How CareFirst, Blue Shield CA and Vori Health Drive Success in the New MA Ratings Era

In this Bright Spots in Healthcare episode, host Eric Glazer brings together Medicare Advantage leaders who are rethinking how digital first and whole person strategies can meet rising Stars expectations. The conversation explores how plans are simplifying engagement, strengthening provider alignment, and integrating specialty and virtual care models to improve quality, experience, and overall performance in the new ratings era. Our guests include: Lisa Franklin, Director of Medicare Business, Product, and Marketing, Strategic Growth and Government Programs, Carefirst Christine McKinney, Vice President Customer Experience and Digital Transformation Blue Shield of California Mary O'Connor, MD, Chief Medical Officer & Co-Founder, Vori Health Together, they explore: How CareFirst reduced member friction by consolidating 175 touchpoints a year into a coordinated digital first experience built around scrolling content cards, real time click behavior, and simplified onboarding. How Vori Health is integrating whole person MSK care with payers through value based arrangements that support coaching, nutrition, behavioral health screening, and earlier risk identification. How Blue Shield of California built a continuous CAHPS simulation program to uncover pain points and used those insights to create the Care Navigation Desk for real time access help. How digital tools like online scheduling, integrated member health records, and proactive pharmacy cost transparency are reducing friction and helping seniors navigate the ecosystem more independently. How plans are using AI and preference based engagement to support new Medicare members, improve medication adherence, and scale outreach during market disruptions. Panelist Bios: https://www.brightspotsinhealthcare.com/events/falling-stars-rising-standards-how-digital-first-whole-person-care-is-fueling-success-in-the-new-ratings-era/ 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/2025/12/Episode_Guide_120425_Vori-Falling-Stars-Rising-Standards.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/2025/12/Key-Takeaways-Erics-Notes-Falling-Stars-Rising-Standards.docx.pdf Resources:  Report: How Physician Led MSK Care Supports Stars Improvement and Whole Person Outcomes This companion report highlights how Vori Health's physician-led, virtual first musculoskeletal care model helps Medicare Advantage plans strengthen performance in the new ratings environment. It includes data and real member stories showing how hybrid specialty access, early gap closure, and whole person support improve outcomes, reduce unnecessary MSK spend, and enhance member experience. Inside you will find insights on Improving access through forty eight hour specialty appointments Reducing opioid use and unnecessary surgeries Supporting preventive screenings and chronic condition management Elevating member satisfaction across measures tied to the 2026 Stars program To request your copy, email [email protected]. Buyer's Guide: The Comprehensive Guide to MSK Care for Health Plans This companion report gives health plans a clear framework for improving MSK strategy, highlighting how fragmented, high cost pathways drive unnecessary imaging, procedures, and surgeries without resolving pain. It outlines four MSK care models and the key elements of a high value program such as physician led care, holistic support, non opioid management, strong engagement, and real claims based ROI. It also shows how solutions like Vori Health bring these components together through coordinated, hybrid access and measurable improvements in outcomes and cost. Inside you will find insights on Improving MSK access and coordination across care models Designing physician led, whole person programs that address root causes of pain Reducing unnecessary imaging, procedures, and surgeries Driving stronger engagement, better outcomes, and meaningful cost savings To request your copy, email [email protected]. Thank You to Our Episode Partner, Vori Health: Vori Health is a physician-led musculoskeletal care practice that delivers fast, evidence-based hybrid care for back, neck, and joint pain. Their whole person approach improves outcomes, reduces unnecessary MSK costs, and supports stronger Medicare Advantage Star Ratings. Learn more at vorihealth.com. Schedule a Meeting with a Dr. Mary O'Connor of Vori Health: To explore how Vori Health can help your organization strengthen whole person MSK care and support better Stars performance, reach out to [email protected] to schedule a meeting with Dr. Mary O'Connor, CMO and Co-founder, 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.  

Recorded live at HLTH, this episode of Bright Spots in Healthcare takes you inside Health2047, the venture studio founded by the American Medical Association to tackle some of healthcare's gnarliest problems. Host Eric Glazer sits down with Warren Templeton, Managing Director at Health2047, to explore how the AMA is backing founders at the earliest stages to reshape physician workflows, chronic disease management, and data liquidity. Warren shares how Health2047 partners with science- and clinician-led startups at the pre-seed and seed stages, wrapping founders with commercial strategy, clinical and billing expertise, and an evergreen capital model that matches healthcare's longer time horizons. He also unpacks why humility and conviction are the two non-negotiable traits he looks for in founders. You'll hear real-world examples from Health2047's portfolio, including: Zing Health – a Medicare Advantage plan built for underserved communities, rooted in social determinants of health and community-based design Phenomics Health – an obesity phenotyping company born from a "failed" diabetes prevention bet, now helping match patients to the right GLP-1s, procedures, and care pathways ScholarRx – a global medical education platform partnering with the WHO to enable high-quality "tertiary care in the wild" for clinicians around the world Warren and Eric also dig into: Why traditional 5–7 year VC timelines often clash with healthcare reality How to balance breakthrough science with practical workflow integration and commercial viability The impact KPIs Health2047 tracks beyond IRR, including lives and care teams impacted If you're a founder, investor, or healthcare leader trying to build something that actually works in the real world—not just on a pitch deck—this conversation offers a candid look at what it takes to design, fund, and scale the next generation of healthcare companies. Bio: https://health2047.com/leadership/warrentempleton/ References: Health2047's portfolio companies mentioned in the episode: Zing Health - https://www.myzinghealth.com/ Phenomics Health - https://www.phenomicshealth.com/ ScholarRx - https://scholarrx.com/ 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/

Guests:  Louis DeStefano, Chief Growth Officer, Oscar Health Jon Van Der Veer, DO, Founder & CEO, Hy-Vee Health In this special HLTH interview, Bright Spots in Healthcare host Eric Glazer speaks with two leaders shaping one of the most innovative payer–provider–retail collaborations in the country: Louis DeStefano, Chief Growth Officer, Oscar Health Jon Van Der Veer, DO, Founder & CEO, Hy-Vee Health Together, Oscar Health and Hy-Vee Health are building a new kind of health plan, one that blends local access, convenient care, primary care-first design, and tech-enabled member experience. Think of it as a hybrid model: part direct primary care, part advanced digital platform, part community-rooted retail ecosystem. This conversation dives into how the two organizations are integrating brick-and-mortar clinics, urgent care, pharmacy, SDOH-friendly retail access, and Oscar's tech stack, including "Oswell," Oscar's AI-powered clinical support tool, to deliver a personalized and coordinated experience. Topics We Cover: Why healthcare must be local, convenient, and relationship-driven How the partnership blends a supermarket chain, primary care clinics, and a tech-enabled health plan into one member experience How ICHRA is opening new doors for employer-driven personalization The role of AI and tools like Oswell in interpreting labs, improving communication, and augmenting care What a modern, scalable direct primary care model could look like The 10-year vision for this collaboration and where it expands next This episode offers a first look into a payer–retail–provider model that could reshape consumer expectations, and redefine how employer-sponsored and individual coverage works in the coming decade. References and Mentions: Learn more about the partnership between Oscar Health and Hy-Vee Health - https://www.hioscar.com/hy-vee-health Meet Oswell, Oscar Health's new health AI agent - https://www.hioscar.com/oswell  Dr. Garrison Bliss, widely recognized as the "Godfather of Direct Primary Care" -  https://www.linkedin.com/in/garrisonblissmd/ Bios: Louis DeStefano: https://hlth.com/events/usa/speakers/2025/louis-destefano Dr. Jon Van Der Veer: https://hlth.com/events/usa/speakers/2025/jon-van-der-veer 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 episode of Bright Spots in Healthcare, recorded live at the HLTH 2025 conference in Las Vegas, Eric Glazer sits down with Scott Arnold from Tampa General Hospital, one of the nation's leading academic health systems, to explore their ambitious digital transformation journey. The conversation dives deep into how TGH built a unified digital foundation across a large, geographically dispersed system, enabling them to scale AI solutions that deliver measurable impact on operations, patient care, and the clinician experience. Scott shares his blueprint for modernizing a major health system, moving AI from pilot project to enterprise-wide tool, and provides practical lessons for health system and health plan leaders seeking to reduce burnout, improve satisfaction, and bring innovation to scale. The conversation dives into: Why a single digital operating system, standardizing the EHR, analytics, and phone systems, is the non-negotiable foundation for scalable AI and consistent patient experience The function of TGH Ventures, the dedicated venture arm used to fund and rapidly implement market-vetted digital health solutions The strategy for prioritizing AI deployment by focusing on human-centric problems, such as clinician burnout and nursing staff turnover How TGH partnered with Palantir to create an AI-enabled Care Coordination Operating System (CCOS) that uses real-time data to optimize patient flow and predict risk The critical need for operational governance to prevent AI from being layered on fragmented infrastructure, which often leads to "faster chaos" Building a culture that is grounded in trust, speed, and experimentation to ensure the organization can keep pace with rapid technological evolution This discussion offers a pragmatic, replicable blueprint for any health system ready to modernize with intention and urgency, demonstrating how digital transformation can be grounded in practicality, not just hype. References: Charlie Munger's famous quote "Trust is one of the greatest economic forces on Earth" Learning from outside healthcare: Scott's view on "taking a page out of Apple" and applying consumer-grade principles to hospital system design Scott Arnold's Bio: https://www.tgh.org/about-tgh/tampa-general-hospital-leadership/scott-arnold 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, host Eric Glazer brings together health system leaders transforming how care continues beyond the hospital stay—using digital coordination, subspecialization, and AI-enabled virtual care to reduce readmissions and improve patient experience. Our guests include: Matthew Sakumoto, MD, Medical Director, Connected Care Clinic, and Regional Chief Medical Informatics Officer, Sutter Health Sean O'Grady, President of Acute and Ambulatory Operations, Endeavor Health Sarah Schenck, MD, Executive Director, Center for Virtual Health, ChristianaCare Tina Nelson, Strategic Partnership Manager, TytoCare Together, they explore: How Sutter Health virtualized Transition-of-Care Management visits to improve post-discharge follow-up, eliminate transportation barriers, and connect hospitalists directly with patients at home. How Endeavor Health is scaling a subspecialized hospital model—combining orthopedics, spine, and cardiovascular centers of excellence with Epic-driven coordination to deliver big-system outcomes in community settings. How ChristianaCare's Center for Virtual Health delivers "high-frequency, low-intensity" primary care—83% asynchronously—supported by Patient Digital Ambassadors who create human-centered, always-on engagement. How TytoCare and Sanford Health are expanding specialty access across rural communities with FDA-cleared diagnostic technology that brings high-quality remote exams to local clinics. How digital tools and aligned incentives are building a new care ecosystem—one that integrates human connection, data, and technology to keep patients home, healthy, and connected. Panelist Bios: https://www.brightspotsinhealthcare.com/events/from-hospital-to-home-scaling-remote-specialty-care-to-close-gaps-and-reduce-readmissions/ 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/2025/11/EpisodeGuideFromHospitaltoHome.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/2025/11/Key-Insights-Summary-and-Erics-Notes-From-Hospital-to-Home_-Scaling-Remote-Specialty-Care-to-Close-Gaps-and-Reduce-Readmissions.docx.pdf  Resources:  Case Studies: Scaling remote exams to improve access, reduce costs, and enhance the patient experience These companion resources explore how digital care coordination, subspecialization, and virtual specialty models are reshaping transitions of care. It includes data and stories from Baptist Health and Sanford Health on how to reduce readmissions, enhance clinician satisfaction, and expand access. To request your copy, email [email protected]. 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.  

In this Bright Spots in Healthcare episode, host Eric Glazer sits down with three leaders reshaping one of healthcare's most overlooked — yet mission-critical — functions: provider credentialing. Credentialing is the quiet infrastructure of trust in healthcare. When it's done right, patients get timely access to high-quality care, providers get paid faster, and health plans stay compliant. When it fails, backlogs grow, compliance risk skyrockets, provider satisfaction plummets, and member access suffers. Joining Eric for this discussion: Sandra Clarke, Former CFO & COO, Blue Shield of California Brett Dooies, Head of Product, Verifiable Janan Dave, VP of Operations, Verifiable Together, they explore how AI and automation are transforming credentialing from a slow, manual compliance task into a strategic capability that improves efficiency, trust, and network readiness. In this episode, you'll learn: Why credentialing sits at the intersection of compliance, provider experience, and member access How legacy processes, staffing limits, and messy data create hidden risk, and why backlogs can grow like quicksand Practical ways health plans are applying AI to reduce verification time, speed onboarding, and triage high-risk cases Why the most successful plans treat credentialing as infrastructure, not paperwork Key metrics to track when modernizing credentialing, including turnaround time, backlog clearance, audit readiness, and provider experience What to automate first,  and why humans still play a critical oversight role Bright Spots include: 97% automated verification in seconds across millions of records monthly New staffing and automation models that increase speed without compromising compliance Real-world examples where AI prevented risk exposure and accelerated network growth Leadership lessons in adopting AI responsibly and avoiding the "lift-and-shift" trap   This conversation offers payer leaders a real-world playbook to modernize credentialing and strengthen the foundation of your healthcare organization. Panelist Bios: Sandra Clarke is a healthcare executive and board advisor with over 25 years of experience leading finance, operations, and large-scale transformation across payer, provider, and life sciences organizations. As former CFO and COO of Blue Shield of California, she oversaw $25B in annual revenue and spearheaded initiatives delivering $700M in annualized savings while reimagining the company's pharmacy care model. Clarke has also held senior leadership roles at Daiichi Sankyo and Philips Healthcare and serves on multiple healthcare boards. She holds degrees from MIT, Bentley University, and Seton Hall University School of Law. Janan Dave is the VP of Operations at Verifiable, a start-up offering software and services solutions for healthcare organizations to ease the challenges surrounding provider network management. Janan has a background in public health and health policy, and has spent the last decade helping scale operations at various healthcare startups. She is passionate about building smart solutions to reduce waste in the healthcare system, and promote better care especially for the aging population, family caregivers, and women. Janan studied public health at the University of Pennsylvania, and lives in Brooklyn, NY. Brett Dooies is the Head of Product at Verifiable, where he leads the development of AI-powered solutions to simplify healthcare credentialing and monitoring. With a decade of experience building enterprise software, he specializes in applying advanced AI and analytics to enhance the customer experience and deliver transformative solutions. Drawing on his background in modernizing banking software, Brett is dedicated to creating products that drive operational excellence, uphold regulatory compliance, and improve data accuracy for Verifiable's partners, helping them scale with confidence in a complex ecosystem. Resources: MIT Sloan "Internet of AI Agents: State of AI in Business 2025" report finds that although over 80 % of organizations have piloted generative AI tools, only around 5 % have achieved meaningful business transformation—a gap dubbed the "GenAI Divide". It highlights that the primary barrier isn't model technology or regulation, but rather the failure of AI systems to integrate deeply into workflows, learn from feedback, and scale beyond the pilot stage. https://mlq.ai/media/quarterly_decks/v0.1_State_of_AI_in_Business_2025_Report.pdf Thank you to our Episode Partner, Verifiable: Verifiable is a credentialing and network monitoring platform built to help healthcare organizations optimize operations with error-free, fast verifications and to stay compliant with ease. Backed by their in-house NCQA certified credentialing team that bring a combined 60+ years of experience, Verifiable's innovation supports managing trusted networks at scale through 97% verification automation in seconds with millions processing each month. Verifiable works with leading healthcare organizations such as Humana Dental, Zelis, Talkspace, Headway, Empower Pharmacy, and many others.   Learn more about them at https://verifiable.com/ Want to go deeper or schedule a briefing with Verifiable? Email [email protected] and we'll coordinate time with the Verifiable team to discuss how their approach can help your plan reduce costs, accelerate onboarding, and strengthen network integrity. 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, we explore how human-centered design can uncover breakthrough solutions already hiding in plain sight. Dr. Kristian Olson, Vice President of Design Impact at Mass General Brigham and leader of the Springboard Studio, shares how slowing down to understand problems leads to faster, more effective innovation. The conversation dives into: The four pillars of effective healthcare innovation: design research, prototyping, supported implementation, and impact measurement How "stupidest ideas" exercises and question storming unlock creative solutions in frontline staff meetings Real results from Salem Hospital's mobility speedometer (300% increase in patient movement, reduced length of stay) The COVID testing booth prototype that saved $1 million per year while reducing gown usage by 97% Developing low-cost neonatal resuscitation devices in Uganda and India that improved ventilation skills Why frontline staff must be co-creators, not just implementers, of healthcare solutions This discussion offers practical frameworks for health plans, hospitals, and healthcare leaders looking to harness their teams' ingenuity and drive measurable improvement. Guest Bio: https://www.massgeneral.org/doctors/17235/kris-olson Resources & References MGB Springboard Studio: www.mgbspringboardstudio.org Augmented Infant Resuscitator: ebinnovations.net Positive Deviance approach to solving malnutrition in Vietnam (referenced as inspiration) 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.

Host Eric Glazer convenes senior leaders from Humana, Noom, and Blue Shield of California to explore how payers are integrating GLP-1 therapies into comprehensive cardio-metabolic care strategies. The conversation outlines how digital, behavioral, and clinical interventions can align to deliver sustainable outcomes, lower costs, and strengthen member engagement. Panelists share real-world playbooks on scaling GLP-1 programs responsibly—balancing access, affordability, and long-term adherence through consumer-centric design and data-driven clinical support. 📘 What You'll Learn How Humana's CenterWell Pharmacy is transforming outcomes through AI-enabled automation, disease-specific Centers of Excellence, and a high-touch consumer experience. How Noom and forward-thinking health plans are using trust as currency to deepen engagement and sustain lifestyle change. How Blue Shield of California is implementing a step-therapy model that balances GLP-1 access with lifestyle interventions and clinical oversight. Why integration across benefit design, behavior change, and pharmacology is redefining obesity management. What future models look like for holistic, clinician-guided weight management and cardiometabolic care. 💬 Quotable Moments "Trust isn't optional—it's the currency that earns you the right to guide someone through change." – Cody Fair, Chief Commercial Officer, Noom "You can have efficiency and still be high-touch. AI and automation don't replace pharmacists—they empower them." – Bethanie Stein, President of Pharmacy, Humana "GLP-1s are a tool, not the strategy. Success means combining medication with behavioral, nutritional, and clinical support." – Angie Kalousek, Ebrahimi Senior Director, Lifestyle Medicine, Blue Shield of California "Culture—caring, curious, and committed—is the foundation of transformation." – Bethanie Stein, President of Pharmacy, Humana ⏱️ Timestamped Hooks 00:08:00 – 00:09:00: Eric introduces the GLP-1 integration playbook and the challenge of turning high-cost therapies into sustainable value. 00:12:30 – 00:14:00: Humana's digital transformation: from internal pharmacy to 95% retention and NPS of 87. 00:15:20 – 00:17:40: Noom on building trust through "Your Ultimate Why." 00:20:00 – 00:25:00: Blue Shield of California on managing GLP-1 demand and step-therapy protocols. 00:31:00 – 00:33:00: Noom's opt-out model driving 90% employer participation. 00:44:00 – 00:47:00: Humana partners with pharma to deliver GLP-1s at up to 70% lower cash prices. 00:55:00 – 00:57:00: "Caring, Curious, and Committed" – the cultural foundation for consumer-centric care. 01:03:30 – 01:04:50: Blue Shield on building Netflix-style personalization for obesity and MSK programs. 🗒️ Show Notes Featured Guests Bethanie Stein, President of Pharmacy, Humana Cody Fair, Chief Commercial Officer, Noom Angie Kalousek Ebrahimi, Senior Director, Lifestyle Medicine, Blue Shield of California Discussion Highlights Integrating GLP-1 therapies within holistic benefit design frameworks. Leveraging AI and automation in pharmacy operations to enhance adherence and experience. The role of behavior-based engagement models in long-term weight management. Data-driven approaches to affordability, utilization, and trust-based engagement. Creating digital ecosystems that mirror personalized consumer experiences in other industries. Panelist Bios: https://www.brightspotsinhealthcare.com/events/the-glp-1-integration-playbook-smarter-plan-design-to-drive-member-engagement-and-outcomes/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Episode_Guide_GLP1_Integration_Playbook.docx.pdf Key Insights Summary: Key Takeaways - Noom The GLP-1 Integration Playbook_ Smarter Plan Design to Drive Member Engagement and Outcomes 10.09.25.docx.pdf Resources:  Benefits beyond weight loss: The expanding impact of GLP-1s in modern healthcare This resource explores how leading health plans are integrating GLP-1 therapies into holistic care pathways—connecting behavioral support, nutrition, and digital engagement to sustain results. It also highlights Noom's evidence-based approach, showing a 48% greater weight loss and over 4x ROI when GLP-1s are combined with behavioral coaching and mindset support. To request your copy, email [email protected]. Thank You to Our Episode Partner, Noom Noom is a digital health company transforming how people achieve lasting health improvements through psychology, technology, and coaching. Their scalable cardiometabolic solutions—including weight management, diabetes prevention, and GLP-1 support through Noom Med—help employers, health plans, and health systems balance affordability with outcomes. To learn more, visit noom.com/health. Schedule a meeting with Cody Fair, Chief Commercial Officer, Noom: To dive deeper into how Noom can help your plan improve outcomes, reduce costs, and strengthen member engagement, or to schedule a meeting with Cody Fair. Reach out to [email protected] to schedule the 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.  

In this Bright Spots in Healthcare episode, host Eric Glazer brings together an all-star panel of leaders who are reshaping the future of Medicaid and social care. Our guests include: Vanita Pindolia, Vice President, Medicare Star Ratings, Emergent Holdings (BlueCross BlueShield Michigan) Jason Merola, MD, Chief Medical Officer, MVP Health Care Charlotta Eriksson, Lead Director, National VBC Partnerships (Specialty), Aetna Mary O'Connor, MD, Chief Medical Officer & Co-Founder, Vori Together, they explore: How Medicare Advantage plans are embedding Stars, CAHPS, and adherence metrics directly into provider contracts to drive accountability, improve quality, and sustain year-over-year performance gains. How payers like Aetna are expanding value-based care into specialty domains—from CKD and oncology to musculoskeletal and cardiology—by partnering with specialty-aligned organizations rather than converting individual specialists to risk models. How MVP Health Care is designing hybrid incentive structures that reward specialists for closing quality gaps and improving outcomes, without requiring full downside risk. Why MSK care is becoming pivotal to Stars success, as physical and mental health measures grow in weight through 2027, and how holistic, physician-led models are improving activity, satisfaction, and cost savings simultaneously. How digital-first specialty networks are solving access challenges, reducing "ghost network" exposure, and creating new opportunities for plans to meet CMS adequacy standards while improving the member experience. How collaboration across utilization management, Stars, and member experience teams helps avoid trade-offs, ensuring that cost controls don't come at the expense of satisfaction or CAHPS performance. Panelist Bios: https://www.brightspotsinhealthcare.com/events/stars-savings-and-satisfaction-unlocking-msk-and-specialty-care-strategies-for-medicare-advantage-success/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://drive.google.com/file/d/1a_rX23Ev5VRrJKqb8_UwAYBd9tUBIfWA/view?usp=sharing Resources:  Maximizing 2026 Medicare Advantage Performance with Physician-Led MSK Care This report outlines how Vori's physician-led, virtual-first musculoskeletal (MSK) model helps Medicare Advantage plans:Improve up to 12 Star measures across preventive care, chronic condition management, and member experience Deliver faster access to care—appointments available within 48 hours Enhance outcomes for pain, fall prevention, and osteoporosis care while achieving an NPS of 87 Align with the new 2026 Star measures for Improving and Maintaining Physical and Mental Health To request your copy, email [email protected]. Clinical Quality Performance of Value-Based and Fee-for-Service Models for Medicare Advantage: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2839238 This JAMA Health Forum article compares clinical quality outcomes for Medicare Advantage patients whose care is delivered under value-based payment (VBP) models versus traditional fee-for-service (FFS). It finds that VBP arrangements, especially those with two-sided financial risk—in general are associated with better performance on standardized clinical quality measures than FFS. Thank you to our Episode Partner, Vori: Vori partners with health plans and providers to improve musculoskeletal (MSK) care through data-driven, physician-led solutions. Their approach helps reduce unnecessary surgeries, improve recovery outcomes, and enhance patient satisfaction—supporting plans in achieving better Stars performance and overall member experience. To learn more, visit vorihealth.com. Schedule a meeting with Mary O'Connor Chief Medical Officer, Vori: To dive deeper into how Vori can help your plan improve outcomes, reduce costs, and strengthen Medicare Advantage Star Ratings,or to schedule a meeting with Mary O'Connor. Reach out to [email protected]  to schedule the 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.  

GLP-1 therapies are transforming pharmacy benefits, and Express Scripts is leading the way. Harold Carter, PharmD, SVP of Trade Relations, joins host Eric Glazer to discuss how one of the nation's largest PBMs is navigating this disruptive moment in healthcare. Harold shares how Express Scripts is: Capping costs of GLP-1 therapies to expand patient access while keeping plan spending predictable. Redesigning funding models to strike a balance between affordability, predictability, and outcomes. Leveraging digital tools and AI to reduce friction in the member experience and support long-term adherence. Rethinking formularies not just as cost-control tools but as part of a broader population health and behavioral change ecosystem. You'll also hear his forward-looking perspective on how PBMs will evolve over the next three to five years, and the key questions health plans and employers should be asking today to prepare for the future of pharmacy benefits. About Dr. Harold Carter:   Harold Carter, PharmD, is responsible for leading all interactions and contracting with pharmaceutical manufacturers and oversees strategy and management of Express Scripts' drug formularies, data & insights, client underwriting, and product strategy and development. In his nearly 14 years with the organization, Harold has held numerous leadership roles oriented around critical efforts to lower the cost of prescription drugs and ensuring medication access for Express Scripts clients and members. Harold's previous responsibilities include oversight of the organization's medical pharma contracting and drug procurement teams, as well as leading the strategy, development and execution of Express Scripts' wholesale market, value-based solutions and generic strategy, and development of Express Scripts' advanced utilization management solutions.  In addition to his work at Express Scripts, Harold serves on numerous boards including LifeWise Stl Board of Directors, St. Louis University High School Board of Trustees and IVI Board of Directors. Harold earned his doctorate in pharmacy from St. Louis College of Pharmacy.   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.