Featured in this latest episode of Tuning In to the C-Suite podcast is Paul Fronstin, director of health benefits research at EBRI, who shed light on the evolving landscape of health benefits with editors of Managed Healthcare Executive. Fronstin discussed the challenges employers face in designing health plans that steer employees toward high-value care. He also shared insights on high-deductible health plans (HDHPs), noting that while they initially lead to reduced healthcare usage, they don’t...
Nov 20, 2024•21 min•Ep. 139
In this latest episode of Tuning In to the C-Suite podcast, Briana Contreras, an editor with MHE had the pleasure of meeting Loren McCaghy, director of consulting, health and consumer engagement and product insight at Accenture, to discuss the organization's latest report on U.S. consumers switching healthcare providers and insurance payers. One of those surveys were on payer experiences and the other on patient experiences. McCaghy shared that ease of interaction, rather than clinical experienc...
Jun 19, 2024•28 min•Ep. 138
In our latest "Meet the Board" podcast episode, Managed Healthcare Executive Editors caught up with board member, Eric Hunter, CEO of Care Oregon, to discuss a number of topics, with one including the merger that never closed with SCAN Health Plan due to local opposition from Oregonians, emphasizing the need for partnerships to meet scaling and capital requirements. On the other hand, Hunter also praised Oregon's careful Medicaid redetermination, resulting in a smaller enrollment decline than ex...
Jun 18, 2024•33 min•Ep. 137
In the latest episode of the Meet the Board podcast series, Managing Editor, Peter Wehrwein, catches up with Chief Clinical Officer at Optum Rx and EAB member, David Calabrese, about his new role alongside his team's progress in improving quality, patient safety and health equity in healthcare. David highlights efforts to address pharmacy deserts and medication shortages; and the two discuss the challenges and future of retail pharmacies, the impact of cell and gene therapies and the rise of GLP...
Jun 04, 2024•35 min•Ep. 136
A limited pharmacy benefit manager (PBM) reform bill may be used as a "pay for" to offset the costs of extending Medicare telehealth flexibilities, shares Kelly, of Capitol Advocacy & Government Affairs.
May 24, 2024•34 min•Ep. 135
In this month’s episode of Meet the Board, MHE’s Managing Editor Peter Wehrwein and spoke with a new member of our editorial advisory board, Marci J. Chodroff, MD, FACP, VP of Medical Affairs at Magellan Rx Management, a Prime Therapeutics company. The two discussed Chodroff's career transition from clinical practice to pharmacy benefits management, then crossed over to highlight challenges like Medicare regulations and the growth of specialty pharmacy, focusing on oncology and GLP-1 agonists. T...
May 08, 2024•28 min•Ep. 134
In this episode, MHE's Peter Wehrwein spoke with Patrick Cooney, president of The Federal Group, discussing Washington's focus on Pharmacy Benefit Managers (PBMs). Cooney highlighted increased federal attention on PBMs, with legislative activity indicating bipartisan interest in reform. Despite recent setbacks in negotiations over PBM-related provisions, both Democrats and Republicans aim for transparency and change. Cooney also predicts eventual PBM legislation in 2024, emphasizing the bipartis...
Apr 11, 2024•17 min•Ep. 133
As we bring back our "Meet the Board" Series podcast series, Managed Healthcare Executive welcomes our newest Editorial Advisory Board member Greg Baker, CEO of AffirmedRx. In this conversation, Baker and Peter Wehrwein, MHE managing editor, discussed insights from Baker's career journey. Drawing from his experiences at Walgreens and Premise Health, Baker highlighted the importance of patient-centered care and process orientation. He discussed AffirmedRx's mission to bring transparency to the PB...
Apr 02, 2024•34 min•Ep. 132
In this second part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein spoke with Ceci Connolly and Margaret "Meg" Murray about Medicare Advantage utilization and challenges, highlighting proposed CMS payment cuts and prior authorization issues. Murray emphasized MA's growth and benefits, while Connolly introduced MA for Tomorrow proposals. They also tackled drug pricing transparency concerns, Medicaid coverage challenges, and predicted affordability as ...
Mar 25, 2024•18 min•Ep. 131
In this first part of a two-part podcast episode, Managed Healthcare Executive' s Managing Editor Peter Wehrwein kicks off our new podcast series "DC Roundtable," with guests Margaret "Meg" Murray, CEO of the Association of Community Affiliated Plans, and member of MHE's Editorial Advisory Board, and CeCi Connolly, president and CEO of the Alliance of Community Health Plans, for a discussion on healthcare policy issues. The trio addressed the impact of Medicaid redetermination, emphasizing ongoi...
Mar 19, 2024•23 min•Ep. 130
In this month’s episode of Tuning In to the C-Suite, Briana Contreras, an editor of Managed Healthcare Executive, got to chatting with Sanjula Jain, Ph.D., chief research officer at Trilliant Health. In the conversation, Sanjula shared the concerning rise in cancer cases among those in their 30s and 40s, despite declining mortality rates. In this age range, neoplasm-related deaths are notably increasing, which could possibly be linked to pandemic-induced declines in primary care and screenings. ...
Feb 23, 2024•21 min•Ep. 129
In this month’s episode, Briana Contreras, an editor of MHE , chatted with Lynn Carroll, executive of HSBlox, about the difference between predictive and generative AI, yet how each works together in preventive healthcare. In the discussion, Carroll expressed the challenges and opportunities with generative AI in clinical documentation, pharmaceutical research, and medical device manufacturing. Also shared were strategies for aligning primary and specialty care in value-based initiatives, along ...
Jan 03, 2024•20 min•Ep. 128
Briana Contreras, an editor of Managed Healthcare Executive, spoke with Fred Turner, CEO of Curative, in this month’s episode. The two talked about the challenges middle-class Americans face in dealing with medical debt, exploring the causes behind it and the impact on overall health. Fred also touched on potential solutions, both from the perspective of organizations like Curative and through collaborative efforts between various stakeholders in the healthcare system. The solutions mentioned in...
Dec 06, 2023•18 min•Ep. 127
Briana Contreras, an editor with Managed Healthcare Executive , spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare. Dr. Rajasimha also shared some examples o...
Nov 08, 2023•22 min•Ep. 126
Managing Editor of Managed Healthcare Executive , Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series. Shrank, a member of MHE's Editorial Advisory Board, also shar...
Oct 25, 2023•27 min•Ep. 125
Managed Healthcare Executive's Managing Editor Peter Wehrwein, and Editor Briana Contreras, had a discussion in July with Mostafa Kamal, president and CEO of Prime Therapeutics, an organization in which Kamal acquired this position in July 2023. Kamal addressed his newer role, plans for Prime, the company’s more recent acquisitions and previous partnerships and some of his thoughts on the multimillion gene therapies and price transparency from a PBM perspective.
Sep 13, 2023•35 min•Ep. 124
In this month’s episode, Briana Contreras, an editor of Managed Healthcare Executive , had the pleasure of catching up with MHE Editorial Advisory Board Member, Ateev Mehrotra, who is a professor of healthcare policy at Harvard Medical School and an Associate Professor of Medicine and Hospitalist at Beth Israel Deaconess Medical Center. What’s been on Ateev’s mind or has been a focus, lately, are most things in the digital health and telehealth space, as well as practice licensure in the U.S. Am...
Aug 10, 2023•20 min•Ep. 123
Welcome back to another episode of "Tuning In to the C-Suite," where Briana Contreras, an editor of Managed Healthcare Executive , had the pleasure of chatting with Cindy Gaines, chief clinical transformation officer at Lumeon. In the conversation the two mainly addressed how automation is filling in the gaps electronic health records are not able to meet and how these gaps are affecting staff, increased costs, workflows and more.
Aug 02, 2023•21 min•Ep. 122
Briana Contreras, an editor of Managed Healthcare Executive, spoke with Brian Adams, President and CEO of Tabula Rasa HealthCare, in this month's episode of Tuning In to the C-Suite podcast. In the episode, Brian and Briana got to chatting about value-based care and why the transition to this type of model has been slower than expected for some practices to adopt. Most of the discussion focused on Brian’s suggestion of simplifying and personalizing value-based care models to improve health outco...
Jul 10, 2023•18 min•Ep. 121
In this episode, Briana Contreras, an editor with Managed Healthcare Executive , and Peter Wehrwein, managing editor of MHE , got to chatting with the newest editorial advisory board member, Jeffrey Casberg, who is vice president of Clinical Pharmacy at IPD Analytics. In the discussion, Casberg shared the most pressing or prominent issues on his mind, he explained what the drug life-cycle is at IPD, and what the latest is on drugs in the pipeline. Casberg also shared his predictions for Sarepta ...
Jun 15, 2023•32 min•Ep. 120
Briana Contreras, an editor of Managed Healthcare Executive, spoke with Leah Dewey, vice president of clinical and consumer engagement operations at Cotiviti, in this month’s podcast episode. In our discussion, Leah talked about what she’s seeing as the process of Medicaid Redetermination is well underway and some of the issues affecting consumers, as many are at risk of losing coverage. Leah also shared best practices for health plans when reaching out to consumers and ways to keep members info...
Jun 10, 2023•19 min•Ep. 119
This month’s episode of the "What's On Your Mind" podcast series features President and CEO of CareOregon, Eric Hunter. MHE Managing Editor, Peter Wehrwein, and Editor, Briana Contreras, picked Hunter's brain to see what’s in fact on his mind when it comes to healthcare. Throughout the discussion, the MHE editors got an idea of enrollment or how Medicaid redetermination is going for CareOregon, and were even able to take a deeper look at the collaboration or “combination” underway between SCAN H...
May 10, 2023•30 min•Ep. 118
This month's episode of Tuning In to the C-Suite features Erica Jain, CEO & co-founder of digital health company, Healthie. In this discussion, Jain shared some of the challenges or things to avoid when creating a digital health startup, based on her journey with starting Healthie in 2016. She also addressed some best practices and tools that can help those working toward a digital health startup.
May 05, 2023•17 min•Ep. 117
In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of c...
Apr 13, 2023•36 min•Ep. 116
Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month’s episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI.
Apr 07, 2023•15 min•Ep. 115
A pandemic is not on anybody’s wish list. But the one that COVID-19 has wrought has ushered in some constructive changes to U.S. healthcare that previously has been more talked about than done, according to Rodrigo Cerdá, senior vice president of health services and chief medical officer at Independence Blue Cross in Philadelphia. Cerda is this month’s guest on the “ What's on Your Mind?” podcast, and in this episode, he talks with Managing Editor Peter Wehrwein, about another pandemic silver li...
Mar 09, 2023•29 min•Ep. 114
Briana Contreras, an editor of Managed Healthcare Executive, chats with Bronwyn Spira, CEO and founder of Force Therapeutics, in this week's episode about CMS' new CPT codes introduced in 2022. These codes focus on musculoskeletal and respiratory conditions and the data collected from patients affected. According to Spira, these codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed.
Mar 01, 2023•19 min•Ep. 113
Our guest in this month’s episode of the “What's on Your Mind” podcast is Margaret Murray, M.P.A., founding CEO of the Association for Community Affiliated Plans (ACAP) and a longtime member of Managed Healthcare Executive ® editorial advisory board. Murray is an expert on Medicaid and healthcare policies that affect people with low incomes. In the interview with Managing Editor of MHE , Peter Wehrwein, she discusses ACAP’s growth and its legislative wins, Medicaid redetermination, “junk insuran...
Feb 10, 2023•31 min•Ep. 112
In this month’s episode of Tuning In to the C-Suite, Managing Editor Peter Wehrwein talks with Rick Bates, MBA, president and CEO of RxSense . In his conversation with Wehrwein, Bates described RxSense as a “technology platform company that has expertise in the direct-to-consumer business.” He emphasized that RxSense is not a pharmacy benefit manager (PBM) — but, rather, a company that supplies PBMs with technology, including some of the up-and-coming PBMs, such as EmsanaRx and Vivid Clear Rx . ...
Feb 02, 2023•26 min•Ep. 111
In this debut podcast series of What's on Your Mind podcast, Perry Cohen, Pharm.D., CEO of The Pharmacy Group, recently shared his thoughts on the current state of healthcare and especially the management of pharmacy costs. This new monthly series brings listeners into the minds of Managed Healthcare Executive's Editorial Advisory Board members. Cohen has decades of experience in managed care and has been on the editorial advisory board of Managed Healthcare Executive® since 1994.
Jan 11, 2023•28 min•Ep. 110
