Becker’s Payer Issues Podcast

In this episode, Jennifer L. Kowalski, Vice President of the Public Policy Institute at Elevance Health, discusses how rigorous research and data shape Medicare Advantage strategy, from supplemental benefits to dual eligible integration. She shares insights on affordability, care navigation, and how evidence based policy can strengthen value, access, and long term sustainability in the program.

In this episode, Karen Walker Johnson, Chief Executive Officer of Clever Care Health Plan, discusses how culturally competent, value based care is reshaping Medicare Advantage. She shares insights on strengthening provider trust, investing in community based engagement, and advocating for quality metrics that recognize cultural competence to improve outcomes and affordability.

In this episode, Jeff Bak, President and Chief Executive Officer of Imagine360, shares how alternative health plan models and reference based pricing can lower employer costs while improving the member experience. He discusses narrowing networks, building provider trust, correcting broker misconceptions, and delivering guaranteed savings in a high pressure cost environment.

In this episode, Emily Durfee, Partner of Corporate Venture Capital at Healthworx, discusses strengthening payer provider collaboration, accelerating responsible AI adoption, and using strategic investment to address regulatory uncertainty and the rising cost of care.

In this episode, Saria Saccocio, MD, MHA, Chief Medical Officer of Essence Healthcare, discusses the growing collaboration between payers and providers, the push for site neutral care and pharmacy cost reform, and the need for stronger investment in cardiometabolic and population health. She also shares how quality performance, member experience, and social determinants of health are shaping healt...

In this episode, Michael Hunn, CEO, and Yunkyung Kim, COO, of CalOptima Health discuss preparing for Medicaid eligibility changes, preventing coverage losses, and supporting providers amid rising uncompensated care risks. They also share plans for a 2027 Covered California marketplace launch and reflect on building community trust through collaboration and mission driven leadership.

In this episode, Jennifer Schirmer, VP of Growth and Community Engagement and interim VP of Duals Program Integration at Blue Shield of California Promise Health Plan, breaks down the sweeping Medicaid changes under HR1 and their impact on California’s Medi-Cal members. She shares how her team is investing in high touch outreach, community partnerships, and duals integration to help vulnerable pop...

In this episode, Elizabeth Crawley, Vice President for Clinical and Care Management Solutions at EXL, explores how AI driven workflows and agentic automation are transforming prior authorization. She discusses balancing efficiency with clinical oversight, scaling decision support across the enterprise, and why data readiness and change management are critical to success. This episode is sponsored...

In this episode, Sheri Johnson, former Vice President of Member Enrollment and Billing at UCare, shares insights on how payer and provider relationships are evolving under cost and workforce pressure, where strategy and operations often misalign, and why AI is poised to reshape health plan performance in the years ahead.

In this episode, Ty Wang, Co-Founder and Chief Executive Officer at Angle Health, shares how his team is rethinking health plan infrastructure to move beyond transactional payer provider relationships. He discusses modernizing operations with AI, improving transparency for employers and brokers, and aligning incentives around outcomes, affordability, and member experience.

In this episode, Eric C. Hunter, President and CEO of CareOregon, discusses how the organization is aligning with providers to improve quality and performance while managing cost pressures. He shares insights on leveraging AI, navigating regulatory challenges, and creating sustainable solutions for Medicaid and community health.

In this episode, Brandy Thompson, Chief Executive Officer of Benefitbay, shares where payer strategy continues to fall short in execution, what investments could reshape health plans, and how reducing administrative complexity can improve margins and access to care.

In this episode, Rob Andrews, Chief Executive Officer of the Health Transformation Alliance, discusses how employers and providers can work more closely to improve value, reduce middleman costs, and drive better outcomes. He shares perspectives on payer competition, transparency, GLP 1 cost pressures, and how technology and personalized medicine may reshape health plans in the years ahead.

In this episode, Melanie Fernando, President and CEO of Aetna Better Health of Illinois, discusses launching a virtual menopause partnership to close gaps in Medicaid women’s health, improve member engagement, and drive better outcomes through tailored, community based solutions.

In this episode, Alex Ding, MD, Enterprise Deputy Chief Medical Officer at Humana, discusses the findings from Humana’s latest Value-Based Care Report, including lower hospital admissions and emergency department visits among Medicare Advantage members in value based arrangements. He shares how deeper primary care continuity, stronger payer provider alignment, and reduced administrative burden are...

In this episode, Steve Sutherland, Senior Vice President of Information Systems at CERIS, shares how AI and machine learning are reshaping payment integrity across the full claims lifecycle. He discusses the shift toward prepayment solutions, the importance of governance and data quality, and how leaders can balance automation with accuracy, fairness, and trust. This episode is spon sponsored by C...

In this episode, Patrick Gilligan, President and CEO of Point32Health, shares how the New England based nonprofit is confronting rising medical and pharmacy costs while staying focused on members and employers as its true shareholders. He discusses the affordability crisis, aligning incentives with providers, and why redesigning care around the patient experience is essential to lowering costs and...

In this episode, Paul Markovich, President and CEO of Ascendiun, discusses his testimony before Congress, the push to eliminate PBM spread pricing and rebates, and why he believes the healthcare industry must confront its cost problem head on. He also shares how Ascendiun’s new structure, digital health record ambitions, and unbundled PBM model aim to build a system that is sustainably affordable...

In this episode, Thomas Graf, MD, Chief Medical Officer for Florida Blue, part of GuideWell, shares how the health plan is improving cancer care through a high-touch, tech-enabled navigation program for Medicare Advantage members. He discusses reducing variation, closing gaps between diagnosis and treatment, and achieving better outcomes, higher satisfaction, and lower costs by centering care arou...

In this episode, Lila Benayoun, Chief Operating Officer at MetroPlusHealth, shares how the organization is translating member affordability data into simpler plan design, predictable costs, and high-touch community support across New York City. She discusses addressing disparities through multilingual outreach, culturally competent services, and operational strategies that help members better unde...

In this episode, Tilak Mandadi, Executive Vice President of Ventures and Chief Experience and Technology Officer at CVS Health, shares how the company is investing in and building technology to simplify healthcare and drive better consumer engagement. He discusses CVS Health Ventures, interoperability, AI strategy, and the vision behind creating an open, consumer-centric platform that connects pay...

In this episode, Dr. Damanjeet Chaubey, Vice President of Clinical Affairs at Clover Health, shares how payer provider relationships are evolving under cost and workforce pressures and where plans often fall short in operational execution. She discusses technology enabled, PCP centric, and home based care models as critical levers for managing utilization, improving outcomes, and sustaining Medica...

In this episode, Craig Kurtzweil, Chief Data and Analytics Officer for UnitedHealthcare’s commercial business, shares insights from UnitedHealthcare’s latest employer health trends report, including rising costs among younger workers, more frequent catastrophic claims, and growing metabolic risks. He discusses how data driven strategies can help employers better target engagement, prevention, and...

In this episode, Brett Bingham, Chief Network Development Officer at Banner Plans and Networks, discusses how payers and providers are shifting toward collaboration amid cost pressures and workforce shortages. He shares where strategy is outpacing execution, why data and payment models matter for value based care, and how Banner is staying disciplined in its long term investments.

In this episode, Kristie Spencer, Vice President of Provider Partnerships at Elevance Health, shares how the company is aligning incentives, leveraging digital tools, and using AI to simplify workflows. She explains how effective partnerships and actionable data are driving better outcomes, affordability, and sustainability in value-based care.