. Lisa also shares how Oracle is applying these capabilities across providers, life sciences, and payers, creating opportunities to accelerate research, improve clinical trial matching, streamline prior authorization, and reduce administrative burden across the ecosystem. Throughout the conversation, she brings a nurse leader's perspective to a central question in healthcare innovation: how do we use technology to make care feel more human, not less? Tune in and learn how embedded AI could reshape the healthcare experience for clinicians, staff, researchers, payers, and patients alike.  About Lisa Gulker: Lisa Gulker is Chief Nursing Officer at Oracle Health, where she helps bring the voice of clinicians into product strategy, innovation, and healthcare transformation. With a background that spans nursing, informatics, analytics, and clinical operations, she has spent her career helping health systems use technology more effectively to improve care delivery and workforce engagement. Before becoming Chief Nursing Officer, Lisa served as Vice President of Product Management and Strategy at Oracle, and previously held senior leadership roles at Cerner, Tenet Healthcare, and Detroit Medical Center, where she focused on clinical transformation, data stewardship, and value realization. She works closely with executive leaders, data science teams, and engineering groups to align innovation with the realities of care delivery. Lisa holds a Doctor of Nursing Practice from Wayne State University and brings a strong blend of clinical, strategic, and operational expertise to healthcare innovation.  Things You'll Learn: When AI is built into the foundation of healthcare technology, it can reduce the burden more effectively than tools simply bolted onto older systems.  Seamless technology should help clinicians focus more on patients and less on screens, documentation, and fragmented workflows. Life sciences organizations can use AI-enabled systems to accelerate research, improve access to studies, and surface insights more efficiently. Payers still rely on slow, labor-intensive administrative processes that AI could help streamline, especially in areas such as pre-authorization and referrals. Human-centered innovation depends on listening closely to end users and designing technology that reflects how clinicians actually work.  Resources: Connect with and follow Lisa Gulker on LinkedIn. Follow Oracle Health on LinkedIn and visit their website.

SummaryThis episode features Sean Weiss and Terry Fletcher discussing recent issues with insurance payers, down coding policies, and the impact on healthcare providers. They analyze the implications of AI-driven denials, the importance of proper documentation, and advocate for provider advocacy and education.Key TopicsInsurance payer policies and down codingImpact of AI and algorithms on medical billingImportance of accurate documentation and provider advocacy

In this episode, host Sandy Vance sits down with Dan Shur, Chief Product Officer at Carenet Health, to talk about what it really takes to guide patients and members through one of the most frustratingly fragmented systems in the world. With over 30 years in the healthcare industry spanning payers, providers, and health tech & services companies, Dan brings a grounded, pragmatic perspective to the AI conversation. From the myth that everyone wants to talk to a chatbot to the importance of letting humans be human, their conversation is a must-listen for healthcare leaders who want to use AI to drive real outcomes without losing the empathy that puts the “care” in healthcare. In this episode, they talk about: Healthcare is the last industry where friction is still considered normal Carenet combines nurses, operations, data, and technology to navigate care at scale AI is best used for flagging risk, prioritizing queues, and gathering context before a human steps in Chatbots are not good at empathy, and healthcare interactions require a whole-person approach Not every problem needs AI; sometimes you just need a PDF to open Payers measure engagement, retention, and closed gaps in care; providers measure acquisition and leakage prevention Fragmentation is getting worse, not better, and navigation solutions have to account for the whole ecosystem Proactive, precise outreach beats education-only programs that leave patients to figure it out alone The clinical and administrative sides of care cannot be separated, and solutions need to address both Dan Shur leads product strategy and innovation at Carenet Health, where he helps healthcare organizations use smarter technology to improve outcomes. With over 30 years in healthcare and health tech, Dan has worked across health plans, provider systems, and startups. He is always focused on turning big ideas into practical solutions. Before Carenet, he founded Aloha Value Advisory, helping early-stage companies find their footing, and previously served as Chief Product Officer at Quantum Health, where he helped scale and modernize the business. Throughout his career, including roles at Cigna, EmblemHealth, Progyny, Cloudbreak Health, and GuideWell's Venture Group, Dan has built a reputation for driving innovation that delivers results.

Based on AHLA's annual Health Law Connections article, this special ten-part series brings together thought leaders from across the health law field to discuss the top ten issues of 2026. In the ninth episode, Kathy Roe, Managing Attorney, Health Law Consultancy, speaks with Judy Waltz, Partner, Foley & Lardner LLP, about the current areas of uncertainty surrounding Medicare Advantage (MA). They discuss why some MA Organizations (MAOs) are withdrawing plans, Humana v. Becerra and the potential impact on Risk Adjustment Data Validation audit processes and calculation of overpayment recoveries for MAOs, potential MAO network provider exposure under the False Claims Act, and what potential changes to MA might be on the horizon. From AHLA's Payers, Plans, and Managed Care and Regulation, Accreditation, and Payment Practice Groups.Watch this episode: https://www.youtube.com/watch?v=Az0cUVAjnFIRead AHLA's Top Ten 2026 article: https://www.americanhealthlaw.org/content-library/connections-magazine/article/a879dda5-35f9-46fb-ad45-1b0799343d74/Health-Law-Forecast-2026Access all episodes in AHLA's Top Ten 2026 podcast series: https://www.americanhealthlaw.org/education-events/speaking-of-health-law-podcasts/top-ten-issues-in-health-law-podcast-seriesLearn 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 Regulation, Accreditation, and Payment Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/regulation-accreditation-and-payment Essential Legal Updates, Now in AudioAHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Comprehensive 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 EducationLearn more about AHLA and the educational resources available to the health law community at https://www.americanhealthlaw.org/. 

In Episode 20 of The Staging Area, Brett McGrath and Tory from dcsports87 discuss the current state of the consignment market.The conversation starts with several notable sales across the hobby. A 1954 Bowman Mickey Mantle PSA 8 set an all-time high at $23,700. A 2013 BBM Shohei Ohtani promo PSA 9 jumped from $3,500 to nearly $20,000. An Aaron Judge Bowman Draft Chrome Auto PSA 10 sold for $7,500 as baseball season approaches.The episode then shifts to a topic many collectors experience but rarely discuss openly.Non-paying buyers.Brett and Tory break down what happens when auctions end and buyers fail to pay, how often this occurs, and what steps platforms and consignors are taking to reduce the problem.The episode closes with a look at the scale of the current market, with dcsports87 moving $14M in January and $17M in February.For collectors who buy, sell, or consign cards, this conversation offers a clear look at how the system works behind the scenes.A special thank you to dcsports87 for supporting this series. Check out dcsports87 for your eBay consignment needs and visit the dcsports87 eBay store to find great cards ending every night.Get your free copy of Collecting For Keeps: Finding Meaning In A Hobby Built On HypeGet exclusive content, promote your cards, and connect with other collectors who listen to the pod today by joining the Patreon: Join Stacking Slabs Podcast Patreon[Distributed on Sunday] Sign up for the Stacking Slabs Weekly Rip Newsletter using this linkFollow dcsports87: | Website | eBay | Instagram | Twitter  Follow Stacking Slabs: | Twitter | Instagram | Facebook | Tiktok ★ Support this podcast on Patreon ★

Hosts Megan Beaver and Savanna Williams talk to Rachel Park and Lisa Umans about the regulation of the organ procurement industry, recent congressional interest in the space, and the latest updates from the Centers for Medicare and Medicaid Services (CMS).  This podcast episode features the following speakers: Rachel Park is a senior counsel in Crowell & Moring's Washington, D.C. office and a member of the firm's Health Care Group. She advises clients on a wide array of health care matters, including Medicare and Medicaid reimbursement, managed care litigation, and health care fraud investigations and oversight. Prior to joining Crowell, she served for 24 years at the U.S. Department of Health and Human Services (HHS), most recently as principal deputy general counsel, the highest-level nonpolitical appointee in the HHS Office of the General Counsel.  Lisa Umans is a partner in Crowell & Moring's New York office and a member of the firm's White Collar and Regulatory Enforcement group and Financial Services group. She represents large institutional clients and individuals in federal and state regulatory and criminal investigations conducted by grand juries, congressional committees, and domestic and international law enforcement and regulatory agencies including the Department of Justice's Criminal and Antitrust Divisions, U.S. Attorney's Offices, Securities and Exchange Commission (SEC), the Commodity Futures Trading Commission (CFTC), the Financial Industry Regulatory Authority (FINRA), and various State Attorneys General. 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, Patrick Velliky, Chief External Affairs Officer at HaloMD, breaks down the latest trends in health care policy, payer consolidation, and the No Surprises Act. He explains how providers can navigate reimbursement challenges, reduce administrative burdens, and focus on delivering care while staying independent.This episode is sponsored by HaloMD.

In this episode, Jakob Emerson, Associate News Director at Becker's Healthcare, joins Scott Becker to break down a brutal week for payers, marked by plunging stocks, Medicare Advantage rate pressure, and intense congressional scrutiny.

On this episode host Fred Goldstein invites Angela Luong, PharmD, Senior Clinical Consultant at Pharmaceutical Strategies Group in this last installment of our rare disease series. Our discussion focuses on the burden of sickle cell disease, chronic pain management, limited treatment options, and the implications for managed care programs, including the use of data and care coordination to improve patient outcomes. This activity is supported by an independent medical education grant from Agios Pharmaceuticals, Inc. AMCP offers CPE for this podcast through December 31, 2026. For additional information and to claim credit, please visit: The Power of Partnership: Bridging Patients and Payers in Sickle Cell Disease Management. 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/

On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with David Muhlstein, PhD, JD, founder and CEO of Simple Healthcare, about his recent articles highlighting Transparency in Coverage (TIC) files and ghost rates from 119 insurers, including 3 national commercial payers. Aetna, Cigna, and United Healthcare TIC files were more than 90% ghost rates—billing codes for procedures that would never be performed by a specific physician. For example, there were billing codes for heart surgery performed by a psychiatrist, Muhlstein said. These ghost rates increase the size of TIC files, making them difficult to evaluate for consumers, researchers, and analysts. Data files of this size muddle the true aim of the TIC files to provide actual transparency that would allow consumers to compare the prices of health care services and choose more affordable options.

On this episode host Fred Goldstein invites Janna Evans, Director of Pharmacy Sales Support at Blue Cross and Blue Shield of Texas, as they continue their rare disease series with a focus on hemophilia and the substantial clinical, financial, and psychosocial burdens it places on patients and families. We discuss how health plans manage high-cost therapies, balance individualized patient needs with access requirements, and navigate prior authorization and step-therapy processes. Janna also highlights the need for better patient-reported outcomes, the day-to-day impact of the disease, and the broader considerations for employers and caregivers within managed care. This activity is supported by an independent medical education grant from Genentech Inc., and Pfizer Inc. AMCP offers CPE for this podcast through December 31, 2026. For additional information and to claim credit, please visit: ⁠The Power of Partnership: Bridging Patients and Payers in Hemophilia Management. 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/

At the 2025 Medical Innovation Olympics, a powerful all-star expert panel moderated by Melissa Norcross (Vice President, Corporate Strategy, Hyland Software) featuring Eddie Power (CEO, Empower Medical, former Global Medical Affairs Leader at Pfizer), Vivek Mukhatyar (Senior Director, Medical AI Team Lead, Pfizer), and Ravi Kiran Koppichetti (Senior Analyst, Manufacturing Technology, Vertex; former Lead IT Data Engineer, Novo Nordisk) cut through the hype and delivered a practical playbook for leaders in healthcare: 1) Fall in love with the problem, not the tool; 2) Think in systems, not silos; and 3) Train your people, not just your models.Timeline00:00 Highlight 1: Why AI Innovation Fails When the Problem Is Mis-framed01:20 Highlight 2: Probable vs Precise Decisions: Where AI Helps vs Where Governance Must Lead03:38 Highlight 3: Falling in Love with the Problem, Not the Solution04:38 Highlight 4: Non-Patient AI Use Cases: Process, Partnership & Proof06:00 Leadership in the Age of AI: Framing the Right Questions08:52 Systems Thinking in Healthcare Innovation (Hepatitis C Case Study)11:35 Constraints in Medical Affairs: Where Humans Must Stay in the Loop13:19 AI as “Intelligence on Tap” vs Clinical Decision Authority17:53 Defining Target Conditions and What “Done” Really Means20:15 Systems Failures in Real-World Healthcare Environments22:50 How Providers, Payers, and Pharma Are Using AI Today25:47 Who Decides: Human vs AI Agents in Regulated Healthcare27:18 Industry 4.0 Explained: Integrating OT and IT in Pharma Manufacturing30:33 Data Quality, Trust, and Why Most Organizational Data Is Unstructured32:03 Probabilistic AI vs Precision Decisions: A Leadership Framework34:35 Trust, Evaluations, and Human-in-the-Loop AI Design39:11 Why 95% of AI Pilots Fail — and the Role of AI Ambassadors43:08 Closing Reflections: Systems Thinking, Learning Loops, and Fearless Curiosity

On this episode Fred Goldstein invites Ami Gopalan, Senior Vice President of Strategic Content and Growth Optimization at Precision AQ in a continion of AMCP's rare disease series with an in-depth look at IgA nephropathy (IgAN), a progressive autoimmune kidney disease that often goes undiagnosed until advanced stages. As a patient living with IgAN, Ami brings both a professional and personal perspective to the discussion as we explore the disease's silent progression, the burden it places on patients and families, the evolving treatment landscape, and how managed care can better incorporate patient value, clinical guidelines, and emerging evidence to support long-term outcomes. This podcast is supported by an independent medical education grant from Alexion and AstraZeneca Rare Disease. AMCP offers CPE for this podcast through December 31, 2026. For additional information and to claim credit, please visit: The Power of Partnership: Bridging Patients and Payers in IgA Nephropathy Management. 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

On this episode Fred Goldstein invites Steve Kheloussi, PharmD, MBA, FAMCP, Principal Consultant at Kheloussi Consulting, LLC, in the first installment of our four-part series on rare diseases. We discuss a practical overview of Duchenne muscular dystrophy (DMD), the current treatment landscape, and the evidence gaps that complicate payer decision-making. We also touch on the importance of what patients and caregivers need to maintain function, reduce fatigue, and navigate the significant emotional and practical burdens of care. This podcast is supported by an independent medical education grant from ITF Therapeutics. AMCP offers CPE for this podcast through December 31, 2026. For additional information and to claim credit, please visit:  ⁠The Power of Partnership: Bridging Patients and Payers in Duchenne Muscular Dystrophy Management⁠. 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

Kathy Roe, Managing Attorney, Health Law Consultancy, speaks with Christine Burke Worthen, Member, Epstein Becker & Green PC, about two important yet not always well understood areas of the health care ecosystem, the health care claim lifecycle and medical coding. They discuss why it is important for health law professionals to have a basic understanding of these topics, the role that artificial intelligence is playing, and AHLA's recently released Health Care Claim Life Cycle 101 & Medical Coding 101 courses, of which Christine contributed. From AHLA's Payers, Plans, and Managed Care Practice Group.Watch this episode: https://www.youtube.com/watch?v=qigQfdPfEvsLearn more about AHLA's Health Care Claim Life Cycle 101 & Medical Coding 101 courses: https://www.americanhealthlaw.org/education-events/101-online-courses/the-health-care-claim-life-cycle-101-medical-codin Learn more about AHLA's Payers, Plans, and Managed Care Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/payers-plans-and-managed-care Essential Legal Updates, Now in Audio AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Comprehensive 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/.

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.

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 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.