Payer executives are increasingly focusing on claims management to cut costs. Prepayment review offers a proactive approach compared to traditional post-payment methods, allowing payers to identify and address potential issues before claims are processed.This episode is sponsored by CERIS.

This podcast discusses the upcoming Health Equity Index (HEI) replacing the Reward Factor in Medicare Advantage Star Ratings with Dr. Ashwin Patel, the Chief Medical Officer at Pyx Health. Learn how this impacts plans in 2024-2025 and what steps they can take to prepare for the HEI shift. We'll also explore how Pyx Health helps identify and address member needs related to social risk factors and the HEI.This episode is sponsored by Pyx Health.

Tune in for today's industry updates.

Tune in for today's industry updates.

Tune in for today's industry updates.

  Tune into this episode featuring Rehan Mirza , Chief Growth Officer at Verifiable, and Dara McDaniel, Associate Director of Credentialing at Humana. Dara and Rehan share insights on credentialing outside of patient safety and compliance, new approaches to leverage technology and much more.   This episode is sponsored by Verifiable.  

In this episode, we explore how member engagement and care navigation are crucial for value-based care, population health, and member satisfaction. We discuss the challenges health plans face and the opportunities presented by AI technology. Our guest, Amanda L. Bury, MS Chief Commercial Officer at Infermedica, shares how AI tools can drive member engagement and improve care journeys. She also dives into real-world examples and the positive outcomes health plans can achieve through this approach.This episode is sponsored by Infermedica.

In this episode, Dr. Bloom returns to discuss the specific challenges and opportunities in supporting preventive care for patients with complex diabetes. We explore how value-based care models can align with best practices in this area, and what future shifts we can expect as chronic disease prevalence rises. Dr. Bloom also shares his insights on exciting developments in caring for this population.This episode is sponsored by Podimetrics.

The rising tide of chronic diseases threatens healthcare costs. In this episode, we are joined by Dr. Sam Toney, CEO of Toney Healthcare, as we explore how payers can leverage care management programs to address this challenge. We discuss the opportunities technology presents to enhance patient care, the importance of psychosocial determinants of health and looking at each patient uniquely, and offer insights into the future of care management for payers.This episode is sponsored by Toney Healthcare.

Payers are on a mission: boost growth and improve member experiences. But navigating new technologies and reducing costs can be tricky. This episode dives into the top challenges and opportunities payers face, plus expert advice on how to streamline operations, leverage exciting tech advancements, and ultimately, empower members.This episode is sponsored by EXL.

Join Nate Maslak, CEO of Ribbon Health, as he hosts health plan leaders Will Shrank and Jill Hummel for a discussion on strategies to improve Medicare Star Ratings using provider data. Delve into the significance of Star Ratings for health plans, the impact on revenue, enrollment, and retention, and the crucial role of accurate provider data in improving ratings. Tune in for valuable insights from two health plan executives on how to prioritize Star Ratings and optimize for more positive member experiences and healthcare outcomes. This episode is sponsored by Ribbon Health.    This episode is sponsored by Ribbon Health.  

Tune in for today's industry updates.

Tune in for today's industry updates.

Join Erika Spicer Mason on the Becker’s Healthcare Podcast as she sits down with Anshul Rathi, Founder, and CEO of CertifyOS, to discuss improving healthcare by addressing critical issues like administrative burdens on providers, inefficiencies in provider data management and the impact on patient care. Learn how improving provider data accuracy will improve access to quality care, enhance provider satisfaction, and ultimately transform the healthcare industry's operational framework for facilitating better care matching.This episode is sponsored by CertifyOS.

Join us in this episode as we speak with Shana Hoffman, President & CEO of Lucet, as she dives deep into how provider shortages are impacting everyone, the importance of timely access and the innovative technology solutions payers are using to bridge the gap. We'll also explore how payers and providers can work together to address the social determinants of health and ensure equitable access to behavioral health care for all. This episode is sponsored by Lucet, The Behavioral Health Optimization Company.

Tune in for today's industry updates.

  Tune in as Jakob Emerson from Becker's Healthcare interviews Dr. John Bulger, Chief Medical Officer of Geisinger Health Plan, exploring the factors driving member satisfaction, integration with Geisinger Health System, and Medicare Advantage strategies for 2024. Gain insights into recent developments in the healthcare landscape and valuable advice for insurance executives in this engaging conversation.  

Join us for an insightful conversation with Caroline Carney, President of Behavioral Health and Chief Medical Officer at Magellan Health, as she shares her background and perspectives on current healthcare challenges. Caroline delves into the major issues of 2024, revealing her excitement and concerns, while also discussing the evolving traits necessary for effective healthcare leadership in the near future.

Paula Blomquist, Chief Experience Officer at GoHealth joins the podcast to share insights into her background in retail & journey into healthcare, trends in urgent care she is keeping an eye on, what healthcare leaders need to be successful in the next 2-3 years, and more.

Tune in for today's industry updates.