Current Trends For Payers

Insider insights and perspectives on trending topics for healthcare professionals. We’re talking to the experts about the unique operating infrastructure necessary for business success and to improve the quality of care for members. Topics include BPaaS, technology, data security, operations, core administration, care management, member engagement, risk adjustment, HEDIS and Star quality measures, start-up and growth tactics, and regulatory and compliance.

Current Trends For Payers is a government podcast hosted by Sponsored by HealthEdge, with 45 episodes on record and a Required Pod Score of 80. PitchCentric scores this show on Booking Probability, Listen Score, and live audience signals refreshed every 24 hours.

Sponsored by HealthEdge hosts Current Trends For Payers, a government show with 45 episodes published.

Our AI reads these to draft pitches. Use them as grounding for a pitch that cites a real guest and a specific topic.

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  Episode #9

  The Cost of Inaction

  Apr 24, 202622 minS4

  <p>Rising margin pressure, regulatory demands, and fragmented operations are forcing health plans to confront a difficult question: when does maintaining the current model become more expensive than changing it? This episode examines the often-overlooked cost of inaction—where financial strain, delayed growth opportunities, and operational complexity quietly compound over time. It explores why incremental fixes and point solutions are no longer enough, and how legacy operating structures can limit scalability, responsiveness, and strategic decision-making.</p><p>At the same time, a shift is underway. A new operating approach is emerging—one that redefines accountability, integrates technology and operations, and intr...

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  Episode #8

  The Hidden Economics of Payer Operations

  Mar 18, 202615 minS4

  <p>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 processes, and vendor complexity may be shaping financial outcomes more than leaders realize. This episode takes a closer look at how hidden cost dynamics emerge and why understanding the full operating picture is becoming a strategic priority for executive teams.</p><p>If your organization is questioning whether incremental efficiency gains are enough to protect margins, this conversation offers an important perspective. Listen to explore the forces redefining...

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  Episode #7

  Stars in Flux: CMS 2027 Changes

  Feb 19, 202610 minS4

  <p>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 changes in measurement priorities, simplification efforts, and evolving expectations around quality performance and operational execution. While some updates appear administrative on the surface, they carry implications for how plans evaluate performance, align internal teams, and prepare for future contract years. The episode explores what these federal signals suggest about CMS’s direction and how plans can interpret them within the context of long-term strategy. What do these changes tr...

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  Episode #6

  Lessons From 2026 Enrollment

  Jan 16, 202611 minS4

  <p>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 enrollment integrity, broker oversight, digital shopping, data quality, and how emerging interoperability requirements will reshape eligibility, provider data, and automation in the seasons ahead.</p><p>Tune in to understand how these changes affect the future of enrollment, and how leading plans are preparing now.</p><p><b>About Our Guest:</b></p><p>Alex Loera oversees the enrollment and billing operations aspect of the BPaaS ecosystem. He specializes...

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  Episode #5

  The Problem With Managing Multiple Vendors

  Dec 16, 202513 minS4

  <p>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. </p><p>This episode explores the challenge of managing multiple vendors and how health plans can escape this antiquated operating model to simplify operations, cut costs, and gain real-time visibility across business functions. Listen to discover how to drive lasting operational excellence with a single, accountable partner.</p><p><b>About Our Guest: </b></p><p>Sean Cattie has deep expertise as a healthcare technology executive focusing on BPaaS delivery models. Sean le...

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