show episodes
 
Each episode, I interview innovators in the healthcare industry to extract the strategies, tactics, tools, and/or routines they utilize to generate extraordinary, positive outcomes. We highlight and breakdown these bright spots so you can apply them at your organization. "See a bright spot .... and clone it!"
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show series
 
CareSource, Independent Health, and AdhereHealth outline strategies for the upcoming Medicare Advantage Star Rating changes, focusing on medication adherence and the Health Equity Index (HEI) starting in measurement years 2024-2025 for the 2027 Medicare Advantage Star Rating Period. Under HEI, plans must identify disparities in populations with soc…
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Fred Turner, co-founder and chief executive officer of Curative, joins Eric to discuss how Curative is reinventing health insurance by adopting a more preventative approach to drive better results and lead to a more affordable delivery of plans. Fred shares Curative’s journey from a pandemic testing company to a health insurance provider with a fir…
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Leading healthcare investors and strategists discuss how to rethink capital in healthcare and share unique ways to grow and scale companies to improve health outcomes, cost savings, and operational efficiencies. Topics include: Components investors look for in 2024 Healthcare sectors with the highest growth projections Human capital strategies Grow…
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Katherine Gergen Barnett, MD, Vice Chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center (BMC) and Cheryl Harding, patient and community advocate, join Eric to share how Boston Medical Center is utilizing storytelling to build trust and connection between the hospital and its community par…
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Elevance Health, Blue Cross Blue Shield of South Carolina, and the Business Group on Health and Socially Determined discuss how plans can provide a more holistic and effective healthcare journey for members by gaining insight into all barriers to caring for your members, including social risks such as food insecurities, housing instabilities, finan…
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Allison Bryant, MD, MPH, Associate Chief Health Equity Officer, Mass General Brigham (MGB), joins Eric to discuss how the health system ensures its innovations are accessible to everyone, particularly those from marginalized communities. Allison elaborates on MGB's unique approach, viewing its mission as providing healthcare and as a catalyst for i…
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Esteemed leaders from CVS Health, Florida Blue, Highmark, and Vori Health delved into the impact of health equity on chronic care. They not only shared strategies and solutions to enhance healthcare accessibility but also shed light on specific programs they have successfully implemented to bridge the health equity gap in chronic disease prevention…
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Dan Fishbein, President of Sun Life U.S., joins Eric to discuss Sun Life’s commitment to supporting holistic care for mental health and how it leverages digital technology to enhance the overall delivery of mental health and caregiver support to all clients. The conversation also touches on how Sun Life is helping patients navigate a challenging he…
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Leaders from Ballad Health, Baystate Health, Stony Brook Medicine and Purple Lab share how health systems can take a more sophisticated and consumer-focused approach to attracting new patients. Our expert panel leads a thought-provoking discussion on the importance of seeing patients as healthcare consumers and understanding how they make decisions…
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Leaders from Independence Blue Cross, Oscar Health and TytoCare explore how health plans can leverage various solutions effectively to optimize pricing structures; exploring technology adoption, cost-effectiveness, and market competitiveness. Our panel of industry experts will share successful strategies and real-world examples you can implement in…
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Kody Kinsley, Secretary of North Carolina’s Department of Health and Human Services, joins Eric to discuss how his state is improving the lives of families and children by expanding Medicaid and improving the mental health system. Secretary Kinsley shares strategies for improving behavioral healthcare access and benefit design for North Carolina’s …
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Leaders from Humana, Blue Cross, and Blue Shield of Rhode Island delve into the dynamic landscape of specialty value-based care, sharing valuable insights and actionable strategies for navigating its complexities. Show Guests: Alexander Ding, MD, MS, MBA, Associate Vice President for Physician Strategy and Medical Affairs, Humana Nick Lefeber, Seni…
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Melissa Newton Smith, Founder of Newton Smith, and Keslie Crichton, Chief Sales Officer of BeneLynk, join Eric to discuss the introduction of the CMS Health Equity Index, which will replace the reward factor within the Medicare Advantage Star Rating program measurement. The Health Equity Index will be a seismic change for Medicare Advantage plans a…
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Leaders from Independence Blue Cross, Banner| Aetna, and Scene Health share exclusive insights on successfully accomplishing chronic condition management success with fewer resources. Our expert panel explores patient-centered and technology-enabled approaches that elevate chronic care management efficiency and effectiveness. Don't miss the opportu…
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Leaders from Blue Cross and Blue Shield of Illinois, Independent Health, Evry Health and Vori Health discuss GP-1s and their role in addressing the global challenge of obesity. The panel shares innovative, multidisciplinary strategies you can implement to complement lifestyle interventions and other therapeutic approaches in your organization. * Im…
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Seema Kumar, CEO of Cure, an innovation campus in New York City, joins Eric to discuss how artificial intelligence can positively impact healthcare and lead to more innovation. She shares how AI has been used in healthcare and the promise it holds for the future. The conversation also highlights the Cure Xchange Challenge: Health AI For Good, an in…
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Blue Shield of California, Highmark, Intellihealth and NourishedRX discuss how they are mitigating the high costs of GLP-1s with lifestyle interventions such as behavior change, physical exercise, nutritional counseling and coaching to optimize outcomes for members living with obesity and diabetes. Hear real-life examples and best practices to equi…
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Leaders from Blue Cross and Blue Shield of Michigan, Highmark and Quest Analytics discuss how health plans are examining and reimagining their provider strategies to stay competitive and meet their members' evolving needs. By focusing on areas such as compliance, network adequacy, data integrity, and performance metrics, plans are redefining their …
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Sonny Goyal, Senior Vice President of Diversified Business Group and Chief Strategy Officer of Blue Cross Blue Shield of North Carolina (Blue Cross NC), joins Eric to share some of Blue Cross NC’s successful initiatives to help members live their best lives. Sonny discussed Blue Cross NC’s approach to mitigating social determinants of health, expla…
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Former New Jersey Congressman and Health Transformation Alliance (HTA) CEO, Robert Andrews, joins Eric to discuss how HTA – a cooperative of more than 60 of America’s leading employers –and its members employers are fixing our broken healthcare system by sharing data, challenging the status quo and implementing innovative solutions. Robert shares m…
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Angela D. Thomas, DrPH, MPH, MBA, Vice President, Healthcare Delivery Research, MedStar Health Research Institute, joins Eric to discuss D.C. Safe Babies Safe Moms, a community-driven collaborative launched in 2020 to improve the health and well-being of mothers and infants in Washington, D.C., and reduce racial disparities in maternal and infant h…
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Leaders from CareFirst, CareSource, UPMC Health Plan and Scene Health explore how proper medication adherence ensures a higher quality of life, improves health outcomes and reduces healthcare costs. Many health plans saw their overall Medicare Star Ratings drop this year due to one particular area – medication adherence. Our expert panel from top-r…
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Kim Barrus, MSN, RN, PMP, Director, Clinical Outcomes Management of SelectHealth, joins Eric to discuss how her plan reinvented the consumer experience for ACA Marketplace health plans. With almost half of ACA Marketplace customers complaining about making appointments with providers and other process challenges, SelectHealth committed to reversing…
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Leaders from Humana, Healthfirst, Health Leads and Vesta Healthcare join Eric to discuss the future of home healthcare for Medicare Advantage plans. As care delivery strategies evolve, the home is critical in achieving clinical and customer satisfaction ratings that drive business success. Home health is also vital to providing equitable care to al…
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Leaders from Network Health, UPMC Health Plan, Healthmine and Benelynk explore how Medicare Advantage plans can attain 5-Stars and share bright spots on improving outcomes for members with social risk factors. Learn how closing gaps in care and reducing health disparities can help your plan reach 5 Stars! Topics include: CMS Health Equity Index Pro…
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Healthcare leaders from Humana, myPlace Health, Mom’s Meals, and SCAN explore the latest product and benefit design trends for the aging population. Our expert panel shares strategies and best practices your plan can implement to bridge the social and clinical care gap and empower seniors to create a lifetime of healthy habits. Topics include: Prod…
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If your plan is struggling to meet performance and quality goals for 2023, there's still plenty of time to turn things around and ensure members get the preventative care they need while raising your plan’s quality scores by closing care gaps across the healthcare ecosystem. Annually, gaps in care cost the U.S. healthcare system a staggering amount…
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Nashville General Hospital CEO Joseph Webb, D.Sc., MSHA, FACHE, joins Eric to discuss how the hospital is using innovation to fulfill its mission and vision to improve the health and wellness of Nashville – one neighbor at a time. During the conversation, Dr. Webb shares details on two innovative initiatives Nashville General implemented to address…
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Healthcare leaders from Geisinger, Intermountain Health, UNC Health and TytoCare join Eric to discuss how AI and machine learning transform the member journey and empower members to take a more active role in their health. Our experts share successful strategies and best practices your healthcare organization can implement to change the member expe…
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This year's end of the Public Health Emergency and the Medicaid continuous coverage provision kicked off a 12-month unwinding period, which is expected to bring an unprecedented churn in Medicaid programs across the country. Redetermination could cause 18 million Americans to lose health coverage, creating care gaps for the most vulnerable and wide…
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Phylicia Schroeder, Manager, Provider Engagement and Quality Analytics at Blue Cross Blue Shield of Arizona Medicare Advantage and Janine Wakim, Head of Operations at ReferWell, join Eric to discuss how the plan is transforming the member journey by instituting a cultural shift putting the member’s needs above the plan’s needs, adding that to accom…
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Psychedelic Researcher and Psychologist Alex Belser, PhD, joins Eric to discuss the efficacy and safety of psychedelics, how they are being applied in practice and the potential pharmacoeconomic and business impact this category of medications can have on patients with severe mental illness. Alex shares information on the latest research and develo…
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Leaders from Humana, SCAN and NourishedRx discuss the link between food, nutrition security and health and the idea that food and nutrition programs can improve health. Many Americans lack access to nutritious food due to food insecurity, contributing to high rates of chronic disease, poor health outcomes and health disparities, especially among un…
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Healthcare leaders from AmeriHealth Caritas, Cigna Healthcare, Highmark, Reliant Medical Group and Corporate Insight share innovations in mental health, including how their organizations are incorporating and maximizing digital mental health tools and platforms. Learn strategies and approaches you can implement in your organization. Panelists Yavar…
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G.T. Sweeney, Chief Information Officer of Healthfirst and Sami Boshut, Chief Information Officer of MediSys Health Network, Inc., join Eric to discuss how their organizations collaborated with a technology company to create a cloud-based platform that enables seamless sharing of patient data across the care continuum. The platform connects longitu…
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John Petito, Corporate Vice President, Transformation of SCAN Health and Ashish V. Shah, CEO of Dina, discuss the power of benefits navigation in attracting and retaining members for Medicare Advantage plans and other government programs. The average Medicare beneficiary has access to over 43 Medicare Advantage plans, and offering supplemental bene…
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Healthcare leaders from Blue Shield of California, CareSource, UT Health Austin and Vori Health discuss the importance of adopting a whole-person approach across the broader healthcare experience to maximize value, drive healthy behavior change and ensure more equitable care. Learn how to develop an integrated whole-person solution framework and im…
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CDPHP, Johns Hopkins Medicine, Priority Health, ATRIO Health Plans and Vatica Health share successful strategies and best practices for provider-centric risk adjustment programs, which enable health plans to enjoy higher compliance, enhanced quality of care, improved risk score accuracy, higher Star and quality ratings and better financial performa…
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AmeriHealth Caritas, Blue Cross Blue Shield, Optum at Home & Reema Health share bright spots and novel tactics for engaging dual eligible beneficiaries. Discussion topics include: building a foundation of trust through a community approach, engaging hard-to-reach or historically unreachable members, and addressing health-related social needs to imp…
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Joanne Mizell, Chief Operating Officer, Banner|Aetna – a joint venture between CVS Health’s insurance arm, Aetna, and health system Banner Health – joins Eric to discuss what makes Banner|Aetna unique from other health insurers and its approach to whole person care. She shared how the company uses MultiDisciplinary Care Teams to provide high-risk p…
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Healthcare leaders from Alignment Health, SCAN, ATI Advisory and Dina discuss the importance of MA plans to ensure members understand available non-medical benefits. Making the experience painless is essential to attracting and retaining members – and improving CAHPS and Star Ratings. Learn successful strategies and best practices your plan can imp…
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Healthcare leaders from United Health Group, Blue Shield of California, Highmark, Oklahoma Complete Health (Centene) and TytoCare share real-world, virtual care success stories. Gain insight into how virtual care boosts outcomes improves equity and reduces costs. Hear case studies, lessons learned, and best practices you can implement in your organ…
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In its Advance Notice, CMS indicates health equity and social needs will be a major focus in Star Ratings shortly, with new measures in these areas expected by 2026. To prepare, plans need to start planning on effectively intervening with members with social needs factors. Our expert panel will share successful strategies for identifying, engaging,…
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Paul Smith is one of the world’s leading experts in business storytelling. He’s one of Inc. Magazine’s Top 100 Leadership Speakers of 2018, a storytelling coach, and the bestselling author of several books on the art and science of storytelling. During the hour-long session, Paul will discuss the following: What is the optimal structure of a story?…
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Industry leaders from MetroPlusHealth, Network Health, Priority Health and ReferWell discuss strategies to advance health equity and improve care access to achieve higher Star Ratings. As health equity initiatives play an increasingly important role in CMS programs, Medicare Advantage plans must commit to addressing social factors hindering access …
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Carle Health, Cedars-Sinai, Cleveland Clinic, and CarePort, powered by WellSky, discuss innovative and novel approaches to care coordination. Topics include: real-time transparency, streamlining and improving communication, and Interoperability between partner organizations. Panelists: Cynthia Deculus, Chief Population Health Officer and Vice Presi…
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CMS is replacing the Global and Professional Direct Contracting (GPDC) Model with the redesigned ACO Realizing Equity, Access, and Community Health (REACH) Model in 2023. ACO REACH is the first accountable care model to directly address health equity and access to care, with a specific directive to meet the needs of patients from marginalized and u…
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Dr. Errol L. Pierre, Senior Vice President, State Programs at Healthfirst, joins Eric to discuss how health plans, providers and other organizations can create a culture of health equity. He notes the challenges of obtaining the data necessary to understand where to start. Errol advises organizations to gain the patient’s or member’s trust to get t…
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Leaders from Blue Cross Blue Shield Association; Horizon Blue Cross Blue Shield of New Jersey, and Icario, offer insights on the priorities to focus on as we enter 2023. As we turn the page from 2022, health plans are facing new challenges impacting member experience, retention, and, most importantly, their member’s health. Topics include: the new …
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Healthcare leaders from Blue Cross NC, KC Blue, Blue Cross MN and MOBE explore how leading health plans can leverage innovations in clinical, wellness and medication management to build and expand a whole-person care framework. Topics include: building digital care models for Whole-Person Care, developing an integrated whole-person solution; Levera…
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