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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Dr. Hassan Rifaat simplifies Value Based Care: what it is, why it matters and how you can benefit. Trained as a physician, Hass also spent 15 years running health plans. His experience from both sides of the industry has helped dozens of providers thrive.
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Conversational technology and patient engagement are two technology trends sweeping through the three trillion dollar healthcare industry. In these short, interactive discussions, industry experts talk about how and where innovation is impacting the customer experience at hospitals, pharmaceutical companies, and the vast array of related services in the industry.
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Change Healthcare is a leading healthcare technology company, focused on accelerating the transformation of the healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system. Learn more at changehealthcare.com. *
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Innovations in Mental Health: A Conversation with Kody Kinsley, North Carolina’s Secretary of Health & Human Services
45:36
45:36
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45:36
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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The Evolution of Specialty Value Based Care
1:00:51
1:00:51
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1:00:51
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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Important and Innovative Approaches to Leveraging the Health Equity Index
49:51
49:51
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49:51
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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Meeting Goals for Chronic Condition Management With Fewer Resources
1:00:16
1:00:16
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1:00:16
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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How Innovators Are Addressing GLP-1s, Obesity and MSK
1:01:27
1:01:27
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1:01:27
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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Supporting Innovation and AI in Healthcare
31:15
31:15
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31:15
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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Lifestyle Modification Strategies to Support Those Living with Obesity and Diabetes
1:01:17
1:01:17
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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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Differentiating Your Health Plan: Reimagining Your Provider Network Strategy
59:56
59:56
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The number one complaint from member centers around directory inaccuracy, highlights a critical need for improved data integrity within provider networks. To tackle this challenge and pave the way for more adaptable, data-driven, and equitable care, health plans are reevaluating and reimagining their provider network strategies. To stay competitive…
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The LLM Inflection Point Moment and the Implications for the Specialty Pharmaceutical Industry
18:48
18:48
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Recent advancements in AI and Large Language Models (LLMs) have caught the world’s attention and for good reason. It’s a big deal. Specialty pharmaceuticals are typically costly, sometimes ranging from $10,000 to over $5 million per patient, per year. The onboarding and approval process that come with these drugs are complex, requiring extensive ef…
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A Conversation with Blue Cross and Blue Shield of North Carolina’s Chief Strategy Officer
31:46
31:46
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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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Talking Bright Spots with Former Congressman Robert Andrews
31:51
31:51
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31:51
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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Safe Babies Safe Moms: Rethinking Equitable Access and Maternity Care
39:15
39:15
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39:15
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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Beyond Medication Adherence: Unleashing the Power of Member Engagement to Elevate Outcomes
1:00:27
1:00:27
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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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Why the ACA Consumer Experience Sucks and How Select Health Fixed It
34:20
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34:20
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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Medicare Advantage and the Next Generation in Home Health Strategies
1:01:25
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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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Can Your Social Care Strategy Drive You to Five Stars?
59:46
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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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The Future of Senior Health: Equitable Access & Open Enrollment
59:12
59:12
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59:12
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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Last-Minute Gaps in Care Strategies
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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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Driving Innovation at Nashville General Hospital
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48:10
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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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AI is Advancing The Member Journey and Improving Lives TODAY
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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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The Disenrollment Tsunami: How to Enhance Your Medicaid Redetermination
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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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How Blue Cross Blue Shield of Arizona is Reinventing the Member Journey
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42:00
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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How Psychedelics Can Bend the Mental Health Cost Curve
37:20
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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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Equity, Engagement & Nutrition: Innovations Empowering the Underserved
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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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How Digital Mental Health is Making an Impact
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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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How Healthfirst is Partnering with a Health System to Make Providers’ Jobs Easier
43:24
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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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The Next Wave of Benefits Navigation for Government Programs
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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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Reduce Total Cost of Care: Innovative Whole Person Models for High-Cost Conditions
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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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Boosting Plan Performance: Improving Provider-Centric Risk Adjustment & Staying Compliant
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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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Unique Approaches to Building Trust with Dual Eligible Members
1:00:22
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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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How Banner|Aetna is Rethinking Whole Person Care
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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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Improve CAHPS through Enhanced Benefits Navigation
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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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Success Stories in Virtual Care Enrollment & Engagement
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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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Partnering for Change: The Benefits of Value-Based Care Models
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VP and Head of Solutions at Nuna, Parag Patel, chats about how the Prometheus Episode Grouper from Change Healthcare has helped Nuna better serve all. Learn More Follow Serrah Linares, vice president of partnerships at Change Healthcare Follow Parag Patel, VP and Head of Solutions at Nuna nuna.com changehealthcare.com/value-based-care/prometheus-an…
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Mitigating Social Risk to Achieve Higher Star Ratings
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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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Sell with a Story in Healthcare with Paul Smith
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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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Equity & Timely Access as a Stars Strategy
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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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Novel Approaches to Care Coordination: The Key to Profitable Risk Models
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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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ACO REACH: Advancing Equity and Optimizing Performance
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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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Building Conversational AI for Healthcare: Tips for Delivering High Patient Satisfaction in a Complex, Regulated Environment
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The full power of conversational AI is being unleashed on the world through a steady stream of technological advancements, such as ChatGPT. It’s only a matter of time before language becomes the dominant interface between humans and machines. The healthcare industry will become one of the prime beneficiaries of this technology leap forward. In this…
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Patient Experience: Social Determinants of Health in Cancer Care
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Thyme Care Co-Founder, President, and CMO, Dr. Bobby Green, joins host Yousuf Zafar, MD, to discuss how his team at Thyme Care are working to provide personalized care guidance to help cancer patients through their journey. Dr. Green also shares the importance of combining a human touch with technology to help improve lives and reduce care costs. L…
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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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Partnering for Change: Improving Access to Care Through Transportation
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Safr Care CEO, Syed Gilani, joins host Serrah Linares to discuss how Safr Care approaches the unique challenges they face, and how Change Healthcare helps Safr Care achieve its mission. Learn More Follow Serrah Linares, vice president of partnerships at Change Healthcare Follow Syed Gilani, President and CEO of Safr Care safrcare.com marketplace.ch…
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2023 Strategy Session: Member Redetermination, CAHPS, and Social Needs
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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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How to Add Innovation to Whole-Person Care
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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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The Power and Potential of Conversational Analytics for Healthcare
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Business intelligence is a cornerstone of every digital transformation, with businesses spending $140B per year in analytics software. As conversational AI and digital engagement technology matures, a new domain of performance insights is emerging with the ability to measure every moment of the interaction between a business and its customers. In t…
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Proactively Managing Risk via Innovations in Last Mile Care
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Health leaders from Network Health, Health Net, Priority Health, and Healthy.io discuss how top health plans improve risk assessment and quality measures through innovations and at-home testing. Topics include: Strategies for deploying novel solutions to drive member engagement and reduce costs for members, especially among traditionally unengaged …
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Peer Support to Improve Medicare Advantage Outcomes
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Our panel of experts from Humana, Regence, SCAN Health Plan and Wisdo discuss how incorporating peer support programs in your MA plans can improve clinical outcomes, lower costs, and boost engagement for members with chronic diseases, behavioral health issues and other social determinants of health. Hear "bright spots" and practical strategies you …
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Staying Ahead of Star Ratings: Planning & Execution Strategies
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Julianne Eckert, Senior Director of Clinical Quality, Clover Health, Andre Bliss, Director of Medicare STARs, UPMC Health Plan and Marisa Howard, Senior Director, MA Operations, Evolent Health, share practical strategies and best practices to help Medicare Advantage plans to execute a successful star rating strategy. Learn significant trends and ga…
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Omolara Thomas Uwemedimo, MD, MPH joins Eric to discuss place-based interventions and how they are used to address health inequities. The place-based model focuses on improving health that aligns with community members, businesses, schools, churches and other institutions in a specific geographic location (a specific community or zip code). Omolara…
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