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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
Medicare Ad Graphics—The Overlooked Element [not-audio_url] [/not-audio_url]

Duration: 12:42
Best practices for Medicare and Medicare Advantage marketing and ads continue to evolve as greater numbers of seniors integrate digital activity, such as online news and Facebook, into their daily routines. While the goa…
A Business Case For Interoperability [not-audio_url] [/not-audio_url]

Duration: 16:53
CMS Interoperability and Patient Access Final Rule was developed to connect healthcare technology systems so members can access their own data. All CMS-backed plans—Medicare Advantage plans, Medicare plans and ACA plans…
How Technology Workflows Influence Quality of Care [not-audio_url] [/not-audio_url]

Duration: 14:44
Technology is essential for today's care management operations, yet it's important to recognize that technology can either help or hinder the business. At its best, technology offers a reduction in the basic cost of doin…
Ethics, Data Science, and SDoH [not-audio_url] [/not-audio_url]

Duration: 16:08
Social determinants of health (SDoH) is an important variable to consider when interacting with Medicare Advantage populations and as the healthcare system increases its use of digital technologies, such as telehealth vi…
Leveraging HEDIS Data [not-audio_url] [/not-audio_url]

Duration: 10:31
“The goal is to support consumers in making informed decisions about which plan to choose” HEDIS hones in on 5 domains of care and measures whether the healthcare services rendered are actually improving conditions. The…
The Technology Debt Dilemma—Why Cloud Operations Are Essential [not-audio_url] [/not-audio_url]

Duration: 14:19
"The operating infrastructure of health plans rely on technology to expedite processes, scale, react quickly to regulatory changes and changes in the market." Technology debt is the cost of maintaining legacy software sy…
Innovations In Claims & Payment Models [not-audio_url] [/not-audio_url]

Duration: 11:10
It’s hard to imagine a time when claims were submitted on paper. In 2003, Medicare required electronic submission of all claims via an electronic data interchange (EDI) for auto-adjudication. This means claims are proces…
Generational Differences In Technology Usage [not-audio_url] [/not-audio_url]

Duration: 13:37
The concept of marketing segmentation isn't new, but what may be new, is the idea of generational segments within the Medicare market. Until recently, messaging to the senior market has involved painting a picture of a p…
Improving CAHPS With Existing Data & New Perspectives [not-audio_url] [/not-audio_url]

Duration: 14:54
“One area of opportunity that a lot of health plans overlook, is taking a step back and looking at data that’s right in front of them with a new perspective..” The weight of the CAHPS survey has steadily increased over t…
Strategies For Reducing Gap and Chase Time Frames [not-audio_url] [/not-audio_url]

Duration: 17:11
“It’s essential to accelerate the speed and time for gaps to identify them faster and proactively.” In the context of risk adjustment gaps, there are two overarching goals—to identify and accurately predict member condit…