Becker’s Payer Issues Podcast

In this episode, Dr. Sanjiv Shah, Chief Medical Officer, MetroPlusHealth, discusses how care management, provider partnerships, and timely information exchange have helped MetroPlusHealth earn consecutive four star Medicare Advantage ratings. He also shares strategies for closing care gaps, improving transitions after hospital stays, and preparing providers for digital quality reporting requiremen...

In this episode, Dr. Alice Chen, Chief Health Officer at Centene, discusses how health plans can use evidence based prevention frameworks to improve outcomes, guide investments, and reduce waste. She shares lessons from food as medicine initiatives and explains why interventions must be supported by rigorous data, tailored to underserved populations, and proven effective before scaling.

In this episode, Ganesh Padmanabhan, CEO and Founder, Autonomize AI, discusses the risks of token maxing, reducing AI variability, and building scalable AI infrastructure for more consistent and accountable payer operations. This episode is sponsored by Autonomize AI .

In this episode, Munjal Shah, Co-Founder & CEO of Hippocratic AI, discusses how healthcare AI can improve patient access and outcomes through rigorous safety testing, clinical safeguards and responsible deployment.  This episode is sponsored by Hippocratic AI .

In this episode, Dan LaVallee, Associate Vice President of Community Engagement at UPMC Health Plan, discusses how an AI powered virtual reality simulator is helping EMT students build clinical readiness, confidence and communication skills. He shares how UPMC’s Freedom House program supports workforce development and how this training model could expand to other communities.

In this episode, Fiona Fang, CEO of Aetna Better Health of Florida, discusses Medicaid challenges, maternal and infant health, whole person care and efforts to help members maintain coverage. She also shares how data, community partnerships and targeted outreach can improve outcomes.

In this episode, Meredith Duncan, president and CEO of Texicare, discusses expanding access to affordable health coverage for small businesses, virtual care, provider network growth and the importance of building strong local relationships with providers and brokers.

In this episode, Ceci Connolly, President and CEO, Alliance of Community Health Plans (ACHP), discusses Medicare Advantage market disruption, plan exits, beneficiary impacts, and the need for risk adjustment reform to support sustainable coverage in local communities.

In this episode, Karen Ignagni, CEO, EmblemHealth, discusses the evolving Medicaid landscape, healthcare affordability, interoperability, and how health plans can use technology, AI, care management, and value-based care to better support members. She also shares insights on her return to the CEO role and EmblemHealth's ongoing transformation.

In this episode, Rick Gordon, Director of Government Programs at Milliman MedInsight, and Nicole Zilliox, Director of Clinical Products at Milliman MedInsight, discuss how Medicare Advantage plans can integrate quality, risk adjustment, clinical data and provider engagement to improve performance. They also explore data governance, audit readiness and proactive workflows for navigating evolving CM...

In this episode, Matthew Hurford, President and CEO of Community Care Behavioral Health at UPMC, discusses workforce development, the growth of UPMC’s Telemedicine Bridge Clinic to 23,000 encounters, and strategies to expand behavioral health access, treatment engagement and recovery.

In this episode, Mike Sanky, Vice President of Healthcare & Life Sciences GTM, Databricks, discusses how health plans can modernize data and AI capabilities to manage rising costs, improve utilization insights and strengthen governance for scalable AI adoption. This episode is sponsored by Databricks .

In this episode, Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross, discusses expanding behavioral health networks, improving access and navigation, and using integrated care strategies to reduce costs and emergency department utilization.

In this episode, Halsey Wise, CEO, Lyric, discusses the importance of trust, truth and transparency in healthcare AI, including decision lineage, governed AI and keeping humans in the loop. He also explores how AI can reduce administrative waste, improve decision-making and strengthen trust among payers, providers and patients. This episode is sponsored by Lyric .

In this episode, Cereasa Horner, Vice President of Payment Integrity and Governance at CERIS, discusses how health plans can adapt to accelerating regulatory changes, strengthen documentation and audit readiness, and improve alignment with providers. She also shares strategies for cross-functional collaboration, transparency and an education-first approach to payment integrity. This episode is spo...

In this episode, David Merritt, Senior Vice President of External Affairs at the Blue Cross Blue Shield Association, discusses rising healthcare costs, employer affordability pressures and the growing impact of the No Surprises Act’s IDR process. He also outlines potential reforms to curb excessive awards, increase transparency and slow premium growth.

In this episode, Jakob Emerson, Associate News Director, Becker’s Healthcare, discusses Centene’s exit from the commercial group markets in California and Oregon, rising employer health insurance costs and growing pressure on coverage. He also explores specialty drug spending, AI-driven administrative costs, payer consolidation and the evolving politics of health insurance.

In this episode, Hunter Foster, VP, Agency Operations and Strategy, benefitbay, explores the growing adoption of ICHRA and defined contribution models, including the demand for flexibility, predictability and employee choice. He also discusses successful implementation, broker adoption, AI's evolving role and what increased carrier participation could mean for the future of health benefits.

In this episode, Nathan Frank, Senior Vice President and Chief Digital and Technology Officer at Aetna, discusses how AI and digital tools are simplifying prior authorization, improving interoperability and enhancing member and provider experiences. He also shares Aetna’s approach to responsible AI, emphasizing human connection, trust and practical technology solutions that reduce administrative b...

In this episode, Dr. Ali Khan, Chief Medical Officer, Aetna Medicare, discusses new findings showing how value-based care improves clinical outcomes, preventive care and hospital utilization for Medicare members. He also shares how Aetna is supporting providers with risk-based arrangements, interoperability and care coordination.

In this episode, Jakob Emerson, Associate News Director, Becker’s Healthcare, discusses the latest Medicare Advantage trends, including SCAN’s new partnership with Costco, insurer market exits, tighter margins, and fewer plan options for seniors. He also explores how changes to Part D subsidies could influence Medicare Advantage enrollment.

In this episode, Amanda Free, Anthem Blue Cross and Blue Shield of Georgia Commercial President, discusses improving healthcare affordability, expanding access in rural communities, strengthening value-based care partnerships and helping members make smarter choices about where and how they receive care.

In this episode, Munjal Shah, Co-founder & CEO of Hippocratic AI, discusses how agentic orchestration can coordinate teams of AI agents to achieve healthcare outcomes such as reducing readmissions, closing care gaps and improving patient follow-up.  This episode is sponsored by Hippocratic AI .

In this episode, Jessica Lopez-Liggett, Commercial State Plan President for Anthem Blue Cross and Blue Shield in Indiana, discusses rising healthcare costs, simplifying the member and provider experience through technology, and expanding high-quality, lower-cost care through provider partnerships. She also shares why addressing social determinants of health and bringing employers, providers and co...

In this episode, Dr. Stanley Crittenden, Chief Medical Officer at Cigna Healthcare, discusses how AI-powered analytics and personalized care management are helping identify health risks earlier, improve outcomes and simplify healthcare navigation. He shares how Cigna is using technology to support clinicians, expand access to care and drive affordability while keeping human connection at the cente...