Unexpected Strategies That Are Closing Gaps in Medicare & Medicaid

Visionary healthcare leaders from The Permanente Medical Group, UC Davis Health, UNC Health, Summit Medical Group and Navina joined Eric Glazer to explore how artificial intelligence transforms clinical workflows and enables better value-based care. Discover how AI-driven chart prep, ambient scribe technology, and risk models streamline provider workflows, improve patient outcomes, and reduce clinician burnout. From overcoming implementation roadblocks to building cross-functional frameworks that promote trust and equity, this episode is packed with strategic insights and real-world success stories you can apply at your organization. Panelists Include: Brian Hoberman, MD, EVP & CIO, The Permanente Medical Group Reshma Gupta, MD, Chief of Population Health and Accountable Care, UC Davis Health Ram Rimel, Manager of Data Science Engineering, UNC Health Eric Penniman, D.O. Executive Medical Director, Summit Medical Group Dana McCalley, VP of Value-Based Care, Navina https://www.brightspotsinhealthcare.com/events/the-new-physician-playbook-ai-workflows-value-based-care-in-action/#url This episode is sponsored by Navina Navina is the clinician-first AI copilot for value-based care. Recently named Best in KLAS for clinician digital workflows, Navina turns fragmented patient data into actionable clinical insights right at the point of care. Natively integrated into the clinical workflow, their AI copilot helps improve risk adjustment, quality metrics, and population health – while significantly easing the administrative burden. Navina has earned the trust of more than 10,000 clinicians and care team members across 1,300 clinics, from some of the leading value-based care organizations in the country like Privia Health, Agilon Health, and Millennium Physician Group. About Bright Spots in Healthcare Bright Spots in Healthcare is produced by Bright Spots Ventures Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime. Visit our website at www.brightspotsinhealthcare.com

As CMS regulations shift, how can you continue to impact complex members? Join us as we explore innovative approaches to member engagement that drive better health outcomes and reduce costs. In this episode, we will hear how plans are leveraging social support, in-home care, and tailored services to reach vulnerable members. Don’t miss this timely conversation: hear how you can be reaching the unreachable and personalizing Medicare engagement in a shifting CMS landscape.   Panelists:  Sheila Yahyazadeh, Chief External Operations Officer, CareFirst Community Health Plan Maryland Eve Gelb, Chief Innovation Officer, Gold Coast Health Plan Andrew Parker, Founder & CEO, Papa   This episode is sponsored by Papa: Papa is your trusted partner in the home. Since 2017, its vetted Papa Pals has completed millions of companion care visits across 7,300 cities — 10x that of Lyft. Papa Pals come from the same communities as the members they serve, build trust in person, and provide tailored support proven to reduce hospitalizations and emergency department visits, increase preventive care trends, and lower costs. But that’s not all Papa Pals do... As an extension of your care team in the home, Papa Pals can now conduct in-home assessments, educate and help members learn new skills, like digital health literacy, and so much more.   Visit papa.com to learn more. Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

Welcome to the debut episode of Executive Briefs—a new short-form series from Bright Spots in Healthcare designed to deliver fast, actionable insights for healthcare leaders. In under 10 minutes, host Eric Glazer shares 10 powerful storytelling takeaways from bestselling author Michael Lewis (Moneyball, The Big Short, The Blind Side) from his keynote address at League Connect 2025. Whether you're a health plan executive, provider leader, or innovator in digital health, these tips will help you better engage your team, inspire change, and drive results. Takeaways 00:50 – Why Michael Lewis and storytelling matter to healthcare leaders 01:42 – 1: Start with a question 02:15 – 2: Stories are about people 02:45 – 3: Good characters are great teachers 03:18 – 4: Find a fresh angle 03:55 – 5: Make data emotional 04:30 – 6: Tension drives the narrative 05:10 – 7: Keep it moving 05:50 – 8: Authenticity over polish 06:25 – 9: End with meaning 07:00 – 10: Tell stories that move people 08:10 – How leaders can apply these lesson 🔗Register for the League Connect Digital Summit 2025 on May 7 at https://connect.league.com/digital-summit/ to see the Michael Lewis keynote. Learn more about League’s digital-first healthcare platform: https://league.com About Bright Spots in Healthcare Bright Spots in Healthcare spotlights real-world “bright spots” from health plans and providers to help leaders scale innovation and drive measurable improvement. We believe that finding and replicating bright spots is the most effective strategy to improve healthcare in our lifetime. Produced by Bright Spots Ventures. Learn more: brightspotsinhealthcare.com.  

Traditional approaches to closing care gaps in Medicare Advantage often fail to reach the members who need it most. This episode goes beyond conventional strategies to explore how innovative, remote, and community-driven solutions are transforming chronic care management—particularly for cardiometabolic conditions like diabetes, hypertension, and heart disease. Learn how health plans are leveraging proactive outreach, virtual engagement, and data-driven interventions to improve HEDIS scores, boost Star Ratings, and drive better long-term outcomes. Through real-world case studies and expert insights, we’ll uncover scalable, cost-effective approaches that enhance care access, reduce avoidable hospitalizations, and deliver measurable impact for both members and plans.   Panelists:  Michael Harris, CEO, HealPros Tejaswita Karve, Ph.D. - Healthcare Quality and Innovation Leader, Stars Leader, Mass General Brigham Health Plan Mike Rapach, SVP Government Programs, President & CEO, CareFirst Community Health Plan Maryland Daniel Weaver, SVP Stars and Quality, Zing Health Bios: https://www.brightspotsinhealthcare.com/podcast-episodes/   This episode is sponsored by HealPros: HealPros helps health plans find and address missed care opportunities in member’s homes, at events in their communities, and remotely. Our team specializes in helping polychronic members access the care they need, from anywhere. HealPros’ Care Access Pros completed over 70,000 in-home visits in 2024 and is committed to engaging even more members in 2025 - including those that are hard-to-reach – as we work towards our vision of transforming millions of live each year. Our Care Connection Specialists make over 4,000,000 calls to members each year. With a sophisticated logistics operation, national footprint, and national network of providers, HealPros is available to work in all 50 states and the US Virgin Islands. For more information, visit www.healpros.com. Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

What if AI could guide every patient through their healthcare journey—nudging them toward better choices, anticipating their needs, and adapting in real time? We talk a lot about engagement in healthcare, but too often, the digital tools we use fail to improve outcomes. AI and data-driven personalization hold incredible promise, yet many health plans and providers still struggle with low participation rates. Dr. Erich Huang, Associate Chief Clinical Officer for Informatics and Technology at Verily, an Alphabet company leading the charge in precision health, joins Eric to discuss what’s next for AI in healthcare. The conversation touches on how AI is redefining patient engagement, the delicate balance between automation and human touch, and how platforms like Verily’s Lightpath are pioneering a new model for chronic care management. If you’re a health plan or hospital leader looking to unlock the next generation of patient engagement, you won’t want to miss this conversation.  About Erich Erich leads a team focused on structuring clinical-grade data that integrates with the clinical research and healthcare data ecosystems and is optimized for precision medicine, analysis, and artificial intelligence.    Erich was previously at Duke University where he served as the Chief Data Officer for Quality at Duke Health, Director of Duke Forge, Director of Duke Crucible, and Assistant Dean for Biomedical Informatics for Duke University School of Medicine. There, he led and deployed machine learning capabilities for complex care management in Duke Health’s Accountable Care Organization, led health data science initiatives, and helped develop Duke Health’s new institutional governance process for algorithmic decision support.    He earned his MD and PhD from Duke University, trained and was a Chief Resident in the Duke General Surgery Residency Program. Erich is previously a Burroughs Wellcome Fund Innovations in Regulatory Science Award recipient, received a Sidney Kimmel Cancer Research Foundation Translational Scholar Award, and is twice a recipient of an IBM Faculty Award.   About Verily Verily is an Alphabet health technology company focused on research, care, and health financing to deliver on the promise of precision health and help people live healthier lives. We are uniquely positioned at the intersection of technology, data science, and healthcare to create tools to accelerate evidence generation, products to enable more personalized care, and approaches to make costs more predictable.  

What if your health plan’s biggest opportunity to improve outcomes wasn’t in a hospital or clinic—but in a home, a grocery store, or a child’s support system? Mark Rakowski, President of Chorus Community Health Plans (CCHP) and Senior Vice President of Children's Wisconsin, joins Eric to explore the plan’s innovative approach to social determinants of health.    From its Housing Navigator Program and Foodsmart initiative to its groundbreaking mental health strategy,  CCHP is driving better health, lowering costs, and achieving remarkable results—including a 70% treatment adherence rate among Medicaid members.   If you’re a healthcare leader looking for scalable, high-impact strategies to address social determinants of health and improve member outcomes, this episode is a must-listen!   About CCHP Chorus Community Health Plans, which is owned by Children’s Wisconsin – the state’s only health care system dedicated 100% to children and teens, is focused on improving the health and well-being of its members by providing access to a broad network of health services and providers, as well as prevention programs. CCHP is the second-largest Medicaid health plan in the state. The plan serves 150,000 Medicaid members in 28 counties in eastern Wisconsin. In 2017, CCHP began offering individual and family plans in the Marketplace in southeastern Wisconsin, and the plan has now expanded to 15 counties in eastern Wisconsin, covering 15,000 members in 2022.   About Mark  Mark is responsible for the health plan's overall operation. He directs the development of strategies and budgets, negotiates contracts and ensures compliance. In addition to these roles, Mark oversees the contractual relationship with the Wisconsin Department of Health Services and monitors and influences state and local healthcare policy.   Mark is also actively involved in the Children’s Wisconsin strategic plan to improve children’s health in Wisconsin. The plan focuses on increasing access to preventive services, addressing social drivers of health, and partnering with providers to improve care coordination. Mark joined Children’s Wisconsin and the CCHP team in 1999 as director of managed care.    Before that, he had 11 years of experience in healthcare-managed care roles. Mark earned a bachelor’s degree in finance from the University of Wisconsin–Whitewater and a master’s in accounting from the University of Wisconsin – Milwaukee.  In 2010, Mark was recognized as a notable health care hero by BizTimes Milwaukee, which was an advancement in healthcare.    Bright Spots in Healthcare is produced by Bright Spots Ventures Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

What if I told you that in 2025, the way we access and exchange healthcare data will be fundamentally different?   For years, we've talked about interoperability—but now, we’re seeing it take shape. Nearly 40% of the CommonWell network and most Q-HINs are responding to patient access requests, opening the door to a new era of seamless, secure, and patient-driven data exchange.   Paul L. Wilder, Executive Director of CommonWell Health Alliance, joins Eric to explore the future of healthcare data and the evolving landscape of healthcare interoperability. Learn about the CommonWell Marketplace, how patient access to data is improving, the increasing role of FHIR, and the critical aspects of trust and AI in healthcare. Paul provides key insights to help you and your organization position yourself for success.   This episode was recorded live at ViVE 2025 in Nashville.    About CommonWell   CommonWell is a not-for-profit interoperability advocate and Qualified Health Information Network under the Trusted Exchange Framework and Common Agreement (TEFCA), which facilitates the secure exchange of patient data across more than 36,000 provider sites, representing over 238 million individuals nationwide. CommonWell has enabled the exchange of more than 7.7 billion healthcare records. Visit https://www.commonwellalliance.org/.   About Paul Paul is leading the organization as it enters a new chapter in its pursuit of empowering clinicians, practitioners and individuals with interoperability services via its robust, nationwide network. With more than two decades of experience in health IT, Paul has held various roles focusing on imaging, clinical informatics, and interoperability.   Before joining CommonWell, Paul was Vice President of Strategy & Business Development for Philips Interoperability Solutions. He also spent close to 10 years with one of the largest regional HIE networks in the world, the New York eHealth Collaborative (NYeC)—serving as its Chief Information Officer, Vice President of Product Management and Program Director for NYeC’s Regional Extension Center. During his time with the NYeC, he helped nearly 10,000 primary care providers attest to Meaningful Use and solidified the state’s status as one of the national leaders in health IT adoption. Each role enabled him to work and hear directly from providers and end-users of Electronic Health Records (EHRs)—which gives him an important perspective as a leader in health IT adoption and execution.   Paul received his Master of Business Administration from New York University, with a concentration in Finance and Operations. He also holds two bachelor’s degrees from the University of Pennsylvania: one from the College of Arts and Sciences in Economics and the other from the School of Engineering and Applied Science in Biomedical Science. Paul lives in the New York area with his wife, two daughters and their newest family member, their dog Penny.   Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

Highmark Health, Mass General Brigham Health Plan, SCAN, and TytoCare leaders discuss strategies for creating innovative, high-impact healthcare products.    Tune in to learn:   How traditional health plans are rethinking product design in the face of growing competition from direct-to-consumer models Strategies for creating more personalized, flexible, and transparent offerings that resonate with today’s healthcare consumers The role of data, technology, and innovation in modernizing health insurance products Real-world success stories from leading organizations who are successfully navigating this evolving market Panelists:  Maria Baker, VP, Health Strategy & Delivery, Highmark Health Lena Perelman, VP, Medicare Product Operations, SCAN Health Plan Roni Mansur, Vice President of Product Management, Mass General Brigham Health Plan Suzi Pigg, Vice President, Payers, TytoCare https://www.brightspotsinhealthcare.com/events/innovating-product-design-for-growth-and-member-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 six 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 the successful deployment and adoption of 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 250 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.   Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

Health plan leaders from Cambia Health Solutions, Highmark Health and League share strategies for driving consumer engagement, improving health outcomes, and optimizing payer-provider relationships. Learn how health plans can shift from broad segmentation strategies to truly personalized, member-centric healthcare by harnessing data, AI, and digital transformation.     Learn how health plans are using AI-driven insights to deliver tailored interventions. 📈 Discover how personalization can enhance member satisfaction and retention. 🔍 Hear real-world examples of digital transformation in action.   Panelists:  Karen Hanlon, EVP & COO, Highmark Health Laurent Rotival (EVP & CIO, Cambia Health Solutions) Michael Serbinis, Founder & CEO, League Bios: https://www.brightspotsinhealthcare.com/podcast-episodes/   This episode is sponsored by League: Founded in 2014, League is the leading healthcare consumer experience platform, reaching more than 20 million people worldwide and delivering the highest level of personalization in the industry. Payers, providers, and consumer health partners build on League’s platform to deliver high-engagement healthcare solutions that improve health outcomes. To date, League has raised $235 million in venture capital funding, powering the digital experiences for some of healthcare’s most trusted brands, including Highmark Health, Manulife, Medibank, and Shoppers Drug Mart.   Bright Spots in Healthcare is produced by Bright Spots Ventures   Bright Spots Ventures brings healthcare leaders together to share working solutions or "bright spots" to common challenges. We build valuable and meaningful relationships through our Bright Spots in Healthcare podcast, webinar series, leadership councils, customized peer events, and sales and go-to-market consulting. We believe that finding a bright spot and cloning it is the most effective strategy to improve healthcare in our lifetime.   Visit our website at www.brightspotsinhealthcare.com  

Top healthcare leaders from HAP, Independent Health, Johns Hopkins Health Plans and Prealize Health explore how predictive analytics and artificial intelligence (AI) revolutionize risk management and care delivery. The discussion delves into real-world applications of AI-driven predictive analytics to enhance patient engagement, improve outcomes, and reduce costs. Learn how leading health plans use AI to identify high-risk populations earlier, optimize care pathways, and improve patient outcomes. If you’re interested in the future of healthcare innovation, this is a must-listen! Key Takeaways: How health plans are leveraging AI to transition from segmentation to personalization The role of unified data lakes in driving insights and improving member experiences Real-world examples of AI in chronic disease management, risk stratification, and end-of-life care The power of AI-driven predictive models in enhancing underwriting accuracy How Generative AI is transforming customer service and operational efficiency Our expert panel includes: Bethany McAleer – Chief Actuary & Chief Analytics Officer, Johns Hopkins Health Plan Amin Serehali – SVP & Chief Data & Analytics Officer, Independent Health Mike Treash – SVP & COO, Health Alliance Plan Dean Noble-Tolla – Chief Product Analytics Officer, Prealize Health https://www.brightspotsinhealthcare.com/events/predictive-analytics-proactive-healthcare-leveraging-ai-to-transform-risk-management-and-care-management/ This episode is sponsored by Prealize Health Founded by two industry thought leaders from Stanford University and through continuous partnership with Stanford, Prealize is a leading provider of AI-driven predictive analytics and insights to health plans, specialty care management companies, healthcare technology companies, employers, and providers across the nation. Committed to transforming healthcare from reactive to proactive, reducing healthcare costs and enabling more people to live healthier lives, Prealize and its partners positively influence the health trajectory of millions of people. www.prealizehealth.com