In this episode, Vinay Kulkarni, Chief Information Officer at SCAN Group, discusses how AI, automation, and digital tools are transforming Medicare Advantage. He explains how these technologies improve care coordination, reduce administrative burden, and personalize care for seniors while maintaining high-quality, empathetic member experiences.

In this episode of Payer Issues, Rachel French, Chief Strategy and Partnerships Officer at MD Live by Evernorth, discusses the impact of point solution fatigue on the member experience, and how MD Live is redefining access with care that's connected, personalized, and provider-guided.This episode is sponsored by MD Live by Evernorth (https://www.mdlive.com/).

This episode features Dave Raccagni, Vice President of Innovation, Market Insights, and Communications at Cigna Healthcare. He discusses Cigna’s partnership with Paytient to expand flexible, no-interest dental payment options for 13 million members, how the program improves preventive and critical care access, and its potential to drive long-term health and cost savings across broader areas of care.

On this episode, Mark Grippi, AmeriHealth Caritas Ohio Market President joins the podcast to discuss opening dialogue with members to improve care, the role of health risk assessments, and overcoming digital fatigue in healthcare.

This episode features Dr. Richard Celko, Chief Dental Officer at UPMC Health Plan who discusses challenges with access to dental care in rural areas, strategies for addressing community needs, and insights on current events shaping the dental industry.

This episode features Heather Tamborino, CFO at EmblemHealth, who discusses the company’s $2 million investment in food security across New York City. She shares how EmblemHealth’s neighborhood care centers are addressing food insecurity, connecting social and medical care, and redefining health equity as both a mission and a strategic imperative.

This episode features Richard Greene, President of Clever Care Health Plan, discussing how the organization is growing through a unique model that combines Eastern and Western medicine, invests in culturally tailored community centers, and builds sustainable relationships with providers and members across California.

This episode features Colleen Briggs, President of the Blue Cross NC Foundation and Vice President of Corporate Responsibility at Blue Cross NC. She discusses the Feed Your Health initiative, how food-based interventions are improving outcomes for members with diabetes, and what it takes to move these programs from pilot to sustainable, systemwide solutions.

In this episode, Michael Carson, President and CEO of Wellcare, a Centene company, shares how his diverse career and mission-driven approach shape Wellcare’s Medicare strategy. He highlights the unique needs of dual eligible members, the importance of integrated care, and the push to improve consumer experience across healthcare.

In this episode, Dan Kueter, CEO of UnitedHealthcare's Employer & Individual business, talks about new tools like the UHC Store, the impact of AI on healthcare navigation, and how employers and members are adapting to rising costs and evolving therapies.

In this episode, Steven Berkow, Senior Advisor for Value-based Care at InterSystems, and Robert Tennant, Executive Director of the Workgroup for Electronic Data Interchange, discuss the evolving landscape of ePrior authorization. They share insights on regulatory changes, industry collaboration, and what healthcare leaders should know as the 2027 compliance date approaches.This episode is sponsored by InterSystems (https://www.intersystems.com/).

In this episode, Zack Myers, National General Manager at SCAN Health Plan, discusses the organization’s expansion into new markets, its nonprofit approach to provider partnerships, and how innovative models like iSNPs are improving care and independence for seniors.

In this episode, Brendan Harris, president of UPMC for You and state programs, shares how initiatives like the Pathways to Work program and Neighborhood Centers are addressing social determinants of health, supporting Medicaid members, and strengthening local communities.

In this episode, Mack McGee, Chief Marketing Officer at CareFirst BlueCross BlueShield, shares how the organization earned top marks for customer experience in Forrester’s 2025 rankings and discusses the importance of trust, personalization, and simplifying healthcare interactions for members.

In this episode, Scott Burton, Market President at Providence Health Plan, shares insights on the growing interest in ICRAs, strategies to manage rising employer health costs, and how Providence is balancing innovation with long-term sustainability in a shifting insurance landscape.

In this episode, Jay Deady, President of Price Optimization at Zelis, discusses why fragmented pricing operations create inefficiencies for health plans and how integrated solutions, advanced technology, and personalization are paving the way for a more connected financial experience across healthcare.This episode is sponsored by Zelis (https://www.zelis.com/?utm_source=adwords&utm_medium=ppc&utm_content=PMAX-LCF&utm_campaign_id=701KX0000008wgvYAA&utm_ad_id=2025-01&creative&keyword&matchtype&network=x&device=c&utm_term&utm_campaign=2025-01-ALL-ENT-PM-BRAND-DISPLAY&hsa_acc=8258471119&hsa_cam=22261073213&hsa_grp&hsa_ad&hsa_src=x&hsa_tgt&hsa_kw&hsa_mt&hsa_net=adwords&hsa_ver=3&gad_source=1&gad_campaignid=22264974718&gbraid=0AAAAACrilZMPl_y5DX9Hjo0IGli6rwgfc&gclid=CjwKCAjwtrXFBhBiEiwAEKen16Oo_Jh65rhTesELzYL777kKIhNT0JA53n7In_Dviyzxc6B52JURehoCOCUQAvD_BwE).

This episode features Cereasa Horner, Director of Policy and Payment Integrity at CERIS, who shares insights on the evolving payer oversight landscape. She discusses the challenges of maintaining consistency across state and federal guidelines, the role of AI and predictive compliance modeling, and strategies for payers to stay proactive in a dynamic regulatory environment.This episode is sponsored by CERIS (https://www.ceris.com/).

In this episode, Bill Harlan, Vice President of Behavioral Health at Point32Health, shares how his team is addressing access challenges, supporting members through navigation services, and building innovative partnerships to improve mental health care delivery.

In this episode, Dan LaVallee and Dr. Brandy Hershberger of UPMC share how the health system is creating innovative apprenticeship programs to support Medicaid members and employees in pursuing meaningful careers. They discuss workforce development, grant funding, and how these programs are shaping the future of healthcare talent pipelines.

In this episode, Alan Cohen, Co-founder and Chief Product Officer at Centivo, joins the podcast to share his perspective on escalating healthcare costs, premium increases, and the risks facing the ACA market. He also explains how Centivo partners with high-performing providers to deliver cost-effective, sustainable coverage for employers and their employees.