EmblemHealth, Doctors HealthCare Plans, Security Health Plan, & MedOrion: Rethinking CAHPS & Member Experience

In this Bright Spots in Healthcare episode, host Eric Glazer brings together payer and strategy leaders to explore a fundamental challenge in Medicare Advantage: why improving experience is not about measuring more, but managing better. This conversation focuses on where performance is actually being lost across the member journey, not within individual programs, but in the gaps between them. Plans continue to invest in outreach, pharmacy, provider engagement, and member services, yet still struggle to translate those efforts into consistent member action and measurable outcomes. This is a candid discussion for executives navigating rising expectations around experience, increasing pressure on Stars performance, and the need to deliver results through coordination, not just activity.   Our guests include: Dan Knecht, MD, Chief Medical Officer, EmblemHealth Stacey Friedman, Senior Director, Quality & HEDIS/Stars, Doctors HealthCare Plans Paula Jacobson, Director, Quality and Population Health, Security Health Plan Dave Burianek, Chief Strategy Officer, MedOrion    Together, they explore: Where member experience breaks down across the journey, especially in the moments immediately following enrollment Why campaign-based outreach is no longer sufficient to drive engagement or outcomes How leading plans are shifting from volume to sequencing, focusing on the next best action rather than multiple simultaneous asks What it takes to align pharmacy, quality, and member experience into a coordinated system How organizations are improving performance by reducing friction, increasing clarity, and guiding members toward action  This episode offers a practical look at how leading plans are rethinking CAHPS as a reflection of the full member journey, and what it takes to design that experience in a way that consistently drives performance.  Panelist Bios: https://www.brightspotsinhealthcare.com/events/beyond-the-survey-how-medicare-advantage-plans-are-rethinking-cahps-and-member-experience/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/April_16_Episode_Guide.docx.pdf Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/04-16-26-KIS-Beyond-the-Survey-Session.pdf Resources:  Report: Redesigning Experience: Why CAHPS Performance Is Won or Lost in the Member Journey This report examines why Medicare Advantage plans often see CAHPS results that don't reflect the effort they put in. The issue is not a lack of activity. It's that CAHPS reflects a year's worth of member experience, shaped by care access, coordination, navigation, and follow-through, not isolated interactions or last-minute interventions. Drawing on real-world examples, the report shows how improving underlying care events like annual wellness visits, redirecting care to the right setting, and strengthening member understanding directly influences CAHPS performance, and why results cannot be changed at the end of the measurement year. Inside, you'll find insights on: Why CAHPS questions act as proxies for clinical events like annual wellness visits and care coordination Where campaign-based engagement models fall short in shaping member experience How friction accumulates across touchpoints and impacts perception long before the survey is fielded What changes when plans shift from disconnected outreach to coordinated, journey-based design How aligning Stars, quality, and care delivery reduces fragmentation and improves outcomes Why understanding member barriers, including access, confusion, and behavioral factors, is critical to driving action The broader lesson is operational: plans that consistently perform on CAHPS are not doing more outreach. They are designing member journeys that reduce friction, coordinate care and communication, and naturally produce better experiences over time. To request your copy of the report, please contact show producer Jessica Tenzer at [email protected]. Thank You to Our Episode Partner, MedOrion: MedOrion helps health plans move beyond static segmentation by using real-time clinical, situational, and behavioral signals to drive meaningful member action. By identifying who to engage, what barriers exist, and when to intervene, MedOrion enables more precise prioritization and coordination of outreach. This approach helps close care gaps, improve adherence, reduce avoidable utilization, and drive more consistent performance across cost, quality, and experience. Learn more at medorion.com.  Schedule a Meeting with a Senior Leader at MedOrion: To explore how MedOrion can support your organization in moving from campaign-based outreach to coordinated, signal-driven engagement, reach out to show producer Nicole Roberts at [email protected] to schedule a conversation with a member of the MedOrion leadership team.    About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

In this Bright Spots in Healthcare episode, host Eric Glazer brings together payer leaders to explore a fundamental challenge in Medicare Advantage: why strong strategies often fail to translate into sustained performance. This conversation focuses on the gap between intention and execution, where plans invest heavily in programs, outreach, and data, yet still struggle to drive the member actions that ultimately determine cost, quality, and experience. This is a candid discussion for executives navigating rising pressure on margins, increasing complexity in member populations, and the growing need to prove performance beyond activity alone. Our guests include: Mike Rapach, President & CEO, CareFirst Community Health Plan Maryland Joshua Meeks, Vice President, Medicare Advantage Individual Business, Blue Cross Blue Shield of Michigan Jen Cohen-Smith, SVP Medicare, Healthfirst Kathleen Faulk, Chief Strategy Officer, Drips Together, they explore: Where Medicare Advantage strategies break down, not in design, but in execution Why member engagement alone is no longer sufficient to drive outcomes How leading plans are shifting from outreach to activation by addressing barriers to action in real time What it takes to align product design, pharmacy strategy, and operational workflows to support long-term sustainability How organizations are translating insight into action to improve adherence, reduce avoidable utilization, and drive measurable ROI This episode offers a practical look at how leading plans are redefining performance in Medicare Advantage, and what it takes to ensure that strategy actually delivers results at scale. Panelist Bios: https://www.brightspotsinhealthcare.com/events/ma-strategy-session-what-actually-drives-long-term-viability/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide here: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/Episode-Guide-MA-Strategy-Session-04-09-26.docx.pdf  Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/04-09-26-KIS-MA-Strategy-Session_-What-Actually-Drives-Long-Term-Viability-Drips.docx.pdf  Resources:  Report: Stop Engaging, Start Activating; The New Architecture of Medicare Advantage Performance This companion report examines how health plans can close the gap between strategy and execution by focusing on what actually drives performance: whether members take action. Drawing on real-world implementation and emerging activation models, the report shows how identifying friction, understanding barriers, and guiding behavior in real time can improve adherence, reduce avoidable utilization, and strengthen outcomes across cost, quality, and experience. Inside, you'll find insights on: Identifying where outreach breaks down and why engagement alone fails to drive meaningful outcomes Understanding the root causes of non-adherence, including confusion, access barriers, competing priorities, and system design gaps Shifting from one-way communication to two-way, real-time conversations that surface and resolve barriers to action Designing activation models that guide members through next steps and increase completion of key actions Aligning engagement strategies with operational workflows to reduce friction and improve performance at scale Why moving from activity-based metrics to action-based outcomes is critical as financial pressure, regulatory changes, and member complexity increase The broader lesson is operational: the strongest Medicare Advantage models are not defined by how much outreach occurs, but by how effectively plans convert insight into action and ensure follow-through on the moments that matter most. To request your copy of the report, please contact show producer Jessica Tenzer at [email protected]. Thank You to Our Episode Partner, Drips: Drips helps health plans and providers drive meaningful member action through AI-powered, two-way communication at scale. By engaging members through familiar channels like text and phone, Drips enables real-time conversations that surface barriers, guide next steps, and improve adherence. Its approach shifts organizations from outreach to activation, helping close care gaps, reduce friction, and deliver more consistent performance across cost, quality, and experience. Learn more at drips.com. Schedule a Meeting with a Senior Leader at Drips: To explore how Drips can support your organization in moving from engagement to activation and improving member follow-through, reach out to show producer Jessica Tenzer at [email protected] to schedule a conversation with a member of the Drips leadership team.   About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

Chronic care isn't failing because of strategy. It's breaking down in execution. In this episode of Bright Spots in Healthcare, host Eric Glazer brings together provider leaders to explore a critical issue: the loss of time, attention, and clinical capacity to inefficient workflows instead of patient care. This conversation highlights how organizations are making structural changes to reduce friction, improve follow-up, and build more sustainable chronic care models. 🎯 What you'll learn: Why chronic care breaks down in workflow, not strategy How leading providers reduce administrative burden What changes when documentation stops dominating care How follow-up systems are redesigned to close care gaps How augmented care models expand capacity without replacing human care 👥 Featured Leaders: Francis Mercado, MD – Board Chair, CommonSpirit Health ACO Danielle Whitacre, MD – Chief Medical Officer, Bloom Healthcare Lilian Alevato, MD – Chief Medical Officer, White-Wilson Medical Center Ava Johnson – Director, Ambulatory CDQI, Mount Sinai Hospital Carol Roeder, MD – Chief Medical Officer, Nightingale.MD 📥 Resources & Links: 👉 Panelist Bios: https://www.brightspotsinhealthcare.com/events/how-leading-providers-are-reclaiming-time-value-in-chronic-care/ 👉 Download the Episode Guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/Episode-Guide-Bright-Spots-in-Health-Care-04-02-26.pdf 👉 Key Insights Summary: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/Key-Takeaways_-Reclaiming-Time-Value-in-Chronic-Care-04-02-26.docx.pdf 📩 Request the full reports: [email protected] 📊 Featured Reports: Chronic Care Breaks Down in Workflow, Not Strategy Learn how redesigning workflows and automating low-value tasks improves capacity and patient outcomes. What an Augmented Care Manager Model Looks Like in Practice See how AI-assisted care models extend reach while preserving human interaction and clinical judgment. 🤝 Episode Partner: Nightingale.MD Nightingale.MD helps provider organizations redesign chronic care workflows using an augmented care model. Their AI assistant, Florence™, supports outreach, follow-up, and documentation while allowing clinical teams to focus on high-value patient care. 🌐 Learn more: https://www.nightingale.md 📩 Schedule a meeting with Carol Roeder, MD: Contact Vekonda Luangaphay at [email protected] 🧠 About Bright Spots Ventures Bright Spots Ventures is a healthcare strategy and engagement company focused on scaling proven innovations. They connect healthcare leaders through podcasts, executive councils, and private events to accelerate measurable impact. 🌐 Visit: https://www.brightspotsinhealthcare.com

In this Bright Spots in Healthcare episode, host Eric Glazer brought together payer and provider leaders to examine a major shift underway in specialty care. Historically, specialty models have been built around episodic intervention, stepping in after a condition has progressed. But as organizations take on greater accountability for outcomes and cost, that model is becoming harder to sustain. The conversation explored how AI, earlier signal detection, and more connected care models can help organizations identify risk sooner, guide members more effectively, and support better outcomes over time. Our guests include: Saria Saccocio, MD, Chief Medical Officer, Essence Healthcare  Ross Lagerblade, Vice President, Value Based Strategies, Humana Mary O'Connor, MD, Chief Medical Officer & Co-Founder, Vori Health   Together, they explored: How specialty care is evolving from reactive, episode-based intervention to models built around continuous visibility and earlier action How organizations are identifying risk that never shows up in traditional data, and what it takes to surface and act on those blind spots How leading plans are redesigning the member experience to create clearer, more guided pathways through complex specialty care journeys What it looks like to use AI and new data sources to scale outreach, triage, and coordination without increasing operational burden How clinically grounded models are ensuring members are directed to the right level of care at the right time, avoiding unnecessary escalation What it takes to align care delivery, incentives, and measurement around sustained outcomes rather than isolated interventions This episode offers an inside look at how leaders are building more proactive, coordinated specialty care models, and what it takes to make them work in practice. Panelist Bios: https://www.brightspotsinhealthcare.com/events/ai-and-specialty-vbc-moving-from-episodic-care-to-longitudinal-outcomes/   Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/03/EpisodeGuideBrightSpotsinHealthCare032626.pdf Key Insights Summary: Find key insights from the discussion and guest takeaways from the conversation. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/03/Key-Insights-03-26-26.docx.pdf Resources:  Report: Moving Specialty Care Upstream: From Episodic Intervention to Longitudinal Outcomes This companion report from Vori Health explores how physician-led, longitudinal care models are helping organizations identify risk earlier, guide members more effectively, and improve outcomes over time. Drawing on real-world implementation, it highlights how combining clinical expertise with data, AI, and coordinated care pathways can shift specialty care from reactive treatment to continuous management. Inside, you'll find insights on: Extending specialty care beyond traditional encounters to support members earlier in their journey Designing clinically grounded care pathways that guide members to the right level of care at the right time Using data, wearables, and AI to surface risk that is not visible in traditional workflows Reducing unnecessary escalation, procedures, and downstream cost through earlier intervention Building scalable models that combine centralized coordination with physician-led care delivery Why longitudinal accountability is becoming essential as expectations for outcomes, experience, and cost continue to rise To request your copy, reach out to show producer Nicole Roberts at [email protected] Thank You to Our Episode Partner,  Vori Health By combining a physician-led care model with data-driven insights and longitudinal support, Vori Health is helping extend specialty care beyond episodic encounters and into continuous, whole-person care. In addition to improving access, Vori Health drives better outcomes, stronger member engagement, and meaningful reductions in unnecessary procedures and total cost of care. You can learn more at vorihealth.com. Schedule a Meeting with a Vori Health Leader: To explore how Vori Health can support your organization in delivering physician-led, longitudinal specialty care and guiding members earlier to the right level of care, reach out to show producer Nicole Roberts at [email protected] to schedule a conversation with a senior leader from Vori Health. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

In this Bright Spots in Healthcare episode, host Eric Glazer convenes provider and health system leaders working at the front lines of rural healthcare transformation across Texas. The conversation explores what it actually takes to extend clinical expertise across distance, workforce shortages, and infrastructure gaps, and how organizations are redesigning care delivery to meet patients where they are. This is a candid discussion for leaders navigating real operational constraints while building models that can scale. Together, the panel explores how hybrid care, digital infrastructure, and new collaboration models are reshaping access across some of the most complex care environments in the country. Our guests include: Pothik Chatterjee, MBA, Executive Director, Digital Health Institute, Rice University & Houston Methodist Reyann Davis, MPH, Director of Value-Based Care, Rural and Community Health Institute, Texas A&M Health Indira Vadlamani, MD, Division Medical Director, Gulf Coast Division, HCA Houston Healthcare Together, they explore: How rural health systems are addressing structural barriers including workforce shortages, transportation challenges, and limited broadband access What it takes to redesign workflows and build repeatable operational playbooks that can scale across rural hospitals How virtual care models such as Virtual ICUs, remote monitoring, and multidisciplinary collaboration are extending clinical expertise beyond traditional settings What actually works when organizations combine centralized support, local care teams, and hybrid care models to improve access and outcomes How emerging technologies including AI, wearables, and remote diagnostics are enabling earlier intervention, improving efficiency, and reducing strain on clinicians This episode offers an inside look at how leaders are building practical, scalable models to close rural care gaps, and what it takes to make those models work in real-world conditions. Panelist Bios: https://www.brightspotsinhealthcare.com/events/the-texas-access-playbook-how-innovation-is-closing-rural-care-gaps/   Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/03/Episode-Guide-Bright-Spots-in-Health-Care-TytoCare-03-19-26.pdf Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/03/Key-Takeaways_-The-Texas-Access-Playbook_-How-Innovation-Is-Closing-Rural-Care-Gaps-03-19-26.pdf  Resources:  Report: Expanding Access to High-Quality School Health Services Across the U.S. This companion report from Avel eCare explores how school-based virtual care models can expand access to timely, high-quality care for students, particularly in rural and underserved communities. Drawing on real-world implementation, the report shows how connecting schools with remote clinicians and equipping them with diagnostic tools can reduce care delays, improve outcomes, and bring clinical expertise directly into the classroom. Inside, you'll find insights on: Extending care into schools to overcome barriers related to transportation, workforce shortages, and limited access to providers Designing hybrid care models that combine school staff with remote clinicians to deliver real-time medical evaluations Using connected diagnostic tools to enable in-school exams that replicate in-clinic care Reducing unnecessary emergency department visits while keeping students in school and engaged in learning Building scalable models that leverage centralized clinical expertise while maintaining local presence and trust Why school-based care is becoming a critical access point as pediatric care gaps continue to widen To request your copy from show producer, Jessica Tenzer at email [email protected]. Thank You to Our Episode Partner, TytoCare: TytoCare is transforming how providers and health plans deliver care by enabling remote, medical-grade exams from home and community settings. Through its Home Smart Clinic and Pro Smart Clinic, TytoCare combines FDA-cleared diagnostic tools with AI-powered guidance to help clinicians deliver real-time diagnosis and care beyond traditional settings. This approach drives higher utilization, improves access, reduces unnecessary emergency department visits, and delivers measurable impact across diverse populations. Learn more at tytocare.com Schedule a Meeting with a TytoCare Leader: To explore how TytoCare can support your organization in extending care into homes, schools, and community settings, reach out to show producer Jessica Tenzer at [email protected] to schedule a meeting with a senior leader from TytoCare. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

In this episode of Bright Spots in Healthcare, recorded live at the ViVE 2026 conference, Eric Glazer sits down with Dr. Reshma Gupta from UC Davis Health to explore how health systems can translate artificial intelligence and predictive analytics into real operational improvement. As Chief of Population Health and Accountable Care, Reshma focuses on turning data and predictive insight into measurable outcomes across prevention, care management, and accountable care programs. Her work highlights a central challenge facing healthcare leaders today: many organizations have the models, but far fewer have built the workflows, governance, and operational alignment needed to turn those insights into action. The conversation dives into: Why successful AI initiatives connect predictions directly to clinical workflows, incentives, and operational ownership How UC Davis Health expanded its high risk population health strategy into the Emergency Department Approaches to measuring the value of prevention including avoided admissions and downstream outcomes Where predictive analytics supports prevention and population health within accountable care models How UC Davis developed the BE FAIR framework to evaluate predictive models for bias and equity The governance structures that help health systems move quickly with AI while maintaining trust and accountability Practical lessons for moving AI from isolated pilots into measurable performance improvement This discussion offers a practical blueprint for health system leaders working to strengthen prevention, population health, and accountable care through data driven insight. The organizations seeing real results are those aligning data, workflow, incentives, and governance so predictive insight translates into better decisions and measurable outcomes. References: BE FAIR Framework: UC Davis Health's framework for assessing, implementing, and redesigning predictive models to reduce bias and improve equity in healthcare. https://pmc.ncbi.nlm.nih.gov/articles/PMC12405130/ UC Davis Health AI for Population Health: How UC Davis Health uses predictive analytics to identify patients at risk and support earlier intervention in population health programs. https://health.ucdavis.edu/news/headlines/uc-davis-health-uses-ai-models-to-leave-no-patient-behind/2025/04 Reshma Gupta Bio: https://health.ucdavis.edu/population-health/leadership/reshma-gupta.html   Partner with Bright Spots Ventures: If you are interested in speaking with the Bright Spots Ventures team to brainstorm how we can help you grow your business through credibility building content and trusted executive relationships, email [email protected] About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.

In this Bright Spots in Healthcare episode, host Eric Glazer convenes health plan leaders who are focused on what happens beyond the clinic visit, the moments between care where behavior, adherence, and risk quietly take shape. The conversation centers on how plans are operationalizing care without proximity by extending support into daily life, redesigning benefit strategies, and moving from episodic measurement to longitudinal influence. This is a candid discussion for executives who are still building, still questioning assumptions, and still shaping what sustainable, whole-person care can become. Together, the panel explores how digitally enabled self-management, continuous insight, and targeted human support are changing how plans influence outcomes over time. Our guests include: Timothy Law, DO, MBA, Chief Medical Officer, Highmark Inc. Deborah Hammond, MD, Vice President, Medical Director, Healthfirst Jamie Zajac, Senior Director of Care Coordination, Colorado Access Omar Manejwala, MD, Chief Medical Officer, DarioHealth Together, they explore: How health plans are designing care models around daily life rather than visit cadence, closing visibility gaps that claims and labs fail to capture What actually works when continuous engagement, behavioral support, and real-time data are combined to influence adherence and sustained behavior change How home-based data capture, AI-driven personalization, and integrated human coaching are improving outcomes across cardiometabolic, behavioral health, and musculoskeletal populations How these capabilities are being embedded into care management, quality improvement, and benefit design, particularly in environments facing access barriers, workforce constraints, and geographic limitations This episode offers an honest look at the structural, operational, and cultural shifts required to manage what happens between visits, and why that interval is where outcomes are ultimately won. Panelist Bios: https://www.brightspotsinhealthcare.com/events/care-without-proximity-winning-the-moments-between-care/   Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://docs.google.com/document/d/1h6TzhQ4-ZlUMY09pBI4NvpqwY1FKkL9lMPOEEpftVHA/edit?tab=t.0   Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/03/Key-Takeaways_-Care-Without-Proximity-02-26-26.docx.pdf Resources:  Report: Designing Benefits for Care Without Proximity and Sustained Outcomes This companion report examines how health plans can redesign benefits to address the most overlooked driver of outcomes: what happens in the time between clinical visits. Drawing on emerging evidence and real-world implementation, the report shows how continuous guidance, low-friction engagement, and integrated human support can influence daily behavior, preserve outcomes beyond treatment, and close the gap between what is authorized and what actually happens. Inside, you'll find insights on: Reframing benefit design from static access and eligibility rules to longitudinal accountability for sustained behavior Using data from daily life, behavioral, biometric, and contextual to move beyond lagging claims and EHR signals Applying operational personalization to intervene earlier and adapt support as member needs change Integrating targeted human support with technology to manage the transition after treatment and prevent backsliding Why investing in care without proximity is becoming urgent as workforce constraints and chronic disease prevalence continue to rise To request your copy from show producer, Vekonda Luangaphay at email [email protected]. Thank You to Our Episode Partner, Dario: Dario is transforming how people manage their health through consumer-friendly digital solutions designed to drive lasting behavior change. By integrating comprehensive support across well-being and chronic condition management, Dario delivers highly personalized, adaptive experiences that help members stay engaged over time—resulting in meaningful clinical outcomes and measurable financial impact for health plans. Learn more at dariohealth.com.  Schedule a Meeting with Omar Manejwala, MD, of Dario: To explore how Dario can support your organization in extending care beyond the clinic and driving sustained behavior change, reach outshow producer, Vekonda Luangaphay at email [email protected] to schedule a meeting with Omar Manejwala, MD, Chief Medical Officer, Dario. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.  

What happens when a health plan stops trying to optimize a legacy system and instead rebuilds the model itself? In this episode of Bright Spots in Healthcare, Eric Glazer sits down with Patrick Quigley, CEO and co-founder of Sidecar Health, for a candid conversation about redesigning health insurance around transparency, incentives, and consumer agency. Rather than focusing on incremental reform, this discussion explores what changes when members can see prices before they receive care, when benefits are structured around clear dollar amounts instead of opaque contracts, and when savings can be shared directly with the individual making the decision. Patrick walks through why traditional insurance design obscures cost and distorts behavior, how employers are responding to rising spend and limited visibility, and what it takes operationally to challenge long standing assumptions about how plans should work. Using examples from employer adoption, member purchasing behavior, and provider pricing dynamics, the conversation surfaces how transparency becomes more than a feature. It becomes the foundation for accountability and market discipline. This episode is designed for health plan leaders, employers, and innovators who are no longer asking whether affordability is a problem, but are questioning whether the current structure can solve it. In this episode, we cover: Why price opacity persists in traditional insurance models What changes when members see real time, upfront pricing How defined benefit structures alter purchasing decisions Why employers are increasingly open to alternative plan design How financial alignment influences utilization patterns The operational realities of building a new insurance model What industry leaders must unlearn to create sustainable affordability About Patrick Quigley: Patrick Quigley is the CEO and co-founder of Sidecar Health, a health insurance company built on a transparency first model. Under his leadership, the organization has focused on creating plans that show members clear prices, allow them to choose providers freely, and share savings when care costs less than expected. His work centers on restoring consumer visibility and aligning incentives across members, providers, and employers to address the structural drivers of healthcare cost growth. Learn more about Patrick Quigley - https://www.linkedin.com/in/quigleyp/ Partner with Bright Spots Ventures: If you are interested in speaking with the Bright Spots Ventures team to brainstorm how we can help you grow your business via content and relationships, email [email protected]. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare—proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com. Visit our website:  www.brightspotsinhealthcare.com. Follow Bright Spots in Healthcare: https://www.linkedin.com/company/shared-purpose-connect/

In this Bright Spots in Healthcare episode, Medicare Advantage leaders confront a hard truth: high activity does not guarantee high impact. As Stars cut points rise and margins tighten, traditional segmentation and broad outreach strategies are no longer sufficient. This discussion explores how leading plans are shifting from static stratification to dynamic signal monitoring, identifying which members are realistically movable, and embedding behavioral intelligence directly into operational workflows. The focus is not on doing more. It is on doing what measurably drives lift. Our guests include: Amin Serehali, Chief Data and Analytics Officer, Independent Health Mike Leiper, Director of Government Quality Programs, Highmark Brendan Generelli, Director of Medicare Stars and Quality, Johns Hopkins Health Plans David Burianek, Chief Strategy Officer for Health Plans, MedOrion Together, they explore: How plans are distinguishing between theoretical risk and practical movability, concentrating outreach on members whose behavior can realistically change within a defined window. How leading organizations are integrating claims, pharmacy, grievance, complaint, and social drivers data with behavioral science modeling to move beyond rules based campaigns. Why simultaneous pressure across HEDIS, CAHPS, and Part D often reflects fragmentation in engagement strategy rather than isolated measure failures. How targeted pilots within defined populations create clarity before scaling enterprise wide changes. Why timing is emerging as a strategic lever, with continuous signal monitoring replacing annual segmentation refresh cycles. How embedding intelligence into frontline workflows improves alignment between engagement effort and measurable Stars influence. Panelist Bios: https://www.brightspotsinhealthcare.com/events/beyond-segmentation-how-medicare-advantage-engagement-is-being-rebuilt/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/02/Updated-Episode-Guide-Beyond-Segmentation.docx.pdf  Key Insights Summary: Find the top six strategic insights from the discussion, including detailed speaker takeaways and moderator notes. https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/02/Key-Takeaways-Beyond-Segmentation-2.12.26.docx.pdf    Resources: Companion Brief: From Segmentation to Signals This companion brief expands on the behavioral intelligence framework discussed in the episode, outlining how health plans can identify movable phenotypes, align engagement timing with readiness signals, and measure causal lift against specific Stars drivers. Inside you will find insights on: Shifting from annual risk stratification to continuous behavioral signal monitoring Identifying members whose behavior is realistically influenceable within a defined measurement window Reducing wasted outreach and improving ROI through precision targeting Embedding intelligence into operational workflows rather than post hoc reporting To request your copy, email [email protected]. Thank You to Our Episode Partner, MedOrion: Medorion partners with Medicare Advantage plans to integrate behavioral science and advanced analytics into engagement strategy. By layering behavioral phenotyping onto clinical and utilization data, Medorion helps plans identify which members are movable, optimize outreach timing, and improve measurable Stars performance. Learn more at https://medorion.com/. Schedule a Conversation with MedOrion: To explore how behavioral intelligence can strengthen your engagement strategy and improve measurable lift across HEDIS, CAHPS, and Part D, reach out to [email protected]  to schedule a discussion with David Burianek and the Medorion team. About Bright Spots Ventures: Bright Spots Ventures helps healthcare leaders separate signal from noise and accelerate the adoption of what works. We bring health plan, provider, and innovation leaders together through curated content and high-trust convenings to build meaningful relationships and turn insight into action. Explore our podcast at www.brightspotsinhealthcare.com.

This episode features a highlighted segment from the ROI Centered Care Virtual Summit, produced by Bright Spots Ventures in partnership with TytoCare and the American Telemedicine Association. In this conversation, Eric Glazer sits down with Fernando Carnavali, MD, Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai and Chief of General Internal Medicine at Mount Sinai Health System, to explore how large academic health systems can translate patient experience, diagnostics, and technology innovation into measurable ROI. Rather than focusing on new tools for their own sake, Dr. Carnavali reframes the challenge: how to use existing data, connected devices, and AI-enabled diagnostics to improve the full patient journey, before, during, and after the visit while also supporting a stretched clinical workforce. Drawing on Mount Sinai's real-world operating environment, the conversation explores how experience, communication, and clinical efficiency are increasingly inseparable from financial performance, especially in inpatient and general internal medicine settings. This discussion moves beyond pilot thinking to address what it takes to operationalize innovation at scale inside a complex health system. What you'll learn in this episode: Why patient experience is a longitudinal journey, not a post-visit survey score How Mount Sinai is using technology and diagnostics to strengthen communication, not replace clinicians The role of AI and connected devices in improving both patient and provider experience Why workforce constraints in primary and general internal medicine demand new care models How health systems can focus on what's already within their control to drive ROI Why proving clinical and economic value upfront is essential to scaling innovation About Dr. Fernando Carnavali: Dr. Carnavali is the Chief of the Division of General Internal Medicine for Mount Sinai Morningside and Mount Sinai West (MSM/MSW) and serves as the Medical Director of the Long COVID Satellite Clinic at Mount Sinai Doctors Ansonia (MSD-Ansonia). In this role, Dr. Carnavali oversees a large, complex division with eight outpatient service locations spanning Manhattan's West Side from Harlem to Chelsea. Clinically, he focuses on the treatment and management of chronic illness, with a particular emphasis on Long COVID care. In early 2020, Dr. Carnavali led MSM/MSW's outpatient response to the COVID-19 pandemic, organizing early testing and triage for community patients and serving for eight weeks on the inpatient COVID units—an experience that provided firsthand insight into the impact of SARS-CoV-2 in New York City. In May 2021, he coordinated the launch of the Long COVID Clinic at MSD Ansonia and continues to personally evaluate new and ongoing patients each week. Committed to sharing Mount Sinai's expertise in Long COVID care, Dr. Carnavali has participated in numerous national and international forums, training providers in this emerging field. He has also built a strong media presence, spotlighting both the Ansonia clinic and the Mount Sinai Long COVID program to raise public awareness. Since 2024, he has served as Co-Principal Investigator on a grant from the Agency for Healthcare Research and Quality (AHRQ) and the Department of Health and Human Services titled "Evaluation of Long COVID Care Practices." In addition to Long COVID work, Dr. Carnavali leads outpatient practice transformation initiatives across MSM/MSW and the Mount Sinai Health System, guiding quality improvement teams to enhance patient satisfaction, improve access to care, and explore innovative service models.   Podcast Recommendation: Check out Access Amplified, brought to you by TytoCare and hosted by Joanna Braunold - a podcast about how digital health is helping increase access to care and equity, one innovation at a time. We'll shine a light on what's actually working to make care more accessible and  inclusive. If you're a healthcare leader, an innovator, a policy shaper, or anyone passionate about health equity, this podcast is for you. New episodes drop every two weeks. Follow or subscribe wherever you get your podcasts. https://www.tytocare.com/resources/access-amplified Thank You to Our Episode Partner, TytoCare. TytoCare enables health systems and plans to deliver high-quality remote exams anytime, anywhere. Their FDA-cleared devices and AI-powered diagnostic platform support virtual specialty care, school-based programs, and home health models—reducing unnecessary ED visits and improving patient experience. To learn more, visit tytocare.com. Schedule a Meeting with a Senior Leader at TytoCare: To explore how TytoCare can help your organization expand virtual specialty access and improve care coordination, reach out to [email protected]  to schedule a meeting. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.