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Author: Sponsored by HealthEdge July 1, 2025 Duration: 10:13
Health plans continue to face operational delays due to fragmented systems and an over-reliance on manual reporting cycles. While data analysts work across multiple platforms to produce static reports, the insights often arrive too late to support real-time decisions. This episode explores why traditional models are no longer sustainable and how self-service dashboards, powered by a connected data ecosystem, are transforming operational agility. Listeners will hear how prebuilt metrics provid...

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
The Hidden Economics of Payer Operations [not-audio_url] [/not-audio_url]

Duration: 15:11
Administrative costs are climbing across the payer industry, but many plans still rely on high-level expense views that mask the true drivers of operational spend. Beneath the surface, fragmented systems, manual processe…
Stars in Flux: CMS 2027 Changes [not-audio_url] [/not-audio_url]

Duration: 9:52
Medicare Advantage organizations are facing a significant policy year as CMS releases updates that signal a recalibration of the Stars program and broader regulatory framework. Recent rule-making and guidance point to ch…
Lessons From 2026 Enrollment [not-audio_url] [/not-audio_url]

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 enrollmen…
The Problem With Managing Multiple Vendors [not-audio_url] [/not-audio_url]

Duration: 13:17
Is managing multiple vendors slowing your health plan down? Disconnected systems, rising costs, and scattered data often stand in the way of efficiency and better member experiences. This episode explores the challenge o…
Bonus: Star Rating Report 2026 [not-audio_url] [/not-audio_url]

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 memb…
Risk Adjustment Across Multiple Lines of Business [not-audio_url] [/not-audio_url]

Duration: 8:00
Navigating risk adjustment across multiple lines of business isn’t just complex, it’s a balancing act of shifting regulations, diverse populations, and evolving models. In this episode, we break down the key differences…
Call Centers in the Age of AI [not-audio_url] [/not-audio_url]

Duration: 10:50
What if your contact center could do more than answer questions? What if it could predict needs, detect fraud, translate languages in real time, and coach agents as they speak to members? In this episode, explore how AI…
Season 4 Trailer [not-audio_url] [/not-audio_url]

Duration: 0:40
This season on Current Trends for Payers, we’re highlighting guest experts in emerging technologies and operational strategies that health plans need to stay agile and competitive. We’ll dig into what’s working and what’…