Bonus: Star Rating Report 2026

Bonus: Star Rating Report 2026

Author: Sponsored by HealthEdge October 15, 2025 Duration: 13:16
The 2026 Medicare Advantage and Part D Star Ratings are out—and they reveal more than just who earned 5 stars. Beneath the numbers lies a clear message: CMS is reshaping what quality means, shifting the balance from member satisfaction to measurable outcomes and data precision. Plans that once thrived on experience scores are now facing tougher cut points, new ECDS-only measures, and the rise of HOS as a major performance driver. This episode unpacks what changed, why it matters, and wh...

Tune in to Current Trends For Payers for a grounded conversation about the forces reshaping health insurance and government-sponsored health plans. Sponsored by HealthEdge, this podcast moves beyond surface-level news to examine the operational backbone required to navigate today's complex landscape. Each episode features direct dialogue with industry experts who understand that real progress hinges on the infrastructure behind the scenes. You'll hear specific discussions on practical areas like leveraging BPaaS and new technology, strengthening data security, and refining core administration processes. We also delve into the critical human elements of care management and member engagement, alongside the metrics that matter, including risk adjustment and HEDIS and Star quality measures. Whether it's strategies for start-up growth or adapting to regulatory shifts, the focus remains on actionable insights that can lead to better business outcomes and, fundamentally, a higher quality of care for members. This is a resource for professionals seeking a deeper understanding of the systems and trends that define success in the payer space.
Author: Language: en-us Episodes: 44

Current Trends For Payers
Podcast Episodes
From Siloes to Synergy: The Power of Data Hub [not-audio_url] [/not-audio_url]

Duration: 10:50
In this episode, we explore how data consolidation is reshaping health plan operations and why it is becoming essential for the future of the industry. From breaking down data silos to enabling real-time, data-driven dec…
Removing Data Silos For A 360-Member Journey [not-audio_url] [/not-audio_url]

Duration: 10:25
Payers are seeking new ways to enhance member engagement and drive long-term retention. This podcast explores a powerful new-to-market strategy for transforming how health plans design member journeys to create a seamles…
The Human Side of Workflow Technology: Claims + Enrollment Processing [not-audio_url] [/not-audio_url]

Duration: 12:45
Claims and enrollment management can feel like a juggling act, especially with rising volumes and the pressure to meet strict accuracy and timeliness standards. What if there were tools to simplify it all? In this episod…
Rethinking Total Cost of Ownership In Core Admin [not-audio_url] [/not-audio_url]

Duration: 21:12
Health plans often underestimate the full financial burden of their core administration systems. This episode shines a light on the hidden costs buried and spread throughout the lifecycle of a typical core admin vendor c…
Achieving a Compliant Query Practice [not-audio_url] [/not-audio_url]

Duration: 16:04
Clinical documentation improvement (CDI) is essential for accurate patient care, compliance, and effective risk adjustment. Health plans and providers must work together to address common challenges like incomplete recor…
Tech Ecosystems: The New Operating Model [not-audio_url] [/not-audio_url]

Duration: 20:20
In this episode, we discuss the history of tech ecosystems for health plans, the most common operating model today, the multiple-vendor model, and an innovative new operating model that relies on an end-to-end ecosystem…
Lessons Learned From the OIG [not-audio_url] [/not-audio_url]

Duration: 13:43
Accurate coding in healthcare is critical, especially with the recent changes brought about by the RADV extrapolation rule. This regulation allows the Office of the Inspector General (OIG) to apply audit findings from a…
From Data to Action: Revolutionizing HEDIS Analytics [not-audio_url] [/not-audio_url]

Duration: 9:55
This episode explores the challenges and opportunities plans face during the digital transition. The most common challenges are outdated systems, fragmented data sources, and managing data integration effectively. We dis…
Bonus Episode: Star Rating Industry Report 2025 [not-audio_url] [/not-audio_url]

Duration: 7:51
The 2025 Medicare Advantage and Part D Star Ratings were released on October 10, 2024. This year brought significant shifts that will impact health plans across the industry. With new challenges in place and more stringe…
Cyber Security Trends: Third-Party Security Assurances [not-audio_url] [/not-audio_url]

Duration: 19:10
Preparation and a vigilant organizational mindset are critical to reducing the financial and reputational risk of cybersecurity incidents. Join CISO, Hans Guilbeaux for an in-depth discussion on ways health plans can ens…