Lessons From 2026 Enrollment

Lessons From 2026 Enrollment

Author: Sponsored by HealthEdge January 16, 2026 Duration: 10:40
Enrollment for 2026 brought major shifts for health plans, driven by new CMS rules, rising consumer expectations, and the growing pressure to modernize operations. This episode explores how plans are rethinking enrollment integrity, broker oversight, digital shopping, data quality, and how emerging interoperability requirements will reshape eligibility, provider data, and automation in the seasons ahead. Tune in to understand how these changes affect the future of enrollment, and how leading ...

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
Prior Authorization Trends & Opportunities [not-audio_url] [/not-audio_url]

Duration: 11:17
While prior authorization serves as vital checks and balances, ensuring clinical quality and preventing fraud, the administrative burden it imposes on providers and payers alike has led to an industry-wide reevaluation o…
Responsible AI For Payers [not-audio_url] [/not-audio_url]

Duration: 16:34
As payers adopt artificial intelligence (AI) technologies in different aspects of healthcare operations, there is a need for AI governance and the careful vetting of vendor AI practices to safeguard patient welfare. AI s…
Unlock The Potential of Prospective Programs [not-audio_url] [/not-audio_url]

Duration: 20:33
As more and more provider organizations enter into risk-sharing agreements, provider engagement programs are experiencing a surge in participation. Provider engagement programs improve the collaborative relationship betw…
NLP For Coding & Compliance [not-audio_url] [/not-audio_url]

Duration: 16:11
NLP is an AI technology that is being used in healthcare IT for clinical documentation and medical coding. For medical coding, the program identifies diagnoses codes for HCC risk adjustable categories and flags it for a…
RADV—The Future of Reimbursement Accuracy [not-audio_url] [/not-audio_url]

Duration: 12:24
The intention for developing RADV audits was to develop a checks and balances to ensure reimbursement payment accuracy for Medicare Advantage Organizations (MAOs). There’s a history of CMS addressing payment accuracy in…
Regulatory Concerns In Enrollment Technology [not-audio_url] [/not-audio_url]

Duration: 9:32
There is a distinct advantage to enrollment technologies that are built specifically for CMS's enrollment and dis-enrollment regulations for Medicare Advantage and Part D. One such specification includes the Application…
Bonus Episode: Star Ratings Industry Report 2023 [not-audio_url] [/not-audio_url]

Duration: 12:09
In this bonus episode, we welcome Stars expert, Megan Piotrowski, for an in-depth review of the recent Star Ratings release. On October 13, 2023, the 2024 Medicare Advantage and Part D Star Ratings were published on Medi…
Shifting Measures In Stars—Making The Quick Pivot [not-audio_url] [/not-audio_url]

Duration: 16:06
In this episode, we discuss the significant changes in the weight of Star measures, with the reversal of the 2022 Final Rule—many measures are returning to their previous weights. In response to the 2022 Final Rule, plan…
The Science of Predicting Member Conditions [not-audio_url] [/not-audio_url]

Duration: 13:44
As stewards of healthcare, health plans are responsible for managing the care of its members. This includes working with providers to capture member conditions accurately and comprehensively via medical charts and coding…