Breaking Down Silos in Health Plan Pricing Operations

In this episode, Steven Berkow, Senior Advisor for Value-based Care at InterSystems, and Robert Tennant, Executive Director of the Workgroup for Electronic Data Interchange, discuss the evolving landscape of ePrior authorization. They share insights on regulatory changes, industry collaboration, and what healthcare leaders should know as the 2027 compliance date approaches.This episode is sponsored by InterSystems.

In this episode, Zack Myers, National General Manager at SCAN Health Plan, discusses the organization’s expansion into new markets, its nonprofit approach to provider partnerships, and how innovative models like iSNPs are improving care and independence for seniors.

In this episode, Brendan Harris, president of UPMC for You and state programs, shares how initiatives like the Pathways to Work program and Neighborhood Centers are addressing social determinants of health, supporting Medicaid members, and strengthening local communities.

In this episode, Mack McGee, Chief Marketing Officer at CareFirst BlueCross BlueShield, shares how the organization earned top marks for customer experience in Forrester’s 2025 rankings and discusses the importance of trust, personalization, and simplifying healthcare interactions for members.

In this episode, Scott Burton, Market President at Providence Health Plan, shares insights on the growing interest in ICRAs, strategies to manage rising employer health costs, and how Providence is balancing innovation with long-term sustainability in a shifting insurance landscape.

In this episode, Jay Deady, President of Price Optimization at Zelis, discusses why fragmented pricing operations create inefficiencies for health plans and how integrated solutions, advanced technology, and personalization are paving the way for a more connected financial experience across healthcare.This episode is sponsored by Zelis.

This episode features Cereasa Horner, Director of Policy and Payment Integrity at CERIS, who shares insights on the evolving payer oversight landscape. She discusses the challenges of maintaining consistency across state and federal guidelines, the role of AI and predictive compliance modeling, and strategies for payers to stay proactive in a dynamic regulatory environment.This episode is sponsored by CERIS.

In this episode, Bill Harlan, Vice President of Behavioral Health at Point32Health, shares how his team is addressing access challenges, supporting members through navigation services, and building innovative partnerships to improve mental health care delivery.

In this episode, Dan LaVallee and Dr. Brandy Hershberger of UPMC share how the health system is creating innovative apprenticeship programs to support Medicaid members and employees in pursuing meaningful careers. They discuss workforce development, grant funding, and how these programs are shaping the future of healthcare talent pipelines.

In this episode, Alan Cohen, Co-founder and Chief Product Officer at Centivo, joins the podcast to share his perspective on escalating healthcare costs, premium increases, and the risks facing the ACA market. He also explains how Centivo partners with high-performing providers to deliver cost-effective, sustainable coverage for employers and their employees.