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TitreDateDurée
Innovations in Medicare Advantage and Beyond: How Devoted Health is Transforming Care08 Aug 202400:56:31

 

Alec Peterson, MD, Chief Medical Officer of Acute and Specialty Care at Devoted Health, joins Eric to explore the innovative care delivery model that sets Devoted Health apart from other Medicare Advantage plans. Devoted Health uniquely integrates healthcare coverage with its in-house, virtual, and in-home care provider, Devoted Medical, in partnership with leading healthcare providers to offer comprehensive care for older Americans.

 

Alec shares the key strategies behind Devoted Health’s impressive success and delves into how Devoted Medical’s groundbreaking model has driven high member satisfaction and improved clinical outcomes. He also unveils the roadmap for achieving a 5-star rating from CMS for their Medicare Advantage plans in Florida and Ohio.



About Alec

Alec Petersen, MD, is an internal medicine physician and Chief Medical Officer, Acute & Specialty Care with the Devoted Medical team of Devoted Health. In his role, Petersen leads Devoted Health’s Care on Demand program and focuses on maximizing the potential of innovative at-home care delivery without overstressing an already maxed-out healthcare workforce.

 

After receiving his medical degree from Vanderbilt University School of Medicine, Alec completed a clinical fellowship and MBA at Harvard. Before his career in medicine, he served as a military intelligence officer. 

 

About Devoted Health

Founded in 2017 by brothers Todd and Ed Park, Devoted Health is a new kind of healthcare company providing all-in-one care for older Americans. Members of the company’s best-in-class insurance plans can receive care through their trusted PCP and complementary preventative care services through Devoted Medical, the first virtual and in-home medical group built from the ground up to serve the specific needs of the Medicare population. The Devoted Medical team of mission-oriented clinicians works closely with members’ primary care physicians and Devoted’s full-service Guides to deliver a new model of advanced primary care, powered by deeply specialized clinical programs and proprietary technology that enables intensive care coordination.



The Blueprint for Speciality Value-Based Care01 Aug 202400:53:32

Rachel Winokur, CEO, TailorCare and Alex Bateman, CEO, United Musculoskeletal

Partners (UMP) join Eric to discuss the evolution and adoption of specialty value-based care, highlighting the significant improvements in patient care, customer satisfaction scores, cost reduction and value creation.

 

Hear how their two organizations partner with a commercial payer to manage musculoskeletal cases, ensuring they assess patients, understand their needs, and match them with the best providers in the market.

 

Rachel and Alex also touched on the keys to implementing a successful value-based care strategy and underscored the transformative power of data analytics in shaping the future of healthcare.

 

Segments

  1. Origin Story

  2. Payer Experience

  3. Patient Experience

  4. Pitfalls

  5. Strategy/Building

An episode of The Bear, is referenced in the interview. Here is a link to a summary of the episode (Season 2, Ep. 2) https://www.imdb.com/title/tt26230348/

 

About Alex

Alex  is an accomplished, results-driven healthcare leader with 20 years of development and operations experience in multi-state, multi-site healthcare services organizations. He is a proven talent and team builder who adapts and thrives in the changing healthcare space. He is analytical, confident in challenging environments, and regarded as a top company performer in both leadership and growth/development.

 

About Rachel

Rachel is the co-founder and CEO of TailorCare, a risk-based care navigation and health management company that provides deeply personal, data-driven support and clinical access to patients living with joint, back, and muscle pain. Prior to founding TailorCare, Rachel launched Bright Health Group, a value-based healthcare company committed to managing population risk. She served as Chief Business Officer of Bright before serving as the CEO of NeueHealth, the risk-based primary care delivery, provider enablement, and network management company she created within Bright. Rachel built her career in executive and leadership roles at Aetna, where she helped start the health plan’s population health management division, The Carlyle Group, as a healthcare investor, and at Datascope, a public medical device company she helped take private. Rachel has previously held positions at Bertelsmann and Goldman Sachs.

 

About United Musculoskeletal Partners

United Musculoskeletal Partners (UMP) was formed in December 2021 by Resurgens Orthopaedics, one of the nation's largest orthopedic practices. UMP partners with entrepreneurial, physician-owned orthopedic practices to deliver exceptional clinical care to patients around the country while simplifying the management functions of the practices under one umbrella company. Website: www.umpartners.com



This episode is sponsored by TailorCare

TailorCare is a risk-based care navigation program that provides deeply personal support to patients living with joint, back, and muscle pain. By combining a careful assessment of patients’ symptoms, health history, preferences and goals with predictive data and the latest evidence-based guidelines, TailorCare helps patients choose—and navigate—the most effective treatment pathway for them, every step of the way. Website: www.tailorcare.com

Navigating the Intersection of Health Equity and Chronic Care10 May 202401:01:20

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 and treatment. 

 

Guests:

  • Joneigh S. Khaldun, MD, MPH, FACEP, Vice President and Chief Health Equity Officer, CVS Health

  • Kelli Tice, MD, Vice President, Medical Affairs & Chief Health Equity Officer, Florida Blue

  • Nebeyou Abebe, Senior Vice President, Social Determinants of Health, Highmark Health

  • Mary O'Connor, MD, Co-Founder & Chief Medical Officer, Vori Health

 

https://www.brightspotsinhealthcare.com/events/navigating-the-intersection-of-health-equity-and-chronic-care/

 

Links to programs mentioned during the episode

 

 

This episode is sponsored by our partner, Vori Health

Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members get back to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spend with up to a 4:1 ROI. For more information, visit www.vorihealth.com.

 

How Sun Life is Rethinking Mental Health02 May 202400:59:32

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 healthcare system. It’s using data and analytics to identify trends and unmet needs and AI to summarize health records quickly to improve health outcomes.

 

In addition, Dan elaborates on Sun Life’s redefined role as a healthcare benefits provider and its collaborations with various healthcare organizations to help promote health and well-being. 



About Dan

As president of Sun Life U.S., Dan has transformed the company into a leader in health-related benefits and services that connect to the broader healthcare ecosystem to help people access the care and coverage they need.

 

Since joining Sun Life in 2014, Dan has overseen several successful acquisitions that have grown the company and its capabilities, including DentaQuest (2022), PinnacleCare (2021), Maxwell Health (2018), and Assurant Employee Benefits (2016). Since 2014 Sun Life U.S. has grown three-fold to $8 billion in revenues, offering more than 50 million Americans group benefits and services through employers, partners and government programs. It serves a block of in-force individual life insurance policyholders. 

 

Before Sun Life, he served as Aetna’s President, Specialty Businesses and held several other senior leadership positions during his 16-year tenure. He previously served in leadership posts at New York Life and MassMutual.

 

Dan earned a bachelor’s degree and a Doctor of Medicine from Boston University. He is a member of the Massachusetts Medical Society and Maine Medical Association. Dan is also a past chair and active board member of Spurwink Services in Portland, Maine, and serves in an advisory capacity on the board of Collective Health, an insurtech start-up based in San Francisco.

 

About Sun Life

Sun Life is a leading financial services company that helps clients achieve lifetime financial security and live healthier lives. Sun Life has operations in a number of markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda.

 

How Top Hospital Systems are Capturing New Patients26 Apr 202401:01:05

 

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, what motivates them, and how, where, and why they engage with the broader healthcare system. 

 

You will discover innovative patient acquisition strategies and best practices you can implement in your organization to break through the market clutter, differentiate your health system’s offerings and create a message that resonates with customers.

 

Themes covered:

  • Consumer Centricity & The Patient Journey

  • Personalized, Data-Driven Marketing

  • Health Equity

 

Guests:

  • Ebrahim Barkoudah, MD, MPH, MBA, System Chief of Hospital Medicine and Regional Chief Medical Officer/Regional Quality Officer, Baystate Health

  • Timothy Brown, Chief Communications and Marketing Officer, Stony Brook Medicine

  • Molly Luton, Chief Marketing and Communications Officer, Ballad Health

  • Ted Sweetser, Vice President, Strategy, Healthcare, Purple Labs

 

Bios: https://www.brightspotsinhealthcare.com/events/how-top-hospital-systems-are-capturing-new-patients/



We are proud to have Purple Lab as the sponsor of this event. Their support is Instrumental in bringing you this insightful discussion.

PurpleLab is a health tech company that puts valuable healthcare insights in customers' hands, enabling the healthcare industry to drive better outcomes through access to real-world data. https://purplelab.com/

 

Differentiating Your Product and Benefit Design to Drive Enrollment19 Apr 202401:01:10

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 your organization.

 

Topics covered include:

  • Matching benefits with member personas

  • Evolving virtual care beyond video

  • Various innovations in product design 

  • Bringing price transparency to ACA and Medicare Advantage products

  • How to penetrate new, highly competitive markets

 

Guests:

Jonathan Stump, Vice President, Product Services, Independence Blue Cross

Bill Bradley, Vice President, Insurance Product Development, Oscar Health

Meni Shikhman, Vice President, TytoCare

 

Bios: https://www.brightspotsinhealthcare.com/events/differentiating-your-product-in-the-healthcare-insurance-marketplace/

 

This episode is sponsored by TytoCare

TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are five times higher than traditional telehealth services, reduces the total cost of care by an average of five percent, diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for successfully deploying and adopting the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 220 major health systems and plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.

Innovations in Mental Health: A Conversation with Kody Kinsley, North Carolina’s Secretary of Health & Human Services28 Mar 202400:45:36

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 Medicaid and Medicare members, including peer support programs, mental health crisis lines, and data systems to track the availability of beds and individuals in need. 

 

The conversation also explores the importance of improving healthcare infrastructure through Medicaid, focusing on preventative measures and addressing social determinants of health. 

 

About Secretary Kinsley

Kody Kinsley serves as North Carolina’s Secretary of Health & Human Services, overseeing a department with over 18,000 staff and a $38 billion budget.

 

With experience centered on health policy and operations, Kinsley worked on digital healthcare transformation, national education, and labor policies and served as the COO and CFO of the U.S. Treasury.

 

Secretary Kinsley’s three priorities for the department include Investing in behavioral health and resilience, improving child and family well-being, and building a solid and inclusive workforce. Under his leadership, North Carolina expanded Medicaid and received the most significant investment to bolster the mental health system in over a decade.

Kinsley grew up in Wilmington, earning his bachelor’s degree from Brevard College and his master’s in Public Policy from the University of California at Berkeley. 

 

The Evolution of Specialty Value Based Care08 Mar 202401:00:51

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, Senior Vice President, Value-Based Care, Contracting, Data & Analytics, Blue Cross Blue Shield of Rhode Island

Rachel Winokur, Chief Executive Officer, TailorCare

 

https://www.brightspotsinhealthcare.com/events/the-evolution-of-specialty-value-based-care/

 

This episode is sponsored by TailorCare

 

TailorCare is a risk-based care navigation program that provides deeply personal support to patients living with joint, back, and muscle pain. By combining a careful assessment of patients’ symptoms, health history, preferences and goals with predictive data and the latest evidence-based guidelines, TailorCare helps patients choose —and navigate—the most effective treatment pathway for them, every step of the way.

 

Important and Innovative Approaches to Leveraging the Health Equity Index21 Feb 202400:49:51

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 and impact revenue associated with Star Ratings. Melissa and Keslie share success stories from plans preparing for the change. 

Links

"Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use": https://jamanetwork.com/journals/jama-health-forum/fullarticle/2814604

Book Links

 

$2.00 a Day: Living on Almost Nothing in America:  https://www.amazon.com/2-00-Day-audiobook/dp/B012E8RDS2/ref=sr_1_1?crid=29MW28TUOFAG0&keywords=%242+a+day&qid=1708126201&s=books&sprefix=2+a+day%2Cstripbooks%2C125&sr=1-1

 

Because I Said I Wouldhttps://store.becauseisaidiwould.org/store/thebook/?_gl=1*qfwy3p*_ga*OTY3NTIzNTYzLjE3MDgxMjYyNDc.*_ga_9YFXHXM1VK*MTcwODEyNjI0Ny4xLjAuMTcwODEyNjI1NC41My4wLjA

 

The Ethical Case Managerhttps://www.amazon.com/dp/194388918X/ref=cm_sw_r_apin_dp_GVBYY6XZGAK9RK9VRHE8

 

About Melissa

Melissa is the founder of Newton Smith. She brings over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. Most recently, she served as Chief Consulting Officer at Healthmine.

Melissa is a well-known healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience. 

About Keslie

Keslie has worked in managed care for over 25 years, focusing on SDoH solutions that improve members' lives and provide a return on investment for our clients.

Keslie drives enterprise growth and innovative partnerships to improve outreach strategies and health outcomes for our client’s members.  Keslie works closely with BeneLynk’s product team to offer differentiated services and capabilities to maintain its market leader position. 

 

This episode is sponsored by BeneLynk

BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. They serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve.

Meeting Goals for Chronic Condition Management With Fewer Resources16 Feb 202401:00:16

 

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 opportunity to learn about strategic solutions tailored to the unique challenges of Medicaid and Medicare health plans.

 

Panelists:

Robert Groves, MD, Chief Medical Officer & Executive Vice President, Banner| Aetna

Reetika Kumar, MD, FACP, Vice President, Market Clinical Solutions and Pharmacy Services, Independence Blue Cross

Sebastian Seiguer, CEO & Co-Founder, Scene Health

Bios: https://www.brightspotsinhealthcare.com/events/meeting-goals-for-chronic-condition-management-with-fewer-resources/

 

This episode is sponsored by Scene Health

Meet Scene Health, the industry leader in MedEngagement. They are going beyond traditional medication adherence to transform disease management.

 

Scene’s MedEngagement approach uses 1:1 async video to deliver medication support at scale.

 

Scene helps members get better fast—getting to the doctor, getting their meds, taking them as prescribed, and getting labs and vitals—driving cost-effective utilization and improving multiple clinical and quality measures in as little as 90 days.

 

Scene was commercialized out of Johns Hopkins, and has developed the most extensive catalog of peer-reviewed publications among medication adherence companies. Visit its website at www.scene.health for more information.

How Innovators Are Addressing GLP-1s, Obesity and MSK26 Jan 202401:01:27

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.

* Improving outcomes by pairing GLP-1s with evidence-based behavior change

* Considering musculoskeletal (MSK) health in obesity treatment

* Understanding the role of GLP-1s in delivering value-based care

 

Panelists:

Shelley Turk, Divisional Senior Vice President of Health Care Delivery, Blue Cross and Blue Shield of Illinois

Martin Burruano, Vice President, Pharmacy Services, Independent Health

Mamata Majmundar, MD, Chief Medical Officer, Evry Health

Mary O'Connor, MD, FAAOS, Co-Founder & Chief Medical Officer, Vori Health

 

https://www.brightspotsinhealthcare.com/events/how-innovators-are-addressing-glp-1s-obesity-and-msk/

 

This episode is sponsored by Vori Health

Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members get back to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spend with up to a 4:1 ROI. For more information visit www.vorihealth.com.

Supporting Innovation and AI in Healthcare17 Jan 202400:31:15

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 initiative to incubate innovations by healthcare startups and entrepreneurs across disciplines and sectors to use artificial intelligence (AI) responsibly and equitably. Cure collaborated with MIT Solve for the Challenge and an independent board of judges selected the ten finalists. The winners will be announced later in the First Quarter of 2024.

 

Seema shares the stories of several finalists, including Oben Health, an AI-enabled platform that facilitates the delivery of healthcare screenings, education, and treatment via barbershops and salons, and Nutrible, artificially intelligent social workers.

 

This episode is part of a series of episodes featuring the Clinton Global Initiative Commitments to Action from the Clinton Global Initiative. Please listen to the previous episode,  Safe Babies Safe Moms: Rethinking Equitable Access and Maternity Care.

 

About Cure

 

Cure is an innovation campus in NYC boasting laboratories, lecture, and office space, as well as technology and other amenities to set up innovators for success across the healthcare industry, including academic institutions and other nonprofits. Visit the website at: https://cure.345pas.com/

Revolutionizing Health Plans: The Connected Member Experience26 Jul 202401:00:36

BlueCross BlueShield of Tennessee, Cambia Health Solutions, Health Plan of San Joaquin/Mountain Valley Health Plan and Pager Health discuss how technology and innovation transform the member experience, improving clinical outcomes and consumer engagement.

 

Segments: 

  1. Strategy & Culture

  2. Data & Decision-Making

  3. Personalization 

  4. Right Care, Right Time

Panelists:

  • Laurent Rotival, EVP & CIO, Cambia Health Solutions

  • Victoria Worthy, CIO, Health Plan of San Joaquin | Mountain Valley Health Plan

  • Sherri Zink, SVP, Chief Data & Engagement Officer, BlueCross BlueShield of Tennessee

  • Rita Sharma, Chief Product Officer, Pager Health

Bios: https://www.brightspotsinhealthcare.com/events/revolutionizing-health-plans-the-connected-member-experience/#url

 

This episode is sponsored by Pager Health

Pager Health is a connected health platform company that enables healthcare enterprises to deliver high-engagement, intelligent health experiences for their patients, members and teams through integrated technology, AI and concierge services. Our solutions help people get the right care at the right time and in the right place and stay healthy while simultaneously reducing system friction and fragmentation, powering engagement, and orchestrating the enterprise. Pager Health partners with leading payers, providers and employers representing more than 28 million individuals across the United States and Latin America.

Lifestyle Modification Strategies to Support Those Living with Obesity and Diabetes22 Dec 202301:01:17

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 equip your members with the tools and strategies to achieve lasting success in managing obesity and diabetes beyond the limitations of GLP-1s.

 

This episode is sponsored by NourishedRX

 

NourishedRx is a leading digital health and nutrition company specializing in comprehensive nutrition solutions for consumer and health plan members living with diabetes, obesity and other diet-related conditions.

 

NourishedRx recognized food's healing and connective power, and partners with healthcare organizations nationwide to address the nutritional needs of their most vulnerable populations.

 

The NourishedRx B:B:C health and nutrition platform facilitates and optimizes personalized, culturally concordant food in addition to the tools necessary to drive lasting behavior change – leveraging technology so YOU can all deliver at scale.

 

Beyond diet, NourishedRx engages with health plan members and patients to support their whole health and lifestyle more broadly. They engage consumers with omnichannel wrap-around support and education, enabling individuals to make informed choices and gain a deeper understanding of the impact of their diet and lifestyle on their overall well-being, empowering them for the long term.

 

NourishedRx is well suited as an early alternative and/or companion therapy to specialized obesity treatment, including GLP-1 and other Anti-Obesity Medication therapies.

Differentiating Your Health Plan: Reimagining Your Provider Network Strategy08 Dec 202300:59:56

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 own roles and enhancing quality and affordability for their members.

Our panel of experts will share their insights and experiences. Possible topics of discussion:

  • Compliance
  • Network adequacy
  • Data integrity
  • Performance metrics & goals

 https://www.brightspotsinhealthcare.com/events/differentiating-your-health-plan-reimagining-your-provider-network-strategy/

Quest Analytics sponsors this episode

Quest Analytics’ software platform empowers you to analyze, expertly manage meticulously, and impeccably report on your provider network‘s adequacy and the provider data accuracy across your entire organization and all lines of business. You can trust them! CMS does, and they are among eight of the nation’s largest health plans that leverage its software and services, not to mention multiple state regulatory agencies and many of the nation’s leading health systems and provider groups. They manage, measure and monitor health plan network performance so that together, we can elevate the health of communities nationwide. They also enable health plans to differentiate their position in the marketplace through a vastly superior provider network. My words, not theirs, and I know I am simplifying things a bit …but think of them as the Kayak for physician quality and accessibility data. For more information, please visit the Quest Analytics website at http://www.questanalytics.com./

 

 

Connect with us on social media:

Facebook: facebook.com/brightspotshc

Instagram: instagram.com/brightspotshc

LinkedIn: linkedin.com/company/shared-purpose-connect

Twitter: twitter.com/BrightSpotsinHC

TikTok: tiktok.com/@brightspotshc

 

 

A Conversation with Blue Cross and Blue Shield of North Carolina’s Chief Strategy Officer21 Nov 202300:31:46

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, explaining the insurer is utilizing test-and-learn models to build quantifiable evidence, scale up successful models and, eventually, expand those ideas through its benefit offerings across the state. Sonny and Eric touch on several topics, including Blue Cross NC’s recent food insecurity pilot program, value-based care, provider relationships and community health initiatives. After listening, you’ll have many bright spots to consider implementing in your organization!

 

Links to articles mentioned during the discussion:

https://www.bluecrossnc.com/blog/expert-takes/transforming-health-care/food-is-medicine

https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0351

https://mediacenter.bcbsnc.com/news/blue-cross-nc-donates-500-000-to-the-forward-fund-established-to-support-transition-efforts-following-mill-closure

 

About Sonny

Sonny leads the diversified business group at Blue Cross and Blue Shield of North Carolina (Blue Cross NC) while also serving as their chief strategy officer, He is responsible for thoughtfully guiding the company as it seeks to achieve sustainable long-term growth by enhancing its existing business and identifying opportunities to expand beyond via inorganic growth.

Among other responsibilities, Sonny is accountable for managing and maturing the company’s best-in-class business partnerships and assets, shaping Blue Cross NC’s short-term goals and long-term strategy, portfolio planning and prioritization, corporate development and utilizing strategic intelligence to improve the experience of key stakeholders across the state.

Before joining Blue Cross NC, Sonny served in leadership roles at several other leading companies in the healthcare, venture capital and finance sectors. Most recently, he was Executive Director for Corporate Strategy and Development for the Advisory Board Company in Washington, DC. Before that, Sonny led Mergers and Acquisitions for Highmark Blue Cross and Blue Shield; brokered acquisitions, divestitures and capital raises ranging from $250 million to $12 billion at Wells Fargo; and assisted in assessing venture capital investments for Garage Technology Ventures in Silicon Valley. 

Connect with us on social media: 

Facebook: facebook.com/brightspotshc

Instagram: instagram.com/brightspotshc

LinkedIn: linkedin.com/company/shared-purpose-connect

Twitter: twitter.com/BrightSpotsinHC

TikTok: tiktok.com/@brightspotshc

Talking Bright Spots with Former Congressman Robert Andrews16 Nov 202300:31:51

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 many bright spots from HTA, including initiatives in medication management and infant mortality. He explains how the cooperative has saved its member companies well over $2 billion in healthcare costs to date.

 

About Robert

As CEO of the HTA, Robert oversees the strategic direction of approximately 60+ major corporations that have come together in an alliance to fix the broken healthcare system. He is also the Chairman of the Board of Lolo Health, a health tech company that connects consumers to a high-value health experience. Andrews previously led the Government Affairs practice at Dilworth Paxson law firm for two years before joining the HTA.

 

Before private practice, Andrews served as a Member of the United States House of Representatives for nearly 24 years. Upon his departure from Congress, President Barack Obama praised Andrews’ service as “an original author of the Affordable Care Act…and a vital partner in its passage and implementation” and cited his “tenacity and skill” in representing the people of New Jersey.

 

About HTA

The Health Transformation Alliance (HTA) is a cooperative of more than 60 of America’s leading employers coming together to fix the broken healthcare system. Formed by four founding members in September 2015, the HTA member companies collectively are responsible for over 8 million employees, dependents, and retirees with an annual healthcare spend of $30+ billion. 

Some members include Walgreens, 3M, Marriott, Shell, Coca-Cola and NextEra Energy.

Safe Babies Safe Moms: Rethinking Equitable Access and Maternity Care09 Nov 202300:39:15

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 health outcomes – one of the most urgent challenges facing the District of Columbia.

 

Combining the expertise of MedStar Health, evidence-based healthcare, and proven community-centric support services, Safe Babies Safe Moms offers services to support birthing individuals before, during, and after pregnancy and until their child reaches age three. 

 

Angela shares success stories from families supported by the initiative and discusses the program's impact. For health systems interested in implementing a similar program, she outlines MedStar Health's steps in building and sustaining the initiative.  

 

She also speaks about the role technology plays in the initiative. Safe Babies and Safe Moms recently launched a Clinton Global Initiative (CGI) Commitment to Action project to use artificial intelligence and machine learning to help reduce disparities in maternal and infant health.

 

About Safe Babies Safe Moms

Made possible by the A. James & Alice B. Clark Foundation, D.C. Safe Babies Safe Moms is a partnership between MedStar Health, Community of Hope, and Mamatoto Village to address critical maternal and infant care disparities in Washington, D.C., which has among the highest rates of maternal and infant mortality in the nation. In FY22, 15,346 mothers and babies received care through the program.

 

Services offered include on-site mental health support during prenatal and postpartum visits, assessments for high-risk or complicated pregnancies, social support services for mothers and families who may be experiencing food or housing insecurity, pro-bono legal services, and other counseling on securing public benefits, transportation to and from appointments, infant care supplies, culturally-aware breastfeeding support, and more.

 

About Angela 

Angela is responsible for leading a team of experts to apply rigorous scientific methods to enable next-generation healthcare delivery through quality, safety, innovation, health economics, payment reform, outcomes, health services research, data science, and health equity. She also ensures that these research activities leverage the collective leadership and unique strengths of MedStar Health and Georgetown University.

Her research interests focus on health equity and patient safety. As the Executive Leader of Safe Babies Safe Moms, Angela is responsible for ensuring the development, implementation, and evaluation of an evidence-based program that will reduce disparities in maternal and infant mortality in Washington, DC. In addition, she contributes her research expertise in disparities, health equity, and patient safety to the initiative to uncover the contributing factors leading to disparities in maternal and infant harm.

 

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Beyond Medication Adherence: Unleashing the Power of Member Engagement to Elevate Outcomes03 Nov 202301:00:27

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-rated plans shares innovative and actionable strategies for overcoming barriers to medication adherence. 

 

Topics for discussion include:

  • Reasons traditional approaches to medication adherence are not effective

  • Best ways to speed up intervention with a personalized, member-centric approach

  • Financial and ratings impacts of medication adherence measures

 

Confirmed Panelists

Tom Manetti, Associate Vice President, Quality Products, CareSource

Molly McGraw, PharmD, BCPS, Manager, Clinical Pharmacy, UPMC Health Plan

Suzanne Moxham, Director, Quality, Accreditation, & Government Programs at CareFirst BlueCross BlueShield

Sebastian Seiguer, CEO & Co-Founder, Scene Health

 

Bios: https://www.brightspotsinhealthcare.com/events/how-medication-adherence-can-be-much-more-than-medication-adherence/

 

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This episode is sponsored by Scene Health 

Meet Scene Health, the medication engagement company that's taking on the colossal $500 billion problem of medication nonadherence. But here's the twist – they're doing it in a novel way by leveraging asynchronous video engagement.

 

Scene's model of care enhances the CDC-endorsed gold standard for ensuring medication adherence, Directly Observed Therapy. Their team of pharmacists, nurses, and health coaches engage with members via back-and-forth videos to build trust through person-to-person connections and empower every patient to take every dose of medication properly.

 

And they're not just all talk. Scene Health has been clinically validated in 20 peer-reviewed publications and is already teaming up with Medicaid and Medicare health plans, public health departments, and life science organizations to tackle a range of conditions, from diabetes & asthma to sickle cell disease.



Why the ACA Consumer Experience Sucks and How Select Health Fixed It27 Oct 202300:34:20

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 the trend and implementing a complete, end-to-end consumer experience.

 

Kim shares the results of SelectHealth’s efforts and outlines the plan’s strategy giving members the seamless experience they want. Listen and get the roadmap for remaking your plan’s ACA consumer experience! 

 

About Kim

 

Kim Barrus began her career with SelectHealth 26 years ago and has worked in various capacities. She developed the SelectHealth Advanced Primary Care (a.k.a. patient-centered medical home) program. She facilitated the initial pilots of the program in 2010. Today the program has 1,240 participating providers at 222 participating clinics. In her current role, Kim oversees quality, medical home, NCQA accreditation, HEDIS and CMS Stars. 

 

Kim is a registered nurse who received her Bachelor of Science in Computer Information Systems and maintains a Project Management Professional (PMP) certification from the Project Management Institute (PMI). 

 

This episode is sponsored by ReferWell

 

Health plans must be acutely aware of their progress towards achieving their Care Gap Closure targets. Their most significant obstacle is to directly impact those specific areas, even though they have limited capabilities to do so. 

 

ReferWell helps health plans improve access to care by efficiently scheduling members for the care they need. 

 

ReferWell care navigators find the "Perfect Match" provider right at the referable moment when the member is saying yes to their care. They then seamlessly schedule the member's appointment while still on the call. It’s a proven process that provides better access, experience and outcomes for members and better quality performance, which affects the health plan’s bottom line.

Medicare Advantage and the Next Generation in Home Health Strategies20 Oct 202301:01:25

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 all members. Our expert panel lays a blueprint for implementing a successful home care model that your plan can use.

 

Confirmed Panelists:

Susan Beane, MD, FACP, Executive Medical Director, Clinical Partnerships, Healthfirst

Chase Dailey, Principal, Home Solutions, Humana

Randy Klein, CEO, Vesta Health

Dominique Morgan, Chief Operating Officer, Health Leads

https://www.brightspotsinhealthcare.com/events/medicare-advantage-and-the-next-generation-in-home-health-strategies/

 

This episode is sponsored by Vesta Healthcare

Vesta Healthcare is a specialized virtual medical group providing high-touch medical support to patients with chronic conditions. Our program uses technology and patient and caregiver engagement to act on insights gleaned from the first mile of patient care: the home. 

We connect the entire care team - patients, family, caregivers, insurance plans, agencies, doctors, and nurses - to support the best care at home. The ancient Roman goddess of hearth and home inspired our name, Vesta, because our mission is to ensure that people stay in the comfort of their homes as long as possible.

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Can Your Social Care Strategy Drive You to Five Stars?22 Sep 202300:59:46

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

  • Product Enhancement

  • Member Activation and Engagement

  • Payer/Provider Collaboration

  • Social Care Strategy Blueprint

 

Panelists:

  • Andre Bliss, Ph.D., MBA, Director, Medicare STARs, UPMC Health Plan 

  • Mallory Mueller, (she/her/hers) Director Quality Health Integration, Network Health

  • Cherie Shortridge, Senior Advisor, Healthmine 

  • Sean Libby, President, BeneLynk

Bios: https://www.brightspotsinhealthcare.com/events/evolution-of-sdoh-2024-and-beyond/

 

BeneLynk sponsors this episode

BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. We serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve.

 

We build stronger human connections supported by innovative technology by employing one dynamic conversation that flows organically to meet Social Determinants of Health challenges.

 

All of our services are customized to the specific geography, where we provide the members with the specific information they need to keep their benefits in place.

 

Our mission is to improve lives and positively impact Social Determinants of Health barriers by providing our healthcare partners with the information they need and people with the advocacy they deserve.



The Future of Senior Health: Equitable Access & Open Enrollment15 Sep 202300:59:12

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:

  • Product Segmentation

  • SDOH/Supplemental Benefits

  • Care Models

  • Payer and Provider Collaboration

 

Panelists:

  • Catherine Macpherson, MS, RDN, Senior Vice President of Healthcare Strategy & Development, Mom’s Meals

  • Erika Pabo, MD, MBA, Chief Transformation Officer & Central Operations, Centerwell & Conviva, Humana

  • Lena Perelman, Senior Director, Product Development, Market Expansion, SCAN Health Plan

  • Robert Schreiber, MD, AGSF, Vice President and National Medical Director, myPlace Health

 

Bios: https://www.brightspotsinhealthcare.com/events/the-future-of-senior-health-equitable-access-open-enrollment/

 

The Episode is Sponsored by Mom’s Meals

Getting the right nutrition is essential to achieving and maintaining good health – yet accessing balanced meals that also support health challenges and fulfill personal tastes is not always as easy as it should be.

 

At Mom’s Meals, our passion is to provide nourishment and deliver wholesome meals to the homes of those who need better nutrition to support their health and wellness, no matter where they live. It’s the reason we’ve built our business from our own personal roots, caring for our clients as we do our own family and loved ones.

 

Our menus are designed by professional chefs and registered dieticians to taste great and support the nutritional needs of common chronic conditions. Clients get to choose every meal, every order. Meals are delivered to any address, no matter how remote.

 

To learn more visit momsmeals.com. 



From the Sidelines to the Boardroom: Leadership lessons with Michael Lombardi27 Jun 202400:49:16

Former NFL general manager and three-time Super Bowl winner Mike Lombardi joins Eric to share what he learned working with coaching legends Bill Walsh of the 49ers, Al Davis of the Raiders, and Bill Belichick of the Patriots, among others, during his three decades in football and how those core leadership lessons directly translate to managing health plans and hospital systems.

 

He discusses building a winning team, handling high-pressure situations, adapting to change, decision-making under uncertainty, and cultivating a winning culture.

  The Daily Coach Network is accepting applications for 15 new members starting in August. If you submit your application before July 29th and write "Bright Spots" in the referral section you'll receive an extra month on your first membership. Submit your application at apply.thedailycoachnetwork.com    To receive The Daily Coach newsletter, visit https://www.thedaily.coach/subscribe   Books mentioned during episode: Jocko Willink, Dichotomy of Leadership: Balancing the Challenges of Extreme Ownership to Lead and Win; Extreme Ownership: How U.S. Navy Seals Lead and Win David Goggins, Never Finished: Unshackle Your Mind and Win the War Within James Clear, Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones

 

   
Last-Minute Gaps in Care Strategies01 Sep 202301:01:51

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 of time and money. In the complex world of healthcare management and care coordination, closing gaps in care is critical to improving health outcomes and reduce costs. In addition, improving quality metrics directly correlates to identifying and addressing care gaps.

 

Our expert panel will share strategies health plans can use to understand gaps in care throughout the member journey. Hear how plans leverage data and real-time analytics to effectively and efficiently close time-sensitive care gaps to improve HEDIS, Stars and other quality scores.

 

Topics include:

  • Create actionable quality programs to eliminate barriers to care
  • Capture and exchange new data sources to close time-sensitive care gaps
  • Ensure better care collaboration between providers and health plans
  • Enhance follow-up care to boost member engagement

 

Driving Innovation at Nashville General Hospital17 Aug 202300:48:10

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 health equity and transform care delivery.

 

Food Pharmacy: In 2018, Nashville General launched the Food Pharmacy to provide access to food for individuals living with food insecurity and to educate those individuals about which foods best fit within the care plan based on their chronic conditions.

 

Congregational Health and Education Network (CHEN): Launched in 2017, CHEN is a 501(c)(3) faith-based initiative with local churches and educational institutions, with a primary focus on reducing health disparities for communities of color through education attainment, access to healthcare, and health literacy. Currently, CHEN includes 100 faith-based organizations of all denominations throughout Nashville. In addition, Dr. Webb provides a blueprint to help other health organizations implement similar, innovative programs to promote healthy communities and reduce health disparities.

 

In addition, Dr. Webb provides a blueprint to help other health organizations implement similar, innovative programs to promote healthy communities and reduce health disparities.

 

About Dr. Webb

Since joining Nashville General in 2015, Dr. Webb has successfully led efforts to improve patient outcomes, enhance the patient experience and grow revenues. 

Before joining Nashville General Hospital, Dr. Webb served as chief operating officer for Common Table Health Alliance in Memphis, Tennessee. As a former chief executive operating officer for Methodist Le Bonheur South Hospital in Memphis, Tennessee, he held additional chief executive roles for Healthcare Services of America at Coastal Carolina Hospital and Northwest Mississippi Regional Medical Center.

Dr. Webb is board certified in Healthcare Management and is a Fellow of the American College of Healthcare Executives. Nationally, he serves as a board member of America’s Essential Hospitals and as chairman of the Governance Committee. He serves on the board of the Nashville chapter of the American Heart Association and as a board member of NashvilleHealth. Dr. Webb is a member of Omega Psi Phi, Incorporated. 

Dr. Webb earned a Doctorate of Science in Health Services Administration and a Master of Science in Hospital and Health Services Administration from the University of Alabama at Birmingham. He also holds a Bachelor of Science and Master of Science in Health and Physical Education from Tennessee State University.

 

About Nashville General Hospital

A leading safety net hospital with 150 beds and more than 22 clinics. Nashville General Hospital serves as the index teaching hospital for the historic Meharry Medical College. 

Nashville General has earned multiple accreditations for its evidence-based measures and practices that provide quality healthcare. These include The Joint Commission’s Gold Seal of Approval accreditation, NCQA PatientCentered Medical Home accreditation, the NCQA Diabetes Recognition Program, accreditation by the Commission on Cancer for Nashville General’s Robert E. Hardy Cancer Center, and Level 3 TNCPE Performance Excellence Award. 

 The hospital also has increased its revenue sources through expanded healthcare services and launched initiatives to attract new commercially insured patients. These efforts ensure that every patient receives high-quality care at Nashville General Hospital regardless of their ability to pay.

 

AI is Advancing The Member Journey and Improving Lives TODAY28 Jul 202301:01:25

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 experience. 

 

Hear the following case studies and learn how:

  • Intermountain Health physicians use AI to diagnose pneumonia

  • Geisinger leverages AI and machine learning to identify patients at higher risk for colon cancer to ensure they go for a colonoscopy

  • UNC Health determines which patients are best suited for home health care vs. the hospital with AI and machine learning

  • TytoCare drives better patient adoption of virtual care technologies with AI

 

Panelists: 

Nathan Dean, MD, Section Chief of Pulmonary and Critical Care Medicine, Intermountain Medical Center

Rachini Moosavi, Chief Analytics Officer, UNC Health

Karen M. Murphy, PhD, RN, EVP/Chief Innovation and Digital Transformation Officer, Geisinger Ohad Pollak, Chief Marketing Officer, TytoCare

Bios: https://www.brightspotsinhealthcare.com/events/how-ai-is-changing-patient-engagement

 

This episode is sponsored by TytoCare

TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are five times higher than traditional telehealth services; reduces the total cost of care by an average of five percent; diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for successfully deploying and adopting the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 220 major health systems and health plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.

The Disenrollment Tsunami: How to Enhance Your Medicaid Redetermination21 Jul 202300:59:57

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 widening health disparities.

 

To navigate Medicaid Redetermination, MCOs must use data-driven strategies to identify members proactively.

 

Topics for discussion include:

  • Best practices and lessons learned in addressing SDOH and social risk among Medicaid members to manage risk, improve outcomes, and advance equity – at scale
  • Leveraging demographic data and social risk analytics to inform outreach strategies
  • Assessing the impact of health literacy challenges and language barriers

 

This episode is sponsored by Socially Determined

Socially Determined is leading the transformation of health care delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to better manage risk, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit: www.sociallydetermined.com

How Blue Cross Blue Shield of Arizona is Reinventing the Member Journey13 Jul 202300:42:00

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 accomplish this goal, the plan uses data and predictive analytics to learn about what makes its members unique.

 

Topics covered during the episode include:

  • Member journey mindset
  • Navigation and physician scheduling
  • Data integration, risk mitigation (as it relates to CAHPS)
  • Provider engagement

 

Phylicia and Janine share many bright spots your plan can implement to provide a tailored experience for your members!

 

This episode is sponsored by ReferWell

Health plans are acutely aware that they are measured and graded on quality, experience and health equity more so than ever before. Their biggest challenge is to impact those areas directly.

 

ReferWell helps health plans advance health equity by scheduling underserved members for the care they need, be it medical, care gap appointments or — through your community partnerships — appointments for transportation assistance, nutritional counseling, mental health services and other community-based organization offerings.

 

Data shows that ReferWell’s solution directly impacts the members who need it most.

 

ReferWell care navigators find the Perfect Match right at the referable moment (when the member is leaning into their care) and schedules the member while on the phone. It’s a proven process that provides better access, experience and outcomes for members, and better quality performance, which affects the health plan’s bottom line. For more information, visit www.referwell.com.

How Psychedelics Can Bend the Mental Health Cost Curve28 Jun 202300:37:20

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 developments in psychedelics and dispels some of the myths around usage. He also discusses how psychedelics may be more cost-effective than conventional drug treatments for mental health issues and how the medications could change mental health care as we know it. 

About Alex

Dr. Alex Belser is a licensed psychologist and researcher focused on psilocybin, MDMA, and DMT therapies. At Yale, Dr. Belser is investigating a psychedelic treatment for OCD. He is the Chief Clinical Officer of Cybin, where he is the co-creator of a new model of psychedelic-assisted psychotherapy called EMBARK.



Equity, Engagement & Nutrition: Innovations Empowering the Underserved27 Jun 202301:00:59

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 underserved communities. 

 

Our expert panel will share solutions and strategies health plans can adopt to improve health equity, reduce healthcare costs and alleviate the adverse impact of limited access to healthy food among your most vulnerable populations. 

 

Panelists

Romilla Batra, MD, MBA, Chief Medical Officer, SCAN

Leah Brucchieri, Director of Medicare Growth and Innovation at Humana

Lauren Driscoll, Founder and CEO of NourishedRx

Bios: https://www.brightspotsinhealthcare.com/events/equity-engagement-nutrition-innovations-empowering-the-underserved/

 

This Episode is sponsored by NourishedRx

NourishedRx aims to eradicate poor diet and nutrition insecurity as top drivers of death, disease, and disparities. Founded in 2019 by Lauren Driscoll, NourishedRx is a digital health and nutrition company that helps people live healthier lives and supports health equity. Leveraging the healing and connective power of food, NourishedRx partners with healthcare organizations nationally to nourish their most vulnerable members, build healthy relationships, and support health equity. NourishedRx delivers highly personalized, culturally relevant meals and groceries to members, along with wrap-around whole health support and nutrition education. The NourishedRx solution delights and engages members and promotes connection that enables NourishedRx not only to support dietary health and glean actionable insights regarding gaps in care and health-related social needs. Through this solution, NourishedRx can drive better health outcomes and lower overall costs at scale. Visit the website at nourishedrx.com



How Digital Mental Health is Making an Impact10 Jun 202301:01:15

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 Moghimi, MD, Chief Psychiatric Medical Officer, AmeriHealth Caritas 
  • Sam Nordberg, PhD, Chief of Behavioral Health, Reliant Medical Group 
  • Demetrios C. Marousis, MA, MBA, LPC, Director, Behavioral Health, Highmark 
  • William M. Lopez, MD, CPE, National Medical Director-Virtual Care, Senior Medical Director-Behavioral Health, Cigna Healthcare
  • Lauren Roncevic, Senior Director of Healthcare Research, Corporate Insight

Bios:  https://www.brightspotsinhealthcare.com/events/how-digital-mental-health-is-making-an-impact/

This episode is sponsored by Corporate Insight.

Corporate Insight delivers competitive intelligence, user experience research and consulting services to the nation’s leading healthcare, financial services and insurance institutions. As the recognized industry leader in customer experience research for over 30 years, Corporate Insight has been the trusted partner to corporations seeking to improve their digital capabilities and user experience. Their best-in-class research platform and unique approach of analyzing the actual customer experience helps corporations advance their competitive position in the marketplace. Visit their website at: www.corporateinsight.com

 

How Healthfirst is Partnering with a Health System to Make Providers’ Jobs Easier25 May 202300:43:24

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 longitudinal data from claims, quality measures and electronic health records (EHRs) to identify gaps in care, making it easier for providers to address patient needs in real-time. The two discuss how the platform supports the next phase of value-based care by ensuring providers have the right information at the right time to address the needs of patients.

 

Sweeney and Boshut also provide a blueprint to help other organizations implement similar provider-centric technology systems.

 

About Our Guests:

 

G.T. Sweeney has been Healthfirst’s Chief Information Officer since 2014, leading the Information Services department to help transform the insurer's business and tightly integrate information systems to further strategic goals.

 

Sami Boshut has a demonstrated history of working in the hospital and healthcare industry with a proven track record and expertise in Healthcare Consulting, Infrastructure Installations, Software Implementation and Vendor Management.

The Next Wave of Benefits Navigation for Government Programs21 May 202300:38:26

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 benefits such as home-centered care, which enables plans to compete and differentiate in the marketplace. But plans must ensure members understand the benefits and that the navigation experience is seamless – and painless. 

 

John and Ashish share successful strategies and best practices plans that can be implemented to improve the member experience and ensure members receive the care they need. 

 

Topics include:

  • How the Medicare Advantage market is shifting
  • New opportunities for risk-bearing entities
  • Why navigation is so hard and how to enhance it
  • Measuring navigation strategy
  • Improving CAHPS and STAR Ratings through enhanced benefit navigation

 

 

This episode is sponsored by Dina

Dina provides benefits and care coordination solutions to support health plans and providers as they extend care management into the home. Customers use our SaaS technology to digitize their network of community and home-centered providers; transform coordination workflows so they spend less time with phone calls and faxes; collect performance data to improve their network continuously; and capture meaningful data directly from home. Last year, Dina was named to the Inc. 5000 list of fastest-growing companies and CB Insights Digital Health 150 list of companies transforming healthcare with digital technology.



Convergence of Pharmacy & the Health Equity Index in 2024 and Beyond21 Jun 202401:03:29

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 social risks and create intervention strategies to address these inequities. Tune in and gain insights on leveraging policy changes, predictive analytics, and strategic implementation to meet these new standards and reach or maintain 4+ Stars.

 

Panelists:

Amin Serehali, Senior Vice President, Chief Data & Analytics Officer, Independent Health

Logan Fox, PharmD, MBA, Director, Enterprise Quality

Improvement, Programs, CareSource

Kempton Presley, MPH, MS, Chief Strategy Officer, AdhereHealth

 

https://www.brightspotsinhealthcare.com/events/convergence-of-pharmacy-the-health-equity-index-in-2024-and-beyond/

 

This episode is sponsored by AdhereHealth

AdhereHealth is at the forefront of delivering purpose-built, innovative technology solutions designed to elevate pay-for-performance achievement for government-sponsored lines of business. This includes improved Star Ratings for Medicare, plus enhanced patient experience scores, improved patient health outcomes, and optimized cost outcomes for clients. The company’s pioneering efforts are particularly noteworthy for addressing social determinants of health (SDOH) and significantly improving patient experiences as a mechanism for improved Star Ratings performance through multi-modal outreach capabilities.

 

Powered by the industry-leading Adhere Platform™, AdhereHealth integrates predictive analytics, intelligent clinical workflow software, and proactive multi-channel outreach. This combination, executed by a nationwide team of licensed clinicians, effectively drives health equity and adherence outcomes that improve quality of care for patients and boost financial results for clients.

 

The impact of AdhereHealth's comprehensive solutions is far-reaching, touching tens of millions of patients across over 100 health plans, self-insured employers and other risk-bearing entities. Since its inception in 2006, AdhereHealth, headquartered in Franklin, Tennessee, has grown into a robust organization with hundreds of dedicated professionals nationwide, all committed to their mission of improving healthcare outcomes. Visit www.adherehealth.com for more information.

Reduce Total Cost of Care: Innovative Whole Person Models for High-Cost Conditions12 May 202301:00:41

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 implement strategies to support members with chronic and high-risk conditions. Topics include:

  • Adopting self-service digital tools and applications to engage members

  • Providing access to resources, health coaches, medication, and mental/behavioral health support

  • Leveraging medical and SDoH data to determine unique needs, tailor care, and sustain healthy behavior change

 

Panelists: Judith Davis, Vice President Clinical Operations, Ohio Market, CareSource, Angie Kalousek Ebrahimi, Senior Director, Lifestyle Medicine, Blue Shield of California, Karl Koenig, M.D., M.S., Executive Director, Musculoskeletal Institute; Division Chief of Orthopaedic Surgery, Associate Professor of Surgery and Perioperative Care, Dell Medical School, Ryan A. Grant, MD, MBA, FAANS, Founder and Chief Executive Officer, Vori Health

Bios: https://www.brightspotsinhealthcare.com/events/reduce-total-cost-of-care-innovative-whole-person-models-for-high-cost-conditions/

 

Request discount code for our Payer & Provider Summit: https://www.brightspotsinhealthcare.com/summit-promo/



This episode is sponsored by Vori Health

Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members return to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spending with up to a 4:1 ROI, for more information, visit www.vorihealth.com.

Boosting Plan Performance: Improving Provider-Centric Risk Adjustment & Staying Compliant21 Apr 202301:00:06

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 performance. Learn how your plan can empower physicians to close care gaps, avoid common pitfalls and maintain compliant record documentation proactively.

 

Panelists: Gregg Kimmer, President & CEO, ATRIO Health Plans; Michelle Ilitch, MPH, Vice President, Vice President of Network Solutions and Value-Based Programming, Priority Health,; Colleen Gianatasio MHS, CPC, CPC-P, CPMA, CRC, CPCO, CDEO, CPPM, CCDS-0, CCS, and AAPC Approved Instructor, Director Clinical Documentation Integrity and Coding Compliance, Capital District Physician’s Health Plan (CDPHP);  Frank Shipp, FACHE, MBA, Executive Director, Johns Hopkins Clinical Alliance, Johns Hopkins Medicine; Hassan Rifaat, MD, CEO, Vatica

https://www.sharedpurposeconnect.com/events/boosting-plan-performance-improving-provider-centric-risk-adjustment-staying-compliant/

 

For more information on our Payer & Provider Roundtable Summit:

https://brightspotssummit.eventbrite.com

 

This episode is sponsored by Vatica Health

Vatica Health is the #1 rated risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting-edge technology, Vatica increases patient engagement and improves coding accuracy and completeness. It helps identify and facilitate closure of care gaps and enhances communication and collaboration between providers and health plans. The company’s unique provider-centric solution helps payers, providers and patients achieve better outcomes, together.

 

Vatica is trusted by many leading health plans and thousands of providers nationwide. Healthcare research firm KLAS named Vatica “Best in KLAS” for risk adjustment in 2023. KLAS also named Vatica to its Emerging Solutions Top 20 list for innovative companies that have the greatest potential to impact and disrupt the healthcare market. For more information, visit VaticaHealth.com.



Unique Approaches to Building Trust with Dual Eligible Members14 Apr 202301:00:22

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 improve clinical outcomes

 

Panelists Include:

Christopher McDade, Vice President, Medicare Integrated Health Plans and Revenue Management, AmeriHealth Caritas, 

Leanna Moran, Managing Director of the Duals Market, Blue Cross Blue Shield of Rhode Island

Catherine Mitchell, Chief Strategy Officer, Optum at Home

Melissa Kjolsing, Head of Engagement Strategy, Reema Health

Bios: https://www.sharedpurposeconnect.com/events/unique-approaches-to-building-trust-with-dual-eligible-members/



This episode is sponsored by Reema Health

Reema is transforming how people navigate the gaps between health care and social care using technology and Community Guides who share their identity with the members they serve. Reema’s approach improves healthcare experiences, leading to higher member engagement and reduced costs. 

 

Reema’s breakthrough health platform uses proprietary technology and predictive data modeling to identify people with the highest level of unmet social needs, power Community Guides with the right information to engage them meaningfully, connect them with the most relevant resources, and improve their health and lives. Because they believe in guiding all members to better health. Learn more at reemahealth.com



How Banner|Aetna is Rethinking Whole Person Care30 Mar 202300:55:16

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 patients with a localized, high-touch, intensive care management strategy with a unique care approach to meet patients face-to-face.

In addition to sharing numerous bright spots, including a Type 2 Diabetes Reversal program, Joanne lays out a blueprint for building innovative, whole person care programs.

 

About Joanne

Joanne joined Banner|Aetna in February 2018 with over 20 years of Aetna experience and nearly 30 years in the Employee Benefits industry. In this role, and as a member of the executive leadership team, Joanne oversees the organization's operations. She supports the execution of the strategic goals set by Banner|Aetna’s Board of Directors and Chief Executive Officer.

 

Bright Spots in Healthcare has a new website! Please visit: https://www.brightspotsinhealthcare.com/

 

 

Improve CAHPS through Enhanced Benefits Navigation 24 Mar 202301:01:13

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 implement to improve member experience and ensure members receive the care they need. Topics include: Humanizing the navigation process; creating a culture of customer service; using technology to streamline benefit navigation, and leveraging home-centered care 

 

Panel:

Dawn Maroney, CEO of Alignment Health Plan and President, Markets of Alignment Health

John Petito, Corporate Vice President of Strategy & Transformation, SCAN Health Plan 

Ashish V. Shah, CEO, Dina

Anne Tumlinson, CEO, ATI Advisory

Bios: https://www.sharedpurposeconnect.com/events/maximizing-the-impact-of-supplemental-benefits-to-increase-star-ratings/

 

Payer & Provider Executive Roundtable Summit Registration: https://www.eventbrite.com/e/payer-provider-roundtable-summit-engagement-clinical-bright-spots-registration-469644799237

 

This episode is sponsored by Dina

Dina provides benefits and care coordination solutions to support health plans and providers as they extend care management into the home. Customers use our SaaS technology to digitize their network of community and home-centered providers; transform coordination workflows so they spend less time with phone calls and faxes; collect performance data to improve their network continuously; and capture meaningful data directly from home. Last year, Dina was named to the Inc. 5000 list of fastest-growing companies and CB Insights Digital Health 150 list of companies transforming healthcare with digital technology. 



Success Stories in Virtual Care Enrollment & Engagement17 Mar 202301:01:03

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 organization.

 

Topics include:

  1. Engagement, Experience and Equity

  2. Plan Design

  3. Local as a Strategy and Hybrid Care

 

Industry Experts: Nina Birnbaum, Medical Director, Innovation Acceleration, Blue Shield of California; Barbara Koch, Senior Vice President, Office of Health Equity, UnitedHealth Group; 

Timothy Law, DO, Chief Medical Officer, Highmark; Douglas Olivo, Director of Rural Care and Telehealth Services, Oklahoma Complete Health, a subsidiary of Centene; Si Yahav Tirosh, Director of Engagement Labs, TytoCare

Bios: https://www.sharedpurposeconnect.com/events/success-stories-in-virtual-care-enrollment-engagement/



This episode is sponsored by TytoCare

TytoCare allows users to access quality medical care anytime, anywhere, enabling providers to conduct a comprehensive examination of the ears, lungs, heart, throat, heart rate, temperature, skin, abdomen, and more ..all remotely. TytoCare’s handheld exam kit and app connect users with a clinician or specialist for a medical exam and telehealth visit no matter where they are. Clinicians can access clinical-quality exam data to help ensure patients receive the best remote diagnosis and treatment possible. Health providers, insurers, hospitals, clinics, businesses, and schools worldwide are leveraging TytoCare’s remote exam system to deliver on the full promise of telehealth. And when it comes to product design and the consumer experience, no one has them beat.  Companies who are already leveraging their knowledge and platform include Kaiser, Elevance, Amazon and the NHS to name a few. TytoCare is fully compliant and cleared with regulatory bodies, including FDA, CE, HealthCanada, ISO medical, HIPAA, HITRUST, and GDPR. 

Visit: www.tytocare.com

 



Mitigating Social Risk to Achieve Higher Star Ratings03 Mar 202301:01:07

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, and addressing members with elevated social risks to drive gap closure and member retention.

  • Understand the connection between unmet social needs and Star rating performance.
  • Learn what the CMS Advanced Notice and proposed Health Equity Index (HEI) reward incentive structure indicates about the impact of health equity and social needs Star Rating measures.
  • Connect members to high-quality community resources and measure the impact on Star Ratings.
  • Close care gaps through SDoH data

 

This episode is sponsored by Socially Determined

Socially Determined is leading the transformation of healthcare delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk better, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit the website at www.sociallydetermined.com.



Sell with a Story in Healthcare with Paul Smith24 Feb 202300:56:16

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?
  • What different types of stories should we all have at our fingertips for our meetings with health plans and provider organizations?
  • How do we leverage these stories to make a sales pitch?
  • How do we use storytelling to close a sale?

 

At the end of the episode, you will leave with a blueprint for a new storytelling strategy for your sales organization!

Equity & Timely Access as a Stars Strategy18 Feb 202301:02:29

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 to care and driving members to take action to improve their health, such as scheduling a preventive care visit or completing a missed screening.

 Topics include:

  • Creating a true health equity strategy  

  • Using a personalized approach to reaching the unreachable members

  • Creating a trustworthy, comfortable approach to care access

  • Navigation and scheduling

  • Partnering with CBOs

 

Panelists:

Elizabeth Benz, Vice President of Quality and Clinical Integration, Network Health; Gene Huang, Executive Chairman, ReferWell; Brindha Sridhar, Vice President, Customer Experience Strategy, MetroPlusHealth; Alexandria Tusek, Director, HEDIS & Data Analytics, Priority Health

 

Panelist Bios:

https://www.sharedpurposeconnect.com/events/equity-timely-access-as-a-stars-strategy/

 

Bright Spots in Healthcare is hosting our first in-person event on August 24 & 25, 2023, in Boston.  The Executive Roundtable Summit is a unique and transformative gathering, bringing together like-minded leaders from health plans, ACOs, health systems, hospitals, government agencies and community-based organizations for large-scale conversations that matter to the future of healthcare.

 

Payer & Provider Roundtable Summit brochure:  https://images.magnetmail.net/images/clients/SPC_/attach/SPCEventBrochure3.pdf

 

Summit Registration: 

https://brightspotssummit.eventbrite.com

 

This episode is sponsored by ReferWell

ReferWell helps health plans advance health equity by scheduling underserved

members for the care they need, be it medical, care gap appointments or — through

your community partnerships — appointments for services like transportation

assistance, nutritional counseling, mental health services and other community-based

organization offerings.

 

Novel Approaches to Care Coordination: The Key to Profitable Risk Models20 Jan 202301:02:58

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 President, Population Health, Cedars Sinai; Margie Zeglen, MBA, RHIA, Vice President, Population Health, Carle Health; Jessica Hohman, MD, MSc, MSc, President and Medical Director, Cleveland Clinic Medicare Accountable Care Organization; Lissy Hu, M.D., MBA, President, Connected Networks, CarePort, powered by WellSky

Bios: https://www.sharedpurposeconnect.com/events/novel-approaches-to-care-coordination-the-key-to-profitable-risk-models/

 

This episode is sponsored by CarePort, powered by WellSky

CarePort is the leading care coordination network of 2,000 hospitals and 130,000 post-acute and community providers. The end-to-end platform bridges acute and post-acute EHRs, providing visibility into the patient journey for providers, physicians, payers and risk-bearing entities. 

With CarePort, healthcare professionals can efficiently and effectively coordinate patient care with visibility and intelligence to manage patients as they move through the continuum. Visit website at: www.careporthealth.com



Everything You Thought about Value-Based Care Is Wrong: A Plan CEO Tells You Why12 Jun 202400:34:52

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 first-of-its-kind plan that eliminates copays and deductibles and advocates that the most effective approach to promote early preventive care is ensuring accessible and cost-free access to top-tier healthcare providers.

 

Fred underlines the significance of simplifying the healthcare system and the positive impact of Curative's approach. The innovative health insurance plan offers unmatched transparency into healthcare costs, providing reassurance to both employees and employers about the affordability and accessibility of healthcare. 

 

Tune in and learn what makes Curative different from other plans and how it makes health care affordable, accessible and engaging for members.



About Fred

Fred Turner is the Chief Executive Officer and co-founder of Curative. A British scientist from West Yorkshire, Turner attended the University of Oxford. Fred was named one of the top 100 practicing scientists in the UK by the Science Council in 2013. Turner was included in Forbes “30 Under 30” list and ranked first in the European Union Contest for Young Scientists. 

 

About Curative

Curative has been critical and a national leader in bringing COVID-19 testing and vaccine-administration resources in response to the pandemic, providing more than 32 million tests and two million vaccines across thousands of locations in 40+ states. Concurrently, Curative has created and launched a first-of-its-kind health insurance plan offering that offers unmatched transparency into health care costs.

ACO REACH: Advancing Equity and Optimizing Performance13 Jan 202301:00:23

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 underserved communities. If you are participating in ACO REACH, the model provides vital insights into the future of value-based care and care collaboration.

 

This panel will discuss the incentives and requirements laid out by the new ACO REACH model and how organizations can develop action plans to identify differences or disparities in their members’ health status.

 

This episode is sponsored by Socially Determined

Socially Determined is leading the transformation of healthcare delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk better, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit the website at www.sociallydetermined.com.



The Key to Your Health Equity Strategy21 Dec 202200:32:11

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 the information. He also touches on setting ROI expectations for health equity programs, defining terms to normalize the discussion of health disparities within the organization and the business imperative of diversity.

 

Errol shares his identity-defining moments and experience as an executive of color in the healthcare industry. He talks about his new book, The Way Up: Climbing the Corporate Mountain as a Professional of Color, which profiles Errol’s career journey from working in a beauty salon warehouse to being a health insurance executive. The book also offers guidance from prominent executives of color and delivers a pragmatic and actionable guide to help underrepresented individuals from all ethnic backgrounds uncover their passion for achieving their professional goals and elevating their careers.

 

About Errol

 

Dr. Errol L. Pierre is a business executive, healthcare strategist, public speaker, professor, and author. He currently serves as a senior executive of Healthfirst, the largest nonprofit health plan in New York. He is also the former Chief Operating Officer of Empire BlueCross BlueShield, the largest for-profit health plan in New York.

 

Errol graduated from Fordham University with a bachelor’s degree in Business Administration. He later obtained a master’s degree in Health Policy and Financial Management from New York University. He completed his Doctorate in Business Administration from the Zicklin School of Business at Baruch College, focusing on Health Economics. He is a professor at Baruch College, Columbia University, and New York University, teaching Health Economics and Health Transformation and serves on several boards, including the Arthur Ashe Institute for Urban Health and MediNova.

                                     

2023 Strategy Session: Member Redetermination, CAHPS, and Social Needs16 Dec 202201:01:31

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 reality health plans and members will face once the PHE ends and how getting ahead will avoid significant membership losses; CMS’ increased weight on CAHPS surveys will lead to more focus on member satisfaction; New Social Need Screening and Intervention (SNS-E) requirement means that plans will need to get more serious about members’ social needs by 2025

Panel: Mikal Sutton, Managing Director, Medicaid Policy, Blue Cross Blue Shield Association; Mildred Menos, Director of Member Advocacy and Community Outreach Transformation, Horizon Blue Cross Blue Shield of New Jersey; Steve Wigginton, CEO, Icario

Link to bios: https://www.sharedpurposeconnect.com/events/2023-strategy-session-member-redetermination-cahps-and-social-needs/

This Bright Spots in Healthcare episode is sponsored by Icario

Icario is a health action platform that unites pioneering technology, data science, and behavioral insights to connect everyone to better health. Icario develops personalized healthcare experiences that move people to better health with every action while reducing member abrasion through extrinsic and intrinsic motivations. Learn more at icariohealth.com.

How to Add Innovation to Whole-Person Care09 Dec 202201:00:09

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; Leveraging pharmacy and medical claims data; and coordinating physical, behavioral and SDOH care.

Panelists: Angela Lynn, Director of Care Management, NC Blue Cross; Laurie Gehrt, MSN, MBA, RN, CSMC, FACHE, Department Vice President, Care Management, KC Blue; Amy Bloomquist, Director of Population Health Design, Blue Cross MN; and Leslie Helou, PharmD, Vice President, Medication Strategies, MOBE

Bios: https://www.sharedpurposeconnect.com/events/how-to-add-innovation-to-whole-person-care/

This episode is sponsored by MOBE

MOBE is a health outcomes company. They improve health by providing a high-touch one-to-one coaching program focused on lifestyle, emotional well-being, and comprehensive medication management. Using advanced analytics, MOBE identifies populations where they can make a real difference in both individual health status and expense reduction for large employers and health plans.

For more information, visit www.mobeforlife.com

 

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