Unexpected Strategies That Are Closing Gaps in Medicare & Medicaid

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

Marc Willard, CEO, Icario, joins Eric to discuss Icario’s new, innovative platform and how it improves member engagement and health outcomes. The conversation also touches on the challenges health plans face in adapting to changing member needs, the importance of data integration and organization, and the potential impact of AI-driven solutions on healthcare delivery and cost reduction. Here are some key takeaways from the conversation: The Power of Personalization – Health plans are lagging in using AI and data-driven insights to create truly personalized member experiences. Icario’s approach focuses on knowing the member through data to improve engagement and outcomes. Beyond Transactions to Long-Term Engagement – Many health plans operate in silos, leading to disconnected member experiences. Icario’s platform shifts from one-time interactions to continuous, AI-driven engagement that adapts to member behaviors and preferences. Smart Outreach Strategies – Effective member engagement requires understanding preferences (text, email, phone, or mobile apps), timing communication to when members are most responsive, and avoiding member abrasion through excessive outreach. Leveraging AI and Machine Learning – Icario’s new platform, Aivella, goes beyond rules-based engines to incorporate machine learning. Based on member responses, it dynamically adjusts outreach strategies in real time. About Marc Marc Willard is responsible for Icario’s overall strategy, growth, and operations. Marc has over three decades of experience leading digital transformation and technology in the digital health sector. Marc is passionate about improving lives with industry-leading, cloud-first digital health platforms.    Marc brings a unique and highly relevant set of abilities, operational experiences, and industry relationships to Icario at the perfect time in the company’s development. Before joining Icario, Marc founded Certify, where he pioneered the first cloud-based data and interoperability platform connecting providers and payors at scale. Marc founded Transcend Insights at Humana, the merger of three Humana acquisitions, including Certify. Transcend developed and launched an innovative cloud-based population health platform. At Humana Corp, as SVP, he led all member, patient, and provider digital engagement initiatives. These initiatives were focused on data and analytics to improve care delivery and quality and lower healthcare costs. In addition, Marc holds several board member positions.   Marc studied Electronic Engineering at Farnborough College of Technology and in classic entrepreneurial style, left to focus on his first start-up. Outside work, he enjoys spending time with his wife and family, collecting classic cars, and being on the water. He also mentors entrepreneurs while supporting the start-up community, which he finds very rewarding.  Find Marc on LinkedIn: https://www.linkedin.com/in/marcwillard/ About Icario Icario serves health plans using robust whole-person data, predictive behavioral science, and a proprietary engagement platform to offer personalized experiences that meet members where they are in their health journey. Icario combines the industry's largest member data repository with unparalleled industry expertise to implement health action programs that deliver personalized member engagement, reduce abrasion and encourage positive health behaviors. Visit Icariohealth.com.   Follow Bright Spots in Healthcare on LinkedIn: https://www.linkedin.com/company/shared-purpose-connect/ Check our YouTube page: https://www.youtube.com/@BrightSpotsinHealthcare

Ted Rath, former VP of Player Performance for the Philadelphia Eagles and two-time “NFL Strength and Conditioning Coach of the Year,” joins Eric to share the most effective approaches to creating a Super Bowl contender in the NFL and provide insights on goal setting, mindset shifts, and building sustainable habits. These lessons can be applied directly to your approach to lifestyle modification programs and value-based care strategies.   Links: Extreme Ownership: How U.S. Navy SEALs Lead and Win by Jocko Willink Beyond Comfort, Master a Growth Mindset with Excellence through Urgency  Ted Rath's YouTube Channel Atomic Habits by James Clear tedrath.com About Ted Rath Ted Rath is the author of Beyond Comfort, Master a Growth Mindset with Excellence through Urgency and the former Vice President of Player Performance for the Philadelphia Eagles.    He has two decades of experience working with athletes, almost all of them in the NFL …his resume beyond the Eagles job includes the LA Rams, Miami Dolphins, Detroit Lions and his alma mater, the University of Toledo.    Rath was voted “NFL Strength and Conditioning Coach of the Year” not once but twice and was elected as the inaugural President to represent the Professional Football Performance Coaches Association (PFPCA) in early 2023. Before Detroit, Rath was an Assistant Strength and Conditioning Coach at The University of Toledo, where he directed the strength and conditioning programs for all fifteen of the school’s Olympic sports.  

Richard Feifer, MD, Chief Medical Officer of InnovAge, joins Eric to explore the transformative potential of the PACE (Program of All-Inclusive Care for the Elderly) model. Richard shares compelling stories and strategies showcasing how PACE integrates medical, physical, social, and emotional care to improve outcomes for seniors and individuals with complex needs. Listeners will gain insights into: The unique interdisciplinary care team (IDT) approach and how it delivers personalized, efficient care. Innovations in reducing hospitalizations and shifting care to home-based settings. Lessons on advanced care planning and end-of-life support that prioritize patient goals. Operational strategies for managing costs while maintaining exceptional patient experiences. Richard explores the economic and practical sustainability of the PACE model, providing actionable insights for healthcare leaders aiming to replicate its success. Link to DC Bipartisan Report on PACE mentioned in podcast: https://bipartisanpolicy.org/press-release/improving-access-to-and-enrollment-in-programs-of-all-inclusive-care-for-the-elderly-pace/ About Richard As a physician executive with broad healthcare industry experience, Dr. Richard Feifer helps organizations achieve their fullest potential in an ever-changing environment. Rich is a board-certified internist with clinical experience in primary care, geriatrics, and urgent care medicine.  As a health system leader, he has also developed expertise in population health management, value-based payment models, clinical analytics, and technology-driven healthcare transformation.   Rich has dedicated his career to improving the quality and efficiency of healthcare and the health of populations he has served. Most recently, as executive vice president and chief medical officer of Genesis HealthCare, he led one of the nation's largest skilled nursing and long-term care providers, operating over 400 facilities in 25 states in 2019. As president of Genesis Physician Services, a Genesis subsidiary with over 450 physicians, nurse practitioners, and physician assistants in 2019, he navigated the successful transition to value-based care delivery. In that capacity, he also launched and served as chief medical officer of the only national accountable care organization focused on nursing home residents, LTC ACO.   Prior to joining Genesis, Rich was Aetna’s chief medical officer of National Accounts, leading the department of Clinical Consulting, Strategy, and Analysis, which helped large employers improve the health and productivity of their employees and dependents. Before Aetna, Rich served as vice president of Clinical Program Innovation and Evaluation at Medco, where he was responsible for the organization’s portfolio of care enhancement programs.   A graduate of Brown University and the University of Pennsylvania School of Medicine, Rich received his master’s in health services management from Columbia University. He is an assistant clinical professor at the University of Connecticut and a board member of the Accreditation Commission on Health Care.    About InnovAge Our passion and mission is to help frail seniors age in their own homes with dignity. InnovAge has done this through PACE for more than 30 years.    As the largest provider of the Program of All-inclusive Care for the Elderly (PACE) based on participants served, InnovAge is dedicated to expanding this successful program to serve as many seniors as possible nationwide. In some communities, like Philadelphia, PACE is known as Living Independence for the Elderly.    With InnovAge's Program of All-inclusive Care for the Elderly (PACE), older individuals have a team of healthcare professionals focused on providing all the connected care they need. This helps seniors live at home for as long as possible, instead of going to a nursing home or other care facility.