health plans

Producers' note: We know a lot of organizations have been and are being affected by the major cyberattack of Change Healthcare systems and resulting outages. We won't be addressing it in this episode, but if you have questions or are looking for more information please go to https://www.unitedhealthgroup.com/changehealthcarecyberresponse.

The relationship between health plans and providers has always included an element of friction, but lately, it seems like the temperature is rising. And you've probably noticed – public contracting disputes increased by 69% between 2022 and 2023.

That's why, in this episode, host Abby Burns invites Advisory Board experts Max Hakanson and Eileen Fennell to discuss why the state of affairs seems to be getting worse, how key flashpoints are fanning the flames, and what each stakeholder says they need to see from their partners in order to mend the relationship. Plus, Advisory Board digital health expert Ty Aderhold makes a cameo appearance to help answer the question: Is AI the solution here?

Links:

• 7 things we want to fix in 2024 (and how to get there)
• A new era of payer-provider relationships
• The new era of provider enablement
• AI in healthcare: Insights from 10 C-suite executives

2024 Raising the Value Bar Summit

A transcript of this episode as well as more information and resources can be found on radioadvisory.advisory.com.

This week, we’re looking at what’s new for the SECURE 2.0 Act in 2024.  

The SECURE 2.0 Act revolutionized retirement planning by simplifying and expanding retirement and health plan benefits. Over a year after the legislation became law, provisions are still rolling out. So, what’s new in 2024? 

Epstein Becker Green attorneys Cassandra Labbees and Mason Gardner tell us more about the recent updates and guidance on the SECURE 2.0 Act.

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AI advancements are moving at lightning pace and the possible use cases for leveraging it are limitless— especially in the healthcare industry where key stakeholders grapple with an ever-growing amount of healthcare data. For payers, the potential for AI to transform member care, reduce growing healthcare costs and usher in the future of personalized preventative care is vast. Yet, even large national payers with advanced AI capabilities face obstacles in connecting the dots between AI expertise and business domain expertise.

In this episode, ZS experts Adam Siskind, Anoop Tripathi and Vinod Swarna discuss some of the most important opportunities available to health plan leaders for transforming their operations through AI. Our panel also unpacks the key factors that health plan leaders should consider—cost, impact and scalability—to ensure their AI investments pay off. If data is the digital gold of the next century, it’s critical that health plans invest in it now.

Adam Siskind is the managing principal of ZS’s health plan and provider practice area and previously led ZS’s European and North America West regions. He has worked in healthcare for more than 20 years, with extensive experience in most strategic and tactical issues across health plans and providers, pharmaceutical, biotech and medtech companies.

Anoop Tripathi leads the health plan and provider practice area’s data and technology function, focusing on patient-data analytics, enterprise-data strategy, machine learning operations and developing cloud and big-data solutions.

Vinod Swarna is a former chief analytics officer at AmeriHealth Caritas. He has decades of experience building data and analytics strategies and AI and machine-learning applications for health plans to deliver valuable business intelligence.

ZS is a management consulting and technology firm focused on transforming global healthcare. Leveraging leading-edge analytics, plus the power of data, science and products, ZS helps health plans make more intelligent decisions, drive growth and improve outcomes for all. Founded in 1983, ZS just celebrated its 40th anniversary last year.

Enam Noor has been an entrepreneur since he graduated from college with a degree in computer programming. After honing his skills in digital analytics and digital workflow, he’s taking what he learned and applying it to the healthcare field. His company, Insightin Health, brings vast healthcare data to bear on care decision-making, empowering health plans to use data as an asset—not just an operational byproduct. By tearing down silos and combining data from physician practices, pharmacies, customer service interactions, and much more, Insightin is using machine learning and natural language processing to drive the next best action for customer health.