Voices of Self Funding: AI in Action: Transforming Utilization Management, Prior Auth, and More

Payers are increasingly using AI to scan claims, flag anomalies, and trigger denials or audits automatically—often without transparency and long before anyone on the hospital side understands what happened. As these systems accelerate, hospitals face growing exposure, especially when documentation, data flow, and internal AI tools aren’t aligned with how payer models interpret clinical and financial information. This session unpacks the mechanics behind automated decision-making, why even accurate claims can be flagged, and how missing audit trails or inconsistent documentation can undermine appeals. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

On this episode of Voices of Self-Funding, host Tom Testa speaks with MIT-trained AI researcher and ClarityCare AI co-founder Hermine Tranie about how artificial intelligence is delivering measurable wins in utilization management (UM) and prior authorization (PA). Hermine explains how AI agents convert unstructured records into structured insights, drive real-time approvals at the point of care, and free up nurses for higher-value tasks – boosting accuracy, efficiency, and compliance. As a preview to her interactive “AI Mini-Hackathon” session at HCAA’s 2026 Executive Forum, Hermine shares a practical roadmap for adoption and what TPAs and self-funded employers can do today to start seeing ROI. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

On this episode Fred Goldstein invites Sheena Crosby, PharmD, BCGP, Inflammatory Bowel Disease Clinical Pharmacist at the Mayo Clinic in Florida. Sheena breaks down the American College of Gastroenterology’s (ACG) updated guidelines for ulcerative colitis and Crohn’s disease, highlighting major shifts in treatment strategy, including the move toward earlier use of advanced therapies and updated goals focused on symptom control, mucosal healing, and sustained remission. She also outlines the critical payer considerations emphasized in the guidelines—from eliminating unnecessary step-therapy requirements to ensuring timely access to induction and maintenance therapy—changes that have direct implications for patient outcomes and health-system performance. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

S1E7: AI in Medical Education: Training the Next Generation, with Dr. Ronald Rodriguez On this episode, host Dr. Heather Bassett welcomes Dr. Ronald Rodriguez, professor of medical education and program director for the MD/MS in Artificial Intelligence dual degree — the nation's first dual degree of this kind — at The University of Texas at San Antonio. Dr. Rodriguez discusses his career journey from MIT, to world expert in the use of cryoablative technologies for kidney and recurrent prostate cancer ... and why he created the MD-AI dual degree program. Drs. Bassett and Rodriguez also discuss AI's evolution in healthcare, its implications for clinical workflows, and various challenges healthcare will continue to navigate, including economic considerations, legal regulations, and the need for thoughtful integration. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Holiday Gifts in Health Care: Are You Breaking the Rules? Ericka Adler is joined by Roetzel shareholder Christina Kuta to break down what health care providers need to know about holiday gift giving. They explain how federal and state laws apply, what’s considered low risk, and how to avoid unintentionally violating kickback rules when showing appreciation to patients, vendors or referral sources. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Episode 79 It's Not Capability, It's Design: Digital Health Equity (HLTH) On this episode host Raj Sundar dives into the inspiring stories of Dr. Fernandez and Dr. Gigi Magan family medicine physicians and co-founders of Alma First. They explore the challenges they observed during the pandemic with digital health disparities in underserved communities and how those moments sparked their mission to promote digital health equity. Together, they discuss the importance of digital health navigators, training pre-health students through equity-centered curricula, and practical ways they introduce technology—like continuous glucose monitors and patient portals—to communities often overlooked by innovation. They also reflect on the need for culturally sensitive, accessible healthcare tech, the impact of provider engagement, and how we can keep evolving our patient education to truly meet people where they are. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Ending Middleware Medicine with Healthcare Communication Orchestration On this episode, host Erica Olenski interviews Dr. Pete Stetson, Chief Medical Information Officer at TigerConnect and a longtime leader in digital health innovation. Drawing on decades of experience as both a physician and informatics expert, Dr. Pete makes the case for rethinking clinical communication through smarter orchestration. From eliminating “middleware” roles that drain clinicians to addressing tech sprawl with AI-driven solutions, this conversation explores what it really takes to build a less chaotic, more coordinated healthcare system. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Healthtech Marketing Predictions for 2026 On this episode host Adam Turinas closes out the year by looking forward. In this episode, you’ll hear a range of voices from across healthtech marketing, growth, PR, podcasting, and the Health Launchpad team as they share what’s already starting to shift beneath the surface—and what that means for the year ahead. Some of the predictions may feel inevitable. Others might make you a little uncomfortable. That’s usually a good sign. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

S3E13: What's Trending NOW is the rising threat of cyber attacks in healthcare, and why resilient, recovery-ready infrastructure is as critical as having skilled clinicians or effective workflows. On this episode Shahid Shah is joined by Scott Taylor, Director of Cyber Resilience and Field Solutions Architect for Pure Storage, a company that stores, manages, and protects the world’s data. Scott shares insights on the inevitability of breaches and why speed of recovery matters more than perfect prevention. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Hosts Colin Hung and John Lynn discuss 2025 Year in Review. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen