In this episode, Steve Sutherland, Senior Vice President of Information Systems at CERIS, shares how AI and machine learning are reshaping payment integrity across the full claims lifecycle. He discusses the shift toward prepayment solutions, the importance of governance and data quality, and how leaders can balance automation with accuracy, fairness, and trust.

This episode is spon sponsored by CERIS.

In this episode, Patrick Gilligan, President and CEO of Point32Health, shares how the New England based nonprofit is confronting rising medical and pharmacy costs while staying focused on members and employers as its true shareholders. He discusses the affordability crisis, aligning incentives with providers, and why redesigning care around the patient experience is essential to lowering costs and improving outcomes.

In this episode, Paul Markovich, President and CEO of Ascendiun, discusses his testimony before Congress, the push to eliminate PBM spread pricing and rebates, and why he believes the healthcare industry must confront its cost problem head on. He also shares how Ascendiun’s new structure, digital health record ambitions, and unbundled PBM model aim to build a system that is sustainably affordable and worthy of patients and families.

In this episode, Thomas Graf, MD, Chief Medical Officer for Florida Blue, part of GuideWell, shares how the health plan is improving cancer care through a high-touch, tech-enabled navigation program for Medicare Advantage members. He discusses reducing variation, closing gaps between diagnosis and treatment, and achieving better outcomes, higher satisfaction, and lower costs by centering care around the patient experience.

In this episode, Lila Benayoun, Chief Operating Officer at MetroPlusHealth, shares how the organization is translating member affordability data into simpler plan design, predictable costs, and high-touch community support across New York City. She discusses addressing disparities through multilingual outreach, culturally competent services, and operational strategies that help members better understand and use their coverage.

In this episode, Tilak Mandadi, Executive Vice President of Ventures and Chief Experience and Technology Officer at CVS Health, shares how the company is investing in and building technology to simplify healthcare and drive better consumer engagement. He discusses CVS Health Ventures, interoperability, AI strategy, and the vision behind creating an open, consumer-centric platform that connects payers, providers, pharmacies, and patients.

In this episode, Dr. Damanjeet Chaubey, Vice President of Clinical Affairs at Clover Health, shares how payer provider relationships are evolving under cost and workforce pressures and where plans often fall short in operational execution. She discusses technology enabled, PCP centric, and home based care models as critical levers for managing utilization, improving outcomes, and sustaining Medicare Advantage performance.

In this episode, Craig Kurtzweil, Chief Data and Analytics Officer for UnitedHealthcare’s commercial business, shares insights from UnitedHealthcare’s latest employer health trends report, including rising costs among younger workers, more frequent catastrophic claims, and growing metabolic risks. He discusses how data driven strategies can help employers better target engagement, prevention, and affordability.

In this episode, Brett Bingham, Chief Network Development Officer at Banner Plans and Networks, discusses how payers and providers are shifting toward collaboration amid cost pressures and workforce shortages. He shares where strategy is outpacing execution, why data and payment models matter for value based care, and how Banner is staying disciplined in its long term investments.

In this episode, Craig Kurtzweil, Chief Data and Analytics Officer for UnitedHealthcare’s commercial business, shares insights from UnitedHealthcare’s latest employer health trends report, including rising costs among younger workers, more frequent catastrophic claims, and growing metabolic risks. He discusses how data driven strategies can help employers better target engagement, prevention, and affordability.