Bright Spots in Healthcare

Eric Glazer

Each episode, I interview innovators in the healthcare industry to extract the strategies, tactics, tools, and/or routines they utilize to generate extraordinary, positive outcomes. We highlight and breakdown these bright spots so you can apply them at your organization. "See a bright spot .... and clone it!" read less
Health & FitnessHealth & Fitness

Episodes

Important and Innovative Approaches to Leveraging the Health Equity Index
3d ago
Important and Innovative Approaches to Leveraging the Health Equity Index
Melissa Newton Smith, Founder of Newton Smith, and Keslie Crichton, Chief Sales Officer of BeneLynk, join Eric to discuss the introduction of the CMS Health Equity Index, which will replace the reward factor within the Medicare Advantage Star Rating program measurement. The Health Equity Index will be a seismic change for Medicare Advantage plans and impact revenue associated with Star Ratings. Melissa and Keslie share success stories from plans preparing for the change.  Links "Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use": https://jamanetwork.com/journals/jama-health-forum/fullarticle/2814604 Book Links   $2.00 a Day: Living on Almost Nothing in America:  https://www.amazon.com/2-00-Day-audiobook/dp/B012E8RDS2/ref=sr_1_1?crid=29MW28TUOFAG0&keywords=%242+a+day&qid=1708126201&s=books&sprefix=2+a+day%2Cstripbooks%2C125&sr=1-1   Because I Said I Would: https://store.becauseisaidiwould.org/store/thebook/?_gl=1*qfwy3p*_ga*OTY3NTIzNTYzLjE3MDgxMjYyNDc.*_ga_9YFXHXM1VK*MTcwODEyNjI0Ny4xLjAuMTcwODEyNjI1NC41My4wLjA.    The Ethical Case Manager: https://www.amazon.com/dp/194388918X/ref=cm_sw_r_apin_dp_GVBYY6XZGAK9RK9VRHE8   About Melissa Melissa is the founder of Newton Smith. She brings over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. Most recently, she served as Chief Consulting Officer at Healthmine. Melissa is a well-known healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience.  About Keslie Keslie has worked in managed care for over 25 years, focusing on SDoH solutions that improve members' lives and provide a return on investment for our clients. Keslie drives enterprise growth and innovative partnerships to improve outreach strategies and health outcomes for our client’s members.  Keslie works closely with BeneLynk’s product team to offer differentiated services and capabilities to maintain its market leader position.    This episode is sponsored by BeneLynk BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. They serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve.
Meeting Goals for Chronic Condition Management With Fewer Resources
Feb 16 2024
Meeting Goals for Chronic Condition Management With Fewer Resources
Leaders from Independence Blue Cross, Banner| Aetna, and Scene Health share exclusive insights on successfully accomplishing chronic condition management success with fewer resources.    Our expert panel explores patient-centered and technology-enabled approaches that elevate chronic care management efficiency and effectiveness. Don't miss the opportunity to learn about strategic solutions tailored to the unique challenges of Medicaid and Medicare health plans.   Panelists: Robert Groves, MD, Chief Medical Officer & Executive Vice President, Banner| Aetna Reetika Kumar, MD, FACP, Vice President, Market Clinical Solutions and Pharmacy Services, Independence Blue Cross Sebastian Seiguer, CEO & Co-Founder, Scene Health Bios: https://www.brightspotsinhealthcare.com/events/meeting-goals-for-chronic-condition-management-with-fewer-resources/   This episode is sponsored by Scene Health Meet Scene Health, the industry leader in MedEngagement. They are going beyond traditional medication adherence to transform disease management.   Scene’s MedEngagement approach uses 1:1 async video to deliver medication support at scale.   Scene helps members get better fast—getting to the doctor, getting their meds, taking them as prescribed, and getting labs and vitals—driving cost-effective utilization and improving multiple clinical and quality measures in as little as 90 days.   Scene was commercialized out of Johns Hopkins, and has developed the most extensive catalog of peer-reviewed publications among medication adherence companies. Visit its website at www.scene.health for more information.
How Innovators Are Addressing GLP-1s, Obesity and MSK
Jan 26 2024
How Innovators Are Addressing GLP-1s, Obesity and MSK
Leaders from Blue Cross and Blue Shield of Illinois, Independent Health, Evry Health and Vori Health discuss GP-1s and their role in addressing the global challenge of obesity. The panel shares innovative, multidisciplinary strategies you can implement to complement lifestyle interventions and other therapeutic approaches in your organization. * Improving outcomes by pairing GLP-1s with evidence-based behavior change * Considering musculoskeletal (MSK) health in obesity treatment * Understanding the role of GLP-1s in delivering value-based care   Panelists: Shelley Turk, Divisional Senior Vice President of Health Care Delivery, Blue Cross and Blue Shield of Illinois Martin Burruano, Vice President, Pharmacy Services, Independent Health Mamata Majmundar, MD, Chief Medical Officer, Evry Health Mary O'Connor, MD, FAAOS, Co-Founder & Chief Medical Officer, Vori Health   https://www.brightspotsinhealthcare.com/events/how-innovators-are-addressing-glp-1s-obesity-and-msk/   This episode is sponsored by Vori Health Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members get back to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spend with up to a 4:1 ROI. For more information visit www.vorihealth.com.
Supporting Innovation and AI in Healthcare
Jan 17 2024
Supporting Innovation and AI in Healthcare
Seema Kumar, CEO, Cure, an innovation campus in New York City, joins Eric to discuss how artificial intelligence can positively impact healthcare and lead to more innovation. She shares how AI has been used in healthcare and the promise it holds for the future.   The conversation also highlights the Cure Xchange Challenge: Health AI For Good, an initiative to incubate innovations by healthcare startups and entrepreneurs across disciplines and sectors to use artificial intelligence (AI) responsibly and equitably. Cure collaborated with MIT Solve for the Challenge and an independent board of judges selected the ten finalists. The winners will be announced later in the First Quarter of 2024.   Seema shares the stories of several finalists, including Oben Health, an AI-enabled platform that facilitates the delivery of healthcare screenings, education, and treatment via barbershops and salons, and Nutrible, artificially intelligent social workers.     This episode is part of a series of episodes featuring the Clinton Global Initiative Commitments to Action action from the Clinton Global Initiative. Please listen to the previous episode, Safe Babies Safe Moms: Rethinking Equitable Access and Maternity Care, available on all podcast apps.   About Cure Cure is an innovation campus in NYC boasting laboratories, lecture, and office space, as well as technology and other amenities to set up innovators for success across the healthcare industry, including academic institutions and other nonprofits. Visit the website at: https://cure.345pas.com/   About Seema Before Cure, Seema spent nearly 20 years at Johnson & Johnson in senior leadership roles, most recently as the Global Head of Office of Innovation, Global Health and Scientific Engagement, and served on J&J’s Innovation Strategy, Public health leadership and the COVID-19 vaccine steering committee. Before her tenure at J&J, Seema was the Chief of Staff to Dr. Eric Lander and the Chief Communications Officer at the Whitehead Institute/Massachusetts Institute of Technology Center for Genome Research, where she played a leadership role in the Human Genome Project.
Lifestyle Modification Strategies to Support Those Living with Obesity and Diabetes
Dec 22 2023
Lifestyle Modification Strategies to Support Those Living with Obesity and Diabetes
Blue Shield of California, Highmark, Intellihealth and NourishedRX discuss how they are mitigating the high costs of GLP-1s with lifestyle interventions such as behavior change, physical exercise, nutritional counseling, coaching to optimize outcomes for members living with obesity and diabetes.   Hear real-life examples and best practices to equip your members with the tools and strategies to achieve lasting success in managing obesity and diabetes beyond the limitations of GLP-1s.    PANELISTS Angie Kalousek Ebrahimi, Senior Director of Lifestyle Medicine, Blue Shield of California Timothy Law, DO, Chief Medical Officer, Highmark Health Katherine H. Saunders, M.D., Executive Vice President & Co-Founder, Intellihealth Lauren Driscoll, Founder & CEO, NourishedRx   https://www.brightspotsinhealthcare.com/events/lifestyle-modification-strategies-to-support-those-living-with-obesity-and-diabetes/   This episode is sponsored by NourishedRX NourishedRx is a leading digital health and nutrition company specializing in comprehensive nutrition solutions for consumer and health plan members living with diabetes, obesity and other diet-related conditions.    NourishedRx recognized food's healing and connective power, and partners with healthcare organizations nationwide to address the nutritional needs of their most vulnerable populations. The NourishedRx B:B:C health and nutrition platform facilitates and optimizes personalized, culturally concordant food in addition to the tools necessary to drive lasting behavior change – leveraging technology so YOU can all deliver at scale.   Beyond diet, NourishedRx engages with health plan members and patients to support their whole health and lifestyle more broadly. They engage consumers with omnichannel wrap-around support and education, enabling individuals to make informed choices and gain a deeper understanding of the impact of their diet and lifestyle on their overall well-being, empowering them for the long term.   NourishedRx is well suited as an early alternative and/or companion therapy to specialized obesity treatment, including GLP-1 and other Anti-Obesity Medication therapies.
Differentiating Your Health Plan: Reimagining Your Provider Network Strategy
Dec 8 2023
Differentiating Your Health Plan: Reimagining Your Provider Network Strategy
Leaders from Blue Cross Blue Shield of Michigan, Highmark and Quest Analytics discuss the importance of a network provider strategy for health plans. To stay competitive and meet the evolving needs of their members, health plans are examining and reimagining their provider strategies.    By focusing on areas such as compliance, network adequacy, data integrity, and performance metrics, plans are redefining their own roles and enhancing quality and affordability for their members.   Panelists include: Steve Anderson, Vice President, Hospital Contracting & Network Administration, Blue Cross Blue Shield of Michigan   Jim Brown, Vice President, Western Pennsylvania Operations and Strategic Priorities, Highmark Health   Steve Levin, CEO, Quest Analytics   Bios: https://www.brightspotsinhealthcare.com/events/differentiating-your-health-plan-reimagining-your-provider-network-strategy/   Quest Analytics sponsors this episode Quest Analytics’ software platform empowers you to analyze, expertly manage meticulously, and impeccably report on your provider network‘s adequacy and the provider data accuracy across your entire organization and all lines of business. You can trust them! CMS does, and they are among eight of the nation’s largest health plans that leverage its software and services, not to mention multiple state regulatory agencies and many of the nation’s leading health systems and provider groups. They manage, measure and monitor health plan network performance so that together, we can elevate the health of communities nationwide. They also enable health plans to differentiate their position in the marketplace through a vastly superior provider network. My words, not theirs, and I know I am simplifying things a bit …but think of them as the Kayak for physician quality and accessibility data. For more information, please visit the Quest Analytics website at http://www.questanalytics.com./     Connect with us on social media: Facebook: facebook.com/brightspotshc Instagram: instagram.com/brightspotshc LinkedIn: linkedin.com/company/shared-purpose-connect Twitter: twitter.com/BrightSpotsinHC TikTok: tiktok.com/@brightspotshc
A Conversation with Blue Cross and Blue Shield of North Carolina’s Chief Strategy Officer
Nov 21 2023
A Conversation with Blue Cross and Blue Shield of North Carolina’s Chief Strategy Officer
Sonny Goyal, Senior Vice President of Diversified Business Group and Chief Strategy Officer of Blue Cross and Blue Shield of North Carolina (Blue Cross NC), joins Eric to share some of Blue Cross NC’s successful initiatives to help members live their best lives.    Sonny discussed Blue Cross NC’s approach to mitigating social determinants of health, explaining the insurer is utilizing test-and-learn models to build quantifiable evidence, scale up successful models and, eventually, expand those ideas through its benefit offerings across the state.   Sonny and Eric touch on several topics, including Blue Cross NC’s recent food insecurity pilot program, value-based care, provider relationships and community health initiatives.    After listening, you’ll have many bright spots to consider implementing in your organization!   Links to articles mentioned during the discussion: https://www.bluecrossnc.com/blog/expert-takes/transforming-health-care/food-is-medicine https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0351 https://mediacenter.bcbsnc.com/news/blue-cross-nc-donates-500-000-to-the-forward-fund-established-to-support-transition-efforts-following-mill-closure   About Sonny Sonny leads the diversified business group at Blue Cross and Blue Shield of North Carolina (Blue Cross NC) while also serving as their chief strategy officer, He is responsible for thoughtfully guiding the company as it seeks to achieve sustainable long-term growth by enhancing its existing business and identifying opportunities to expand beyond via inorganic growth. Among other responsibilities, Sonny is accountable for managing and maturing the company’s best-in-class business partnerships and assets, shaping Blue Cross NC’s short-term goals and long-term strategy, portfolio planning and prioritization, corporate development and utilizing strategic intelligence to improve the experience of key stakeholders across the state. Before joining Blue Cross NC, Sonny served in leadership roles at several other leading companies in the healthcare, venture capital and finance sectors. Most recently, he was Executive Director for Corporate Strategy and Development for the Advisory Board Company in Washington, DC. Before that, Sonny led Mergers and Acquisitions for Highmark Blue Cross and Blue Shield; brokered acquisitions, divestitures and capital raises ranging from $250 million to $12 billion at Wells Fargo; and assisted in assessing venture capital investments for Garage Technology Ventures in Silicon Valley.  Connect with us on social media:  Facebook: facebook.com/brightspotshc Instagram: instagram.com/brightspotshc LinkedIn: linkedin.com/company/shared-purpose-connect Twitter: twitter.com/BrightSpotsinHC TikTok: tiktok.com/@brightspotshc
Talking Bright Spots with Former Congressman Robert Andrews
Nov 16 2023
Talking Bright Spots with Former Congressman Robert Andrews
Former New Jersey Congressman and Health Transformation Alliance (HTA) CEO Robert Andrews joins Eric to discuss how HTA –  a cooperative of more than 60 of America’s leading employers –and its members employers are fixing our broken healthcare system by sharing data, challenging the status quo and implementing innovative solutions. Robert shares many bright spots from HTA, including initiatives in medication management and infant mortality. He explains how the cooperative has saved its member companies well over $2 billion in healthcare costs to date.   About Robert As CEO of the HTA, Robert oversees the strategic direction of approximately 60+ major corporations that have come together in an alliance to fix the broken healthcare system. He is also the Chairman of the Board of Lolo Health, a health tech company that connects consumers to a high-value health experience. Andrews previously led the Government Affairs practice at Dilworth Paxson law firm for two years before joining the HTA.   Before private practice, Andrews served as a Member of the United States House of Representatives for nearly 24 years. Upon his departure from Congress, President Barack Obama praised Andrews’ service as “an original author of the Affordable Care Act…and a vital partner in its passage and implementation” and cited his “tenacity and skill” in representing the people of New Jersey.   About HTA The Health Transformation Alliance (HTA) is a cooperative of more than 60 of America’s leading employers coming together to fix the broken healthcare system. Formed by four founding members in September 2015, the HTA member companies collectively are responsible for over 8 million employees, dependents, and retirees with an annual healthcare spend of $30+ billion.  Some members include Walgreens, 3M, Marriott, Shell, Coca-Cola and NextEra Energy.
Safe Babies Safe Moms:  Rethinking Equitable Access and Maternity Care
Nov 9 2023
Safe Babies Safe Moms: Rethinking Equitable Access and Maternity Care
Angela D. Thomas, DrPH, MPH, MBA, Vice President, Healthcare Delivery Research, MedStar Health Research Institute, joins Eric to discuss D.C. Safe Babies Safe Moms, a community-driven collaborative launched in 2020 to improve the health and well-being of mothers and infants in Washington, D.C., and reduce racial disparities in maternal and infant health outcomes – one of the most urgent challenges facing the District of Columbia.   Combining the expertise of MedStar Health, evidence-based healthcare, and proven community-centric support services, Safe Babies Safe Moms offers services to support birthing individuals before, during, and after pregnancy and until their child reaches age three.    Angela shares success stories from families supported by the initiative and discusses the program's impact. For health systems interested in implementing a similar program, she outlines MedStar Health's steps in building and sustaining the initiative.     She also speaks about the role technology plays in the initiative. Safe Babies and Safe Moms recently launched a Clinton Global Initiative (CGI) Commitment to Action project to use artificial intelligence and machine learning to help reduce disparities in maternal and infant health.   About Safe Babies Safe Moms Made possible by the A. James & Alice B. Clark Foundation, D.C. Safe Babies Safe Moms is a partnership between MedStar Health, Community of Hope, and Mamatoto Village to address critical maternal and infant care disparities in Washington, D.C., which has among the highest rates of maternal and infant mortality in the nation. In FY22, 15,346 mothers and babies received care through the program.   Services offered include on-site mental health support during prenatal and postpartum visits, assessments for high-risk or complicated pregnancies, social support services for mothers and families who may be experiencing food or housing insecurity, pro-bono legal services, and other counseling on securing public benefits, transportation to and from appointments, infant care supplies, culturally-aware breastfeeding support, and more.   About Angela  Angela is responsible for leading a team of experts to apply rigorous scientific methods to enable next-generation healthcare delivery through quality, safety, innovation, health economics, payment reform, outcomes, health services research, data science, and health equity. She also ensures that these research activities leverage the collective leadership and unique strengths of MedStar Health and Georgetown University. Her research interests focus on health equity and patient safety. As the Executive Leader of Safe Babies Safe Moms, Angela is responsible for ensuring the development, implementation, and evaluation of an evidence-based program that will reduce disparities in maternal and infant mortality in Washington, DC. In addition, she contributes her research expertise in disparities, health equity, and patient safety to the initiative to uncover the contributing factors leading to disparities in maternal and infant harm.   Connect with us on social media: Facebook: facebook.com/brightspotshc Instagram: instagram.com/brightspotshc LinkedIn: linkedin.com/company/shared-purpose-connect Twitter: twitter.com/BrightSpotsinHC TikTok: tiktok.com/@brightspotshc
Beyond Medication Adherence: Unleashing the Power of Member Engagement to Elevate Outcomes
Nov 3 2023
Beyond Medication Adherence: Unleashing the Power of Member Engagement to Elevate Outcomes
Leaders from CareFirst, CareSource, UPMC Health Plan and Scene Health explore how proper medication adherence ensures a higher quality of life, improves health outcomes and reduces healthcare costs. Many health plans saw their overall Medicare Star Ratings drop this year due to one particular area – medication adherence. Our expert panel from top-rated plans shares innovative and actionable strategies for overcoming barriers to medication adherence.    Topics for discussion include: Reasons traditional approaches to medication adherence are not effective Best ways to speed up intervention with a personalized, member-centric approach Financial and ratings impacts of medication adherence measures   Confirmed Panelists Tom Manetti, Associate Vice President, Quality Products, CareSource Molly McGraw, PharmD, BCPS, Manager, Clinical Pharmacy, UPMC Health Plan Suzanne Moxham, Director, Quality, Accreditation, & Government Programs at CareFirst BlueCross BlueShield Sebastian Seiguer, CEO & Co-Founder, Scene Health   Bios: https://www.brightspotsinhealthcare.com/events/how-medication-adherence-can-be-much-more-than-medication-adherence/   Connect with us on social media: Facebook: facebook.com/brightspotshc Instagram: https://www.instagram.com/brightspotshc/https://www.instagram.com/brightspotshc/ LinkedIn: https://www.linkedin.com/company/shared-purpose-connect/ Twitter: https://twitter.com/BrightSpotsinHChttps://twitter.com/BrightSpotsinHC TikTok: https://www.tiktok.com/@brightspotshchttps://www.tiktok.com/@brightspotshc This episode is sponsored by Scene Health  Meet Scene Health, the medication engagement company that's taking on the colossal $500 billion problem of medication nonadherence. But here's the twist – they're doing it in a novel way by leveraging asynchronous video engagement.   Scene's model of care enhances the CDC-endorsed gold standard for ensuring medication adherence, Directly Observed Therapy. Their team of pharmacists, nurses, and health coaches engage with members via back-and-forth videos to build trust through person-to-person connections and empower every patient to take every dose of medication properly.   And they're not just all talk. Scene Health has been clinically validated in 20 peer-reviewed publications and is already teaming up with Medicaid and Medicare health plans, public health departments, and life science organizations to tackle a range of conditions, from diabetes & asthma to sickle cell disease.
Why the ACA Consumer Experience Sucks and How Select Health Fixed It
Oct 27 2023
Why the ACA Consumer Experience Sucks and How Select Health Fixed It
Kim Barrus, MSN, RN, PMP, Director, Clinical Outcomes Management, Select Health, joins Eric to discuss how her plan reinvented the consumer experience for ACA Marketplace health plans.    With almost half of ACA Marketplace customers complaining about making appointments with providers and other process challenges, SelectHealth committed to reversing the trend and implementing a complete, end-to-end consumer experience.    Kim shares the results of SelectHealth’s efforts and outlines the plan’s strategy giving members the seamless experience they want. Listen and get the roadmap for remaking your plan’s ACA consumer experience!   About Kim  Kim Barrus began her career with SelectHealth 26 years ago and has worked in various capacities. She developed the SelectHealth Advanced Primary Care (a.k.a. patient-centered medical home) program. She facilitated the initial pilots of the program in 2010. Today, the program has 1,240 participating providers at 222 participating clinics. In her current role, Kim oversees quality, medical home, NCQA accreditation, HEDIS and CMS Stars.   Kim is a registered nurse who received her Bachelor of Science in Computer Information Systems and maintains a Project Management Professional (PMP) certification from the Project Management Institute (PMI).   This episode is sponsored by ReferWell Health plans must be acutely aware of their progress towards achieving their Care Gap Closure targets. Their most significant obstacle is to directly impact those specific areas, even though they have limited capabilities to do so. ReferWell helps health plans improve access to care by efficiently scheduling members for the care they need. ReferWell care navigators find the "Perfect Match" provider right at the referable moment when the member is saying yes to their care. They then seamlessly schedule the member's appointment while still on the call.  It’s a proven process that provides better access, experience and outcomes for members and better quality performance, which affects the health plan’s bottom line.
Medicare Advantage and the Next Generation in Home Health Strategies
Oct 20 2023
Medicare Advantage and the Next Generation in Home Health Strategies
Leaders from Humana, Healthfirst, Health Leads and Vesta Healthcare join Eric to discuss the future of home healthcare for Medicare Advantage plans. As care delivery strategies evolve, the home is critical in achieving clinical and customer satisfaction ratings that drive business success. Home health is also vital to providing equitable care to all members. Our expert panel lays a blueprint for implementing a successful home care model that your plan can use.   Confirmed Panelists: Susan Beane, MD, FACP, Executive Medical Director, Clinical Partnerships, Healthfirst Chase Dailey, Principal, Home Solutions, Humana Randy Klein, CEO, Vesta Health Dominique Morgan, Chief Operating Officer, Health Leads https://www.brightspotsinhealthcare.com/events/medicare-advantage-and-the-next-generation-in-home-health-strategies/   This episode is sponsored by Vesta Healthcare Vesta Healthcare is a specialized virtual medical group providing high-touch medical support to patients with chronic conditions. Our program uses technology and patient and caregiver engagement to act on insights gleaned from the first mile of patient care: the home.  We connect the entire care team - patients, family, caregivers, insurance plans, agencies, doctors, and nurses - to support the best care at home. The ancient Roman goddess of hearth and home inspired our name, Vesta, because our mission is to ensure that people stay in the comfort of their homes as long as possible. Connect with us on social media: Facebook: facebook.com/brightspotshc Instagram: https://www.instagram.com/brightspotshc/ LinkedIn: https://www.linkedin.com/company/shared-purpose-connect/ Twitter: https://twitter.com/BrightSpotsinHC TikTok: https://www.tiktok.com/@brightspotshc
Can Your Social Care Strategy Drive You to Five Stars?
Sep 22 2023
Can Your Social Care Strategy Drive You to Five Stars?
Leaders from Network Health, UPMC Health Plan, Healthmine and Benelynk explore how Medicare Advantage plans can attain 5-Stars and share bright spots on improving outcomes for members with social risk factors. Learn how closing gaps in care and reducing health disparities can help your plan reach 5 Stars!   Topics include:  CMS Health Equity Index Product Enhancement Member Activation and Engagement Payer/Provider Collaboration Social Care Strategy Blueprint   Panelists: Andre Bliss, Ph.D., MBA, Director, Medicare STARs, UPMC Health Plan  Mallory Mueller, (she/her/hers) Director Quality Health Integration, Network Health Cherie Shortridge, Senior Advisor, Healthmine  Sean Libby, President, BeneLynk Bios: https://www.brightspotsinhealthcare.com/events/evolution-of-sdoh-2024-and-beyond/   BeneLynk sponsors this episode BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. We serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve.   We build stronger human connections supported by innovative technology by employing one dynamic conversation that flows organically to meet Social Determinants of Health challenges.   All of our services are customized to the specific geography, where we provide the members with the specific information they need to keep their benefits in place.   Our mission is to improve lives and positively impact Social Determinants of Health barriers by providing our healthcare partners with the information they need and people with the advocacy they deserve.
The Future of Senior Health: Equitable Access & Open Enrollment
Sep 15 2023
The Future of Senior Health: Equitable Access & Open Enrollment
Healthcare leaders from Humana, myPlace Health, Mom’s Meals, and SCAN explore the latest product and benefit design trends for the aging population. Our expert panel shares strategies and best practices your plan can implement to bridge the social and clinical care gap and empower seniors to create a lifetime of healthy habits.    Topics include: Product Segmentation SDOH/Supplemental Benefits Care Models Payer and Provider Collaboration   Panelists: Catherine Macpherson, MS, RDN, Senior Vice President of Healthcare Strategy & Development, Mom’s Meals Erika Pabo, MD, MBA, Chief Transformation Officer & Central Operations, Centerwell & Conviva, Humana Lena Perelman, Senior Director, Product Development, Market Expansion, SCAN Health Plan Robert Schreiber, MD, AGSF, Vice President and National Medical Director, myPlace Health   Bios: https://www.brightspotsinhealthcare.com/events/the-future-of-senior-health-equitable-access-open-enrollment/   The Episode is Sponsored by Mom’s Meals Getting the right nutrition is essential to achieving and maintaining good health – yet accessing balanced meals that also support health challenges and fulfill personal tastes is not always as easy as it should be.   At Mom’s Meals, our passion is to provide nourishment and deliver wholesome meals to the homes of those who need better nutrition to support their health and wellness, no matter where they live. It’s the reason we’ve built our business from our own personal roots, caring for our clients as we do our own family and loved ones.   Our menus are designed by professional chefs and registered dieticians to taste great and support the nutritional needs of common chronic conditions. Clients get to choose every meal, every order. Meals are delivered to any address, no matter how remote.   To learn more visit momsmeals.com.
Last-Minute Gaps in Care Strategies
Sep 1 2023
Last-Minute Gaps in Care Strategies
Senior healthcare leaders from AmeriHealth Caritas, AvMed, HealthTeam Advantage, and ReferWell share strategies health plans can use to understand gaps in care throughout the member journey.    For health plans participating in risk-based agreements, gaps in care have severe implications for members' health outcomes and their ability to attain higher quality scores necessary to receive financial bonuses and drive member enrollment.    Hear how plans leverage data and real-time analytics to effectively and efficiently close time-sensitive care gaps to improve HEDIS, Stars and other quality scores.   Topics covered include: Provider Plan Partnerships Building a Relationship with Members Identification & Targeting Systems & Incentives   Confirmed Panelists Marsha Barlocker, RN, BSN, MS, Senior Director, Quality & Case Management, HealthTeam Advantage Chad Baugh, Chief Strategy Officer, ReferWell Vandna Bhrany, Vice President, HEDIS Strategy & Analytics, AmeriHealth Caritas Frank Izquierdo, Senior Vice President Provider Solutions and Strategic Alliances, AvMed   Bios: https://www.brightspotsinhealthcare.com/events/last-minute-gaps-in-care-strategies/   This episode is sponsored by ReferWell  Health plans must be acutely aware of their progress towards achieving their Care Gap Closure targets. Their most significant obstacle is to directly impact those specific areas, even though they have limited capabilities to do so.   ReferWell helps health plans improve access to care by efficiently scheduling members for the care they need.   ReferWell care navigators find the "Perfect Match" provider right at the referable moment when the member is saying yes to their care). They then seamlessly schedule the member's appointment while still on the call.  It’s a proven process that provides better access, experience and outcomes for members and better quality performance, which affects the health plan’s bottom line.
Driving Innovation at Nashville General Hospital
Aug 17 2023
Driving Innovation at Nashville General Hospital
Nashville General Hospital CEO Joseph Webb,D.Sc., MSHA, FACHE, joins Eric to discuss how the hospital is using innovation to fulfill its mission and vision to improve the health and wellness of Nashville  – one neighbor at a time. During the conversation, Dr. Webb shares details on two innovative initiatives Nashville General implemented to address health equity and transform care delivery. Food Pharmacy - In 2018, Nashville General launched the Food Pharmacy to provide access to food for individuals living with food insecurity and to educate those individuals about which foods best fit within the care plan based on their chronic conditions.Congregational Health and Education Network (CHEN) -  Launched in 2017, CHEN is a 501(c)(3) faith-based initiative with local churches and educational institutions with a primary focus on reducing health disparities for communities of color through education attainment, access to healthcare, and health literacy. Currently, CHEN includes 100 faith-based organizations of all denominations throughout Nashville. In addition, Dr. Webb provides a blueprint to help other health organizations implement similar, innovative programs to promote healthy communities and reduce health disparities.   About Dr. Webb Since joining Nashville General in 2015, Dr. Webb has successfully led efforts to improve patient outcomes, enhance the patient experience and grow revenues.  Before joining Nashville General Hospital, Dr. Webb served as chief operating officer for Common Table Health Alliance in Memphis, Tennessee. As a former chief executive operating officer for Methodist Le Bonheur South Hospital in Memphis, Tennessee, he held additional chief executive roles for Healthcare Services of America at Coastal Carolina Hospital and Northwest Mississippi Regional Medical Center. Dr. Webb is board certified in Healthcare Management and is a Fellow of the American College of Healthcare Executives. Nationally, he serves as a board member of America’s Essential Hospitals and as chairman of the Governance Committee. He serves on the board of the Nashville chapter of the American Heart Association and as a board member of NashvilleHealth. Dr. Webb is a member of Omega Psi Phi, Incorporated.  Dr. Webb earned a Doctorate of Science in Health Services Administration and a Master of Science in Hospital and Health Services Administration from the University of Alabama at Birmingham. He also holds a Bachelor of Science and Master of Science in Health and Physical Education from Tennessee State University.   About Nashville General Hospital A leading safety net hospital with 150 beds and more than 22 clinics. Nashville General Hospital serves as the index teaching hospital for the historic Meharry Medical College.  Nashville General has earned multiple accreditations for its evidence-based measures and practices that provide quality healthcare. These include The Joint Commission’s Gold Seal of Approval accreditation, NCQA PatientCentered Medical Home accreditation, the NCQA Diabetes Recognition Program, accreditation by the Commission on Cancer for Nashville General’s Robert E. Hardy Cancer Center, and Level 3 TNCPE Performance Excellence Award.   The hospital also has increased its revenue sources through expanded healthcare services and launched initiatives to attract new commercially insured patients. These efforts ensure that every patient receives high-quality care at Nashville General Hospital regardless of their ability to pay.
AI is Advancing The Member Journey and Improving Lives TODAY
Jul 28 2023
AI is Advancing The Member Journey and Improving Lives TODAY
Healthcare leaders from Geisinger, Intermountain Health, UNC Health and TytoCare join Eric to discuss how AI and machine learning transform the member journey and empower members to take a more active role in their health. Our experts share successful strategies and best practices your healthcare organization can implement to change the member experience.    Hear the following case studies and learn how: Intermountain Health physicians use AI to diagnose pneumonia Geisinger leverages AI and machine learning to identify patients at higher risk for colon cancer to ensure they go for a colonoscopy UNC Health determines which patients are best suited for home health care vs. the hospital with AI and machine learning TytoCare drives better patient adoption of virtual care technologies with AI   Panelists:  Nathan Dean, MD, Section Chief of Pulmonary and Critical Care Medicine, Intermountain Medical Center Rachini Moosavi, Chief Analytics Officer, UNC Health Karen M. Murphy, PhD, RN, EVP/Chief Innovation and Digital Transformation Officer, Geisinger Ohad Pollak, Chief Marketing Officer, TytoCare Bios: https://www.brightspotsinhealthcare.com/events/how-ai-is-changing-patient-engagement   This episode is sponsored by TytoCare TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are five times higher than traditional telehealth services; reduces the total cost of care by an average of five percent; diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for successfully deploying and adopting the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 220 major health systems and health plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.
The Disenrollment Tsunami:  How to Enhance Your Medicaid Redetermination
Jul 21 2023
The Disenrollment Tsunami: How to Enhance Your Medicaid Redetermination
Healthcare leaders from Health Net, Horizon Blue Cross Blue Shield of New Jersey and Socially Determined shared successful Medicaid Redetermination strategies and best practices to help ensure your plans’ most vulnerable populations do not lose essential health coverage.   With the end of the Public Health Emergency and the Medicaid continuous coverage provision in April, Redetermination could cause 18M Americans to lose health coverage, creating care gaps for the most vulnerable & widening health disparities. Our expert panel provides you with important information about navigating the disenrollment storms ahead.   Mildred Menos, Director, Medicaid Product Administration, Horizon Blue Cross and Blue Shield of New Jersey Darrel Ng, Vice President, Communications & Marketing, Health Net Trenor Williams, MD, Co-Founder & CEO, Socially Determined Bios: https://www.brightspotsinhealthcare.com/events/the-disenrollment-tsunami-how-to-fix-your-medicaid-redetermination-strategy/   This episode is sponsored by Socially Determined Socially Determined is leading the transformation of health care delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to better manage risk, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit: www.sociallydetermined.com
How Blue Cross Blue Shield of Arizona is Reinventing the Member Journey
Jul 13 2023
How Blue Cross Blue Shield of Arizona is Reinventing the Member Journey
Phylicia Schroeder, Manager, Provider Engagement and Quality Analytics at Blue Cross Blue Shield of Arizona Medicare Advantage and Janine Wakim, Head of Operations at ReferWell, join Eric to discuss how the plan is transforming the member journey by instituting a cultural shift putting the member’s needs above the plan’s needs, adding that to accomplish this goal, the plan uses data and predictive analytics to learn about what makes its members unique. Topics covered during the episode include: - Member journey mindset - Navigation and physician scheduling - Data integration, risk mitigation (as it relates to CAHPS) and  - Provider engagement.    Phylicia and Janine share many bright spots your plan can implement to provide a tailored experience for your members!   About Phylicia Phylicia is a highly skilled Medicare Stars quality (HEDIS, CAHPS, HOS) analyst and strategist who specializes in data analysis, extrapolation and visualization through building dashboards in Power BI, technology implementation, provider engagement and clinical workflows, project management, process improvement and documentation.  She is a true innovator who never says “No” and sees obstacles as opportunities to apply creative problem-solving to find a solution.   About Janine As Head of Client Operations, Janine Wakim is keenly focused on the success and satisfaction of ReferWell’s customers.  Janine leads the team that works with some of the largest healthcare systems and payers in the United States from onboarding to growth to ongoing support.  She is an operations leader with over 20 years of experience in strategic planning and process improvement, leading client experience and business analytics teams. At Gartner, she served as the lead in building the offshore center of excellence for Business Analysis to provide insights into the Research and Advisory business to grow its footprint and retain its client base. She also served in leadership roles at Datto and Potoo Solutions. Janine earned a Bachelor of Science in Finance from Lehigh University, an MBA from Columbia Business School, and an MPH in Hospital Administration from Columbia University Mailman School of Public Health. This episode is sponsored by ReferWell Health plans are acutely aware that they are measured and graded on quality, experience and health equity more so than ever before. Their biggest challenge is to impact those areas directly. ReferWell helps health plans advance health equity by scheduling underserved members for the care they need, be it medical, care gap appointments or — through your community partnerships — appointments for transportation assistance, nutritional counseling, mental health services and other community-based organization offerings. Data shows that ReferWell’s solution directly impacts the members who need it most.    ReferWell care navigators find the Perfect Match right at the referable moment (when the member is leaning into their care) and schedule the member while on the phone. It’s a proven process that provides better access, experience and outcomes for members, and better quality performance, which affects the health plan’s bottom line. For more information, visit www.referwell.com.