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Although Medicare Advantage plan member satisfaction has dropped, areas for improvement have emerged in the form of digital innovations, according to the J.D. Power 2025 U.S. Medicare Advantage Study.

Mistrust, Confusion in Medicare Advantage Plan Members, Survey Says

Here’s what you missed this week on Managed Healthcare Executive.

MHE Week in Review – Different Prices for the Same Procedures, AI Racial Bias in Schizophrenia Diagnoses and More

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The next step for the Rise For Health study researchers is to study the health benefits of frequent standing in older men and women. 

Postmenopausal Women Aren’t The Only Ones Who Could Benefit From Frequent Standing  

Sexual and gender minority individuals still face insurance denials and cost-sharing barriers when accessing pre-exposure prophylaxis (PrEP), despite having a Grade A recommendation from the United States Preventive Services Task Force (USPSTF). 

A Conversation With Alexa D’Angelo, Ph.D., M.P.H., Recent Doctoral Graduate from the CUNY School of Public Health and Health Policy

Managed Healthcare Executive gives C-suite executives in health plans and provider organizations news and strategies for value-driven solutions.

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In this month’s episode, Briana Contreras, an editor of 

 Editorial Advisory Board Member, Ateev Mehrotra, MD, MPH, 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. Among many topics discussed in the conversation, Ateev shared his thoughts on the push for better virtual visit opportunities and the fact that insurers are now offering virtual first health plans with lower premiums. 


Briana Contreras, an editor of Managed Healthcare Executive, had the pleasure of catching up with MHE Editorial Advisory Board Member, Ateev Mehrotra, MD, MPH, 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. 

In the Scope of Virtual Health and the Future of “Website” Manner, Per Ateev Mehrotra

In this week’s episode of "Tuning In to the C-Suite," Briana Contreras, editor of Managed Healthcare Executive, spoke with Ramin Bastani, CEO of Healthvana. Ramin addressed the ongoing issue of underserved communities lacking access to care and shared the efforts made specifically through digital health to help. He also discussed the steps that remain to be taken to improve access to care.

In this week’s episode of "Tuning In to the C-Suite," Briana Contreras, editor of Managed Healthcare Executive, spoke with Ramin Bastani, CEO of Healthvana. 

The Ongoing Battle to Improve Access to Care Through Digital Health, per Ramin Bastani of Healthvana

In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.

Meet the Board: Ateev Mehrotra of Harvard Medical School Talks About Telehealth Issues, Price Transparency, His Latest Hobby and More

In this week's episode, Briana Contreras, editor of Managed Healthcare Executive, spoke with Peter Durlach, chief strategy officer of Nuance. The two discussed how artificial intelligence drives value for patients and providers and how AI tools and solutions are helping health systems reach the quadruple aim of care.


Peter Durlach of Nuance Talks on How Artificial Intelligence Drives Value for Patients and Providers

Briana Contreras, editor of Managed healthcare Executive, spoke with Dr. Ian Tong, chief medical officer of Included Health in today’s episode. The two discussed telehealth use vs. in person care, and more specifically, the racial and ethnic differences in this use of care. They concluded the conversation with how telehealth use has continued to expose more benefits for all patients and for the industry through examples like improvements in reimbursement policies and in addressing health equity issues.


Dr. Ian Tong of Included Health Addresses Racial Differences in Telehealth Use

In this week’s episode Briana Contreras, associate editor of Managed Healthcare Executive, met with Greg Miller, vice president of Industry Strategy, Healthcare and Life Sciences at Talkdesk. The two discussed that while virtual care has become a convenient tool in healthcare during the pandemic and has helped treat more patients, this form of care isn’t completely solving patient’s underlying issues. However, Miller shared how AI is helping ease the patient experience and improving care in this conversation.

Greg Miller of Talkdesk Discusses How AI is Easing the Patient Experience in Care

In this week’s episode, Managed Healthcare Executive Associate Editor Briana Contreras had the pleasure of meeting CEO of Quanterix and founder of Powering Precision Health, Kevin Hrusovsky. Quanterix is a blood-based biomarker analysis company. In this discussion, the two discussed Powering Precision Health and some tools like the Disruptive Innovation 5-step model that brings his vision closer of detecting and improving the health of patients sooner. 


Kevin Hrusovsky of Quanterix Shares Successful Tools Toward Improving Precision Health and More

Managed Healthcare Executive had a conversation with Kelly Chillingworth, RPh, director of business development at RxBenefits this week about the unique connection between pharmacy and telemedicine, what impact telemedicine & its pharmacy costs have on self-funded employers and how the right virtual care services a health provider offers to their members can be essential to building a competitive benefit. 

The Connection Between Telehealth, Pharmacy and How it Affects Self-Funded Employers

Briana Contreras, associate editor of MHE, spoke with Edmundo Gonzalez, CEO of Marpai Health, for this week's episode of Tuning In to the C-Suite podcast. The two talked about the significance of AI and deep learning in healthcare and how they will benefit the self-insurance market. 


The Significance of AI, Deep Learning in the Self-Insurance Market

Briana Contreras of MHE spoke with Josh Claman, CEO of Rimidi about the strong need for a permanent remote patient monitoring, or RPM, reimbursement reform, and how our health industry can come together to influence this change. The two also discussed the benefits of RPM technology for underserved, uninsured or Medicaid populations, and the benefits of RPM during and beyond the COVID-19 pandemic. 


The Need for Permanent RPM Reimbursement, Benefits of RPM Beyond COVID-19

Without guardrails, artificial intelligence can be abused, leading to overbilling and high volumes of appeals. But with the right strategy, AI can enhance — not compromise — the integrity of care and payment.

Health System AI: A New Frontier for Payment Integrity

Few question the benefits of adopting a universal healthcare data exchange standard but achieving that goal will prove to be difficult.

FHIR Idea Burns Bright.  Implementation Flickers

The technology to leverage healthcare data exists. The problem, according to Highlander Health, is outdated structures and silos.

Want to Improve Patient Care? Waste Not the Data

Artificial intelligence is quickly becoming a valuable tool in the U.S. healthcare industry. Experts say a thoughtful approach can head off ethical problems and optimize efficiency.

How AI is Changing Healthcare

Telehealth has become a permanent part of U.S. healthcare delivery, 
and states are taking steps to regulate it

Telehealth is a Go, and States Are Having Their Say So

As health insurers promise to streamline prior authorizations by embracing digital tools and automation, some experts are urging caution—especially when artificial intelligence is involved.

For Hari Prasad, CEO of Yosi Health, the potential for AI to improve efficiency is real, but so are the risks if not implemented carefully.

Founded in 2015, Yosi Health’s mission has been focused on reducing the administrative burden that keeps physicians away from patients. The company’s work aligns with insurers’ latest pledge to simplify prior authorization through digitization and real-time approvals.

 that AI must be deployed in a way that supports, not weakens, clinical care.

“There’s a lot of hype around AI, but there’s also a lot of proven success when it’s used well and when it's used for addressing certain key challenges we face within healthcare,” Prasad said. “In this case—because some of the administrative processes could be handled by AI better—we believe there's a net positive outcome in utilizing AI to improve the process, but at the same time, we also have to recognize that this is new.”

He noted that AI can help handle repetitive administrative tasks, freeing up staff and providers for more meaningful work. But without strong checks in place, the use of AI could lead to rushed decisions or inappropriate denials of care.

Prasad stressed that AI tools should not operate in isolation. Human oversight is key, especially as the technology continues to evolve. He added that health systems must track outcomes to ensure AI tools are delivering as intended.

“At the end of the day, behind every one of these decisions is a patient, there is a family, there’s medical outcomes,” Prasad said. “So it’s very important for us to make sure that any decisions made by AI is looked at and is approved and validated before it ends up adversely impacting a patient.”

In this part two interview of a three-part video series, Hari Prasad, CEO of Yosi Health, said in an interview with MHE that AI can reduce administrative delays in prior authorization, but it must be paired with oversight to ensure patient safety.

AI Can Ease Prior Authorization Burdens if Used Responsibly

Bronwyn Spira of Force Therapeutics talked to Managed Healthcare Executive about CMS' new CPT codes that were introduced in 2022. These codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed through remote care. 

"In releasing these codes, CMS was very thoughtful about creating boundaries or minimal requirements," Spira said. "Because we want to make sure that these patients are receiving care that has parity to in-person care." 

She added that it's crucial the outcome of care is delivered as expected by the patient when it comes to reimbursed care.

How CMS CPT Codes Are Assisting Underserved Musculoskeletal Patients

"It's really important, as we think about virtual care being reimbursed, that the care delivers the outcomes that patients expect and that those outcomes are being measured and delivered back to the care team," Spira said. "It really has to be a true ecosystem of care. All care should be predicated on delivering an outcome to the patients."

In this second part of a two-part video series, Bronwyn Spira of Force Therapeutics talked to Managed Healthcare Executive about CMS' new CPT codes that were introduced in 2022. These codes help more patients in underserved populations receive better access to care as barriers like cost and transportation are removed through remote care.

Reimbursable Remote Care For Patients in Need, The Future of Remote Care

Founder and managing partner of Third Culture Capital (3CC), Julien Pham, chatted with 

about alternative routes to care outside of telehealth. Pham expressed that funding for telehealth is on the decline and will only continue on this path. He explained why this is happening and shared those alternative routes of care organizations can take to address disparities and improve access to care.

Founder and managing partner of Third Culture Capital (3CC), Julien Pham, expressed that funding for telehealth is on the decline and will only continue on this path. Pham explained why this is happening and shared alternative routes of care organizations can take to address disparities and improve access to care.

Alternative Ways to Address Disparities Outside of Telehealth

In this final video of a two-part video series, Jason Warrelmann, global director of Healthcare and Life Sciences at UiPath, addressed why automation is necessary for patients and providers and how other healthcare organizations can better overcome the challenges of adopting automation within their health system.


Jason Warrelmann of UiPath Shares Patient Benefits of Automation, Tips for Orgs Adopting Automation

In this first of a two-part video series, Jason Warrelmann, global director of Healthcare and Life Sciences at UiPath, addressed the incline of automation in healthcare, why it's necessary for patients and providers and how other healthcare organizations can better overcome the challenges of adopting automation within their health system.

Jason Warrelmann of UiPath Addresses the Incline of Automation and its Importance in Healthcare

Below is a brief Q&A of the interview with Reynolds. It has been edited for clarity.

Q: Do you see any potential for overuse of telehealth and remote care?

 It's is interesting because, personally, I love the telehealth. I love the fact that I don't have to drive to a doctor's office and sit in there and kill two hours of my time for a five-minute assessment. That said, I think there's probably some care that can only be done for the patient at the doctor's office. There's some tests that you need to go in person for - the the lot of the the assessments that a clinician might want to make, whether that's body weight, visibly looking at a patient's body, collecting blood pressures, things like that need to be in person. I do think that telehealth is likely here to stay, especially for some therapeutic areas versus others. I think that we've seen a huge rise in the mental health usage of telehealth. Definitely others as well. 

It's interesting because when we wrote this paper, one of the critical issues was the switch from typical medical assessments to telehealth. I took it upon myself to take a look at the literature and see that is it effective, where's it effective, who's effective, and the literature is still fairly mixed. I found a systematic review of reviews and of those about a quarter found that the telehealth was effective, a quarter found that there was some suggestive evidence, but it was unclear. The other half of it really had incomplete or non positive findings. That said, I still can't take much away because when I started digging through those studies, the types of clinicians using it, the type of therapies being used, what they call telemedicine, there are all of the different diseases being incorporated here. There was such heterogeneity. I don't know that there's an easy takeaway.  

I do think that over the next year or so we're going to be seeing more and more studies come out to say, "does it work here?", "Does this type of teletherapy work?", "Does this teletherapy work better than this one?" You know, really understanding the factors associated with effective telehealth. I don't think we're there yet. I think it's starting to come out. Those insights I think will help to drive whether we're going to overuse it or potentially that we're not even using it enough.

Q: Has the pandemic-associated decline in utilization perhaps winnowed out some low-value care? If so, any particular tests or services? If not, why?

 I have seen some papers here that have talked about low-value care really more tied to the overuse of services and procedures and such that maybe don't have a lot of benefit or cause results in patient dissatisfaction when compared to their utility in their benefit. It seems like things such as, potentially, some screenings or diagnostic tests, laboratory test, use of antibiotics, overuse of antibiotics; there are a list of things that I think are being evaluated now that I've seen in 

, a number of these others where we have thought leaders talking about assessing this, but I have not seen results come through yet. 

Given that I'm an epidemiologist and not someone who specializes in say managed care or even health economics per se, it's tough for me to answer that question, but I do expect that will be one benefit of this pandemic we likely will find out some of the services we really didn't need and or provided very low utility or marginal benefit. Don't know what those answers are yet. I gave a couple of examples, but those are those are all secondhand from what I've read from the experts in this field.

Matthew Reynolds, PhD, vice president of real-world evidence at IQVIA, discusses his appreciation for telehealth and remote care, but feels over the next year or so we're going to be seeing more studies come out questioning if some telehealth is needed in certain areas. The discussion came from findings of a recent paper with the National Pharmaceutical Council on how COVID-19 affected real-world data and research.

ISPOR: Matthew Reynolds of IQVIA Addresses Potential Overuse of Telehealth

 Associate Editor, Briana Contreras, speaks with CEO of Virtual Health, Adam Sabloff, who discusses the transformation of value-based care in healthcare and what he thinks the future may look like for value-based care after COVID and the presidential election.

In this part two of three video series, CEO of VirtualHealth, Adam Sabloff, discusses the role technology plays in providing a whole-person view as a component in value-based care and how the election will impact the future of this specific type of care.

Technology

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