In this episode, Michael Hunn, CEO, and Yunkyung Kim, COO, of CalOptima Health discuss preparing for Medicaid eligibility changes, preventing coverage losses, and supporting providers amid rising uncompensated care risks. They also share plans for a 2027 Covered California marketplace launch and reflect on building community trust through collaboration and mission driven leadership.

In this episode, Jennifer Schirmer, VP of Growth and Community Engagement and interim VP of Duals Program Integration at Blue Shield of California Promise Health Plan, breaks down the sweeping Medicaid changes under HR1 and their impact on California’s Medi-Cal members. She shares how her team is investing in high touch outreach, community partnerships, and duals integration to help vulnerable populations maintain coverage and access to care amid rising administrative complexity.

In this episode, Elizabeth Crawley, Vice President for Clinical and Care Management Solutions at EXL, explores how AI driven workflows and agentic automation are transforming prior authorization. She discusses balancing efficiency with clinical oversight, scaling decision support across the enterprise, and why data readiness and change management are critical to success.

This episode is sponsored by EXL.

In this episode, Sheri Johnson, former Vice President of Member Enrollment and Billing at UCare, shares insights on how payer and provider relationships are evolving under cost and workforce pressure, where strategy and operations often misalign, and why AI is poised to reshape health plan performance in the years ahead.

In this episode, Ty Wang, Co-Founder and Chief Executive Officer at Angle Health, shares how his team is rethinking health plan infrastructure to move beyond transactional payer provider relationships. He discusses modernizing operations with AI, improving transparency for employers and brokers, and aligning incentives around outcomes, affordability, and member experience.

In this episode, Eric C. Hunter, President and CEO of CareOregon, discusses how the organization is aligning with providers to improve quality and performance while managing cost pressures. He shares insights on leveraging AI, navigating regulatory challenges, and creating sustainable solutions for Medicaid and community health.

In this episode, Brandy Thompson, Chief Executive Officer of Benefitbay, shares where payer strategy continues to fall short in execution, what investments could reshape health plans, and how reducing administrative complexity can improve margins and access to care.

In this episode, Rob Andrews, Chief Executive Officer of the Health Transformation Alliance, discusses how employers and providers can work more closely to improve value, reduce middleman costs, and drive better outcomes. He shares perspectives on payer competition, transparency, GLP 1 cost pressures, and how technology and personalized medicine may reshape health plans in the years ahead.

In this episode, Melanie Fernando, President and CEO of Aetna Better Health of Illinois, discusses launching a virtual menopause partnership to close gaps in Medicaid women’s health, improve member engagement, and drive better outcomes through tailored, community based solutions.

In this episode, Alex Ding, MD, Enterprise Deputy Chief Medical Officer at Humana, discusses the findings from Humana’s latest Value-Based Care Report, including lower hospital admissions and emergency department visits among Medicare Advantage members in value based arrangements. He shares how deeper primary care continuity, stronger payer provider alignment, and reduced administrative burden are key to scaling sustainable, outcomes driven care. Learn more here: https://humana.com/vbc