From Detection to Prevention: AI’s Role in Payment Integrity

In this episode, Jhana Spence, Senior Vice President of Strategy at CERIS, discusses the shift toward proactive payment integrity and what it means to “move left” in the claims lifecycle. She explores how health plans are leveraging data, analytics, and automation to reduce financial leakage, improve provider relationships, and build accuracy before payment goes out the door. This episode is sponsored by CERIS.

In this podcast, Steve Province, former CEO of a major MCO, joins Kendall Lockhart, Founder & CEO of Me+U Care, to unpack why “meeting people where they are” remains so hard in practice for many health plans, and what it will take to rebuild trust under growing HR1 pressures. A grounded, real world conversation about the human side of member retention.This episode is sponsored by Me+U Care.

In this episode, Dr. Faisal Tai, board-certified psychiatrist and founder of PsychPlus, discusses how fragmented systems, limited connectivity, and misaligned incentives are driving gaps in behavioral health access and rising costs. He shares how vertically integrated care models, unified platforms, and better care coordination can improve outcomes, reduce ED utilization, and lower total cost of care at scale.This episode is sponsored by PsychPlus.

In this episode, Gene German, Chief Technology Officer at Lyric, explores how small, domain-specific language models (SLMs) are driving measurable improvements in claims and payment integrity. He outlines how combining AI with human judgment can increase efficiency, reduce variability, and enhance accuracy across complex healthcare workflows. Gene also shares a practical roadmap for scaling AI, from identifying the right use cases to building the data, governance, and feedback systems needed for sustained impact.This episode is sponsored by Lyric.ai.

In this episode, Gretchen Wagner, Associate Vice President - Risk Management, Humana, discusses how health plans are navigating cost pressures, workforce challenges, and rapid change by strengthening value-based partnerships and operational efficiency. She highlights the critical role of data interoperability, digital innovation, and analytics in improving member experience and long-term sustainability.

In this episode, Josh Lumbley, MD, Chief Quality Officer and Senior Vice President of Physician Operations at NorthStar Anesthesia, discusses the critical factors health system leaders should evaluate before transitioning anesthesia partners. He shares practical guidance on transition planning, staffing strategy, transparency, and how strong clinical partnerships ensure operating room stability and long term success.This episode is sponsored by NorthStar Anesthesia.

In this episode, Dr. Sameer Amin of L.A. Care Health Plan discusses how building durable community infrastructure, rather than short-term programs, supports continuity of care amid Medicaid enrollment shifts. He explains how investments in housing, food access, and care coordination can deliver measurable ROI while improving outcomes and reducing administrative burden.

In this episode, Brian Cheney, Division SVP of Sales Operations and Commercial Markets Growth at Health Care Service Corporation, discusses the launch of Unity Health Hub and how it helps employers navigate the growing number of digital health solutions. He explains how the platform integrates vetted vendors, improves member engagement, and delivers clearer data on outcomes and impact.

In this episode, Rhonda Randall, DO, Chief Medical Officer for UnitedHealthcare’s employer and individual business, discusses the company’s expansion of doula coverage to millions of members and the evidence behind its impact on maternal and infant health. She also explains how doulas support care teams and why employers are increasingly prioritizing better maternity care outcomes.

In this episode, Daniel J. Elliott, MD, MSCE, FACP, FAAP, Chief Medical Officer of Provider Experience at Centene Corporation, discusses how payers and providers can work together to address cost pressures, workforce challenges, and care coordination. He also shares perspectives on using AI, improving data sharing, and reducing friction in processes like prior authorization to strengthen the healthcare ecosystem.