Medicare Advantage For Health Plans

About Medicare Advantage For Health Plans

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 operating models, technology infrastructure, 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.

Publisher

Sponsored by HealthEdge

Category

government

Language

en

Explicit

No

First episode

2 Mar 2022

Latest episode

24 Apr 2026

Latest episodes

6 of 50 episodes have a transcript.

1. 

   24 Apr 2026

   The Cost of Inaction

   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 lim...

2. 

   18 Mar 2026TRANSCRIPT

   The Hidden Economics of Payer Operations

   Host [Host Name] interviews Payer Operations Expert [Guest Name] about the hidden economic drivers of payer operational spend and how to gain a clearer financial picture.

3. 

   19 Feb 2026TRANSCRIPT

   Stars in Flux: CMS 2027 Changes

   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, a...

Inside a recent episode

The Hidden Economics of Payer Operations

Published 18 Mar 2026 · Transcript excerpt

[…] Let's talk about how you actually uncover the full picture. Walk us through your assessment framework. How do you evaluate financial, operational, and technology layers together rather than in silos? Sure. So we start by understanding how the business operates into end, what lines of business they serve, what states they operate in, where their leadership perceives the major pain points are. From there, we use detailed questionnaires to explore specific functional areas. We gather operational metrics such as claims volumes, auto adjudication rates, and processing timelines. Then we collect cost data, including staffing levels and average labor costs, so we can evaluate the labor tie to each function, and finally, we map the technology landscape, identifying the platforms used for the court administration, claims editing, pricing, and other workflows, along with our associated costs. […]

Reach and audience

Public platform figures. Ratings count people who left a rating, not total listeners.

Apple Podcasts (US)

5.0 / 5

10 ratings

Spotify

5.0 / 5

4 ratings

Podcast Authority Score: 38 / 100

A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.

Quality

39

Social presence

0

YouTube

0

Engagement

95

Contact Medicare Advantage For Health Plans

Guest appearances

Books guests

Based on episode analysis; this does not confirm that the show is currently accepting guests.

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