PODCAST

Current Trends For Payers

All Episodes

10:40

Lessons From 2026 Enrollment

Current Trends For Payers ·

2026/01/16

Enrollment for 2026 brought major shifts for health plans, driven by new CMS rules, rising consumer expectations, and the growing pressure to modernize operations. This episode explores how plans are rethinking enrollment integrity, broker oversight, digital shopping, data quality, and how emerging interoperability requirements will reshape eligibility, provider data, and automation in the seasons ahead. Tune in to understand how these changes affect the future of enrollment, and how leading ...

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13:17

The Problem With Managing Multiple Vendors

Current Trends For Payers ·

2025/12/16

Is managing multiple vendors slowing your health plan down? Disconnected systems, rising costs, and scattered data often stand in the way of efficiency and better member experiences. This episode explores the challenge of managing multiple vendors and how health plans can escape this antiquated operating model to simplify operations, cut costs, and gain real-time visibility across business functions. Listen to discover how to drive lasting operational excellence with a single, accountab...

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12:57

Pay Now or Pay Later—What Whistleblower Lawsuits...

Current Trends For Payers ·

2025/11/03

Whistleblower lawsuits are pulling back the curtain on risky coding practices and costly compliance gaps in risk adjustment. From inflated RAF scores to vendor oversight failures, the consequences are real and growing. This episode unpacks several DOJ cases that reveal how coding shortcuts, unsupported diagnoses, and non-compliant queries can escalate. From internal governance gaps to coding-policy breakdowns, the message is clear: vendor oversight is a necessity. Listen now to uncover what t...

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13:28

Bonus: Star Rating Report 2026

Current Trends For Payers ·

2025/10/15

The 2026 Medicare Advantage and Part D Star Ratings are out—and they reveal more than just who earned 5 stars. Beneath the numbers lies a clear message: CMS is reshaping what quality means, shifting the balance from member satisfaction to measurable outcomes and data precision. Plans that once thrived on experience scores are now facing tougher cut points, new ECDS-only measures, and the rise of HOS as a major performance driver. This episode unpacks what changed, why it matters, and wh...

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8:12

Risk Adjustment Across Multiple Lines of Business

Current Trends For Payers ·

2025/10/01

Navigating risk adjustment across multiple lines of business isn’t just complex, it’s a balancing act of shifting regulations, diverse populations, and evolving models. In this episode, we break down the key differences between Medicare Advantage, Medicaid, and ACA, and explain why understanding these nuances is crucial for health plans that manage all three simultaneously. Whether you’re grappling with audits, coding accuracy, or technology gaps, this conversation offers real-world insight a...

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11:34

Call Centers in the Age of AI

Current Trends For Payers ·

2025/09/03

What if your contact center could do more than answer questions? What if it could predict needs, detect fraud, translate languages in real time, and coach agents as they speak to members? In this episode, explore how AI is transforming call centers into strategic experience hubs. From agent assist tools that streamline workflows to virtual agents that replace outdated IVRs, we dig into the innovations shaping the future of member engagement. Think a contact center is just about an...

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1:20

Season 4 Trailer

Current Trends For Payers ·

2025/08/04

This season on Current Trends for Payers, we’re highlighting guest experts in emerging technologies and operational strategies that health plans need to stay agile and competitive. We’ll dig into what’s working and what’s coming next, with candid conversations from executives, product, and business leaders. Whether you're focused on risk adjustment, member engagement, or core admin, this season offers a clear look at how forward-thinking health plans are staying ahead. Subscribe to Current Tr...

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11:18

No Analysts Needed

Current Trends For Payers ·

2025/07/01

Health plans continue to face operational delays due to fragmented systems and an over-reliance on manual reporting cycles. While data analysts work across multiple platforms to produce static reports, the insights often arrive too late to support real-time decisions. This episode explores why traditional models are no longer sustainable and how self-service dashboards, powered by a connected data ecosystem, are transforming operational agility. Listeners will hear how prebuilt metrics provid...

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11:19

Bonus Ep: RADV Acceleration: What It Means for...

Current Trends For Payers ·

2025/06/06

CMS has issued a major announcement that’s reshaping how Medicare Advantage plans approach risk adjustment audits. A new era of oversight is here. Defined by tighter timelines, expanded audit scope, and heightened expectations around data accuracy. Along with the announcement, a detailed compliance memo introduces new submission deadlines that demand immediate attention from health plans. This shift has wide-reaching implications for compliance strategy, resource allocation, and revenue prote...

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11:33

From Siloes to Synergy: The Power of Data Hub

Current Trends For Payers ·

2025/06/02

In this episode, we explore how data consolidation is reshaping health plan operations and why it is becoming essential for the future of the industry. From breaking down data silos to enabling real-time, data-driven decisions, data hubs offer health plans a scalable solution to improve efficiency and streamline processes. Discover the challenges health plans face today and how a data-centric ecosystem can unlock powerful insights, enhance member engagement, and drive cost savings. Curious ho...

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11:13

Removing Data Silos For A 360-Member Journey

Current Trends For Payers ·

2025/05/02

Payers are seeking new ways to enhance member engagement and drive long-term retention. This podcast explores a powerful new-to-market strategy for transforming how health plans design member journeys to create a seamless experience in a combination of offline and online environments. Don’t miss the insights in this episode that will redefine how your plan approaches member engagement. About Our Guest: Barb Ody is a payer consultant and expert in member experience solution...

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13:43

The Human Side of Workflow Technology: Claims +...

Current Trends For Payers ·

2025/04/02

Claims and enrollment management can feel like a juggling act, especially with rising volumes and the pressure to meet strict accuracy and timeliness standards. What if there were tools to simplify it all? In this episode, we dive into the game-changing power of modern workflow solutions. Discover how these tools eliminate inefficiencies, prevent cherry-picking by claims and enrollment processors, and streamline auditing, all while boosting internal team communication and productivity. Whethe...

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21:52

Rethinking Total Cost of Ownership In Core Admin

Current Trends For Payers ·

2025/03/04

Health plans often underestimate the full financial burden of their core administration systems. This episode shines a light on the hidden costs buried and spread throughout the lifecycle of a typical core admin vendor contract. We will discuss what total total cost of ownership is, how to evaluate it, and what to do when costs are unexpectedly higher than you anticipated due to spread-out expenses, complex integrations, and recurring upgrades. Listeners will learn how to identify the operati...

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16:43

Achieving a Compliant Query Practice

Current Trends For Payers ·

2025/02/03

Clinical documentation improvement (CDI) is essential for accurate patient care, compliance, and effective risk adjustment. Health plans and providers must work together to address common challenges like incomplete records, workflow disruptions, and slow technology adoption. By integrating solutions that fit seamlessly into provider workflows—whether through EMR-compatible platforms or flexible engagement models—health plans can reduce administrative burdens while ensuring compliance with CMS...

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21:00

Tech Ecosystems: The New Operating Model

Current Trends For Payers ·

2025/01/07

In this episode, we discuss the history of tech ecosystems for health plans, the most common operating model today, the multiple-vendor model, and an innovative new operating model that relies on an end-to-end ecosystem from a single, accountable vendor partner. We discuss the pros and cons of the different models, as well as provide recommendations for future-forward plans that are ready to improve the delivery of healthcare and reduce the inefficiencies native to the industry. About Ou...

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14:24

Lessons Learned From the OIG

Current Trends For Payers ·

2024/12/02

Accurate coding in healthcare is critical, especially with the recent changes brought about by the RADV extrapolation rule. This regulation allows the Office of the Inspector General (OIG) to apply audit findings from a sample across an entire Medicare Advantage plan, significantly increasing the financial risks associated with coding errors. For example, a $500,000 penalty for mistakes in coding can now balloon to millions, making it essential for health plans to prioritize coding accuracy a...

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10:37

From Data to Action: Revolutionizing HEDIS Analytics

Current Trends For Payers ·

2024/11/04

This episode explores the challenges and opportunities plans face during the digital transition. The most common challenges are outdated systems, fragmented data sources, and managing data integration effectively. We discuss innovative strategies to reshape HEDIS reporting and analytics—from integrating diverse digital data into a unified platform to accelerating processing speeds for real-time insights. Plans can leverage these powerful analytical tools, flexible reporting, and actionable da...

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8:29

Bonus Episode: Star Rating Industry Report 2025

Current Trends For Payers ·

2024/10/16

The 2025 Medicare Advantage and Part D Star Ratings were released on October 10, 2024. This year brought significant shifts that will impact health plans across the industry. With new challenges in place and more stringent performance measures, it’s essential for health plans to understand how these changes have affected Star Ratings. The introduction of updated methodologies, such as the use of Electronic Clinical Data Systems (ECDS) for certain measures, and increased weight on critical per...

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19:50

Cyber Security Trends: Third-Party Security Assurances

Current Trends For Payers ·

2024/10/01

Preparation and a vigilant organizational mindset are critical to reducing the financial and reputational risk of cybersecurity incidents. Join CISO, Hans Guilbeaux for an in-depth discussion on ways health plans can ensure their vendors have implemented industry best practices and are prepared for incident response with detailed disaster recovery and business continuity processes.About Our Guest:Hans Guilbeaux is the UST HealthProof CISO and has over 25 years of experience in network a...

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1:15

Season 3 Trailer

Current Trends For Payers ·

2024/08/29

Previously, Medicare Advantage For Health Plans podcast, we're changing names in Season 3 to Current Trends For Payers podcast. In response to the growing needs of our audience, we’re expanding our topic coverage to include commercial, ACA, government-sponsored health plans, and more. You’ll be hearing from experts across all aspects of the business and learning about cutting-edge strategies and tactics used by some of the nation’s most successful health plans. Tune in monthly for exclu...

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Current Trends For Payers

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