AI could transform the healthcare system by predicting risk and fixing inefficiencies - Parul Mistry

The Value-Based Care Chaos for Healthcare Leaders to Fix Broken Incentives with Mahrukh Saif

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest Mahrukh Saif, [https://www.linkedin.com/in/mahrukhsaif/] Principal Consultant | Value-Based Care Strategy at HQI Strategies [https://www.linkedin.com/company/hqi-strategies/], to explore the operational realities of value-based care. Together, they unpack why many value-based care initiatives struggle not because of clinical shortcomings, but due to fragmented data, misaligned incentives, operational complexity, and disconnected workflows. The conversation examines payer-provider relationships, quality incentive programs, social determinants of health, AI's role in healthcare, and the systemic changes needed to make value-based care work for frontline providers. With a background in healthcare analytics and data science, she works closely with physician practices, value-based care organizations, and healthcare stakeholders to improve operational performance, care gap management, and quality reporting. Her work focuses on bridging the gap between value-based care contract design and real-world clinical execution while exploring how emerging technologies like AI can support more effective healthcare delivery. Expect to Learn: - Why value-based care often fails because of operational challenges rather than clinical performance. - How fragmented payer contracts create complexity for healthcare practices. - The biggest misconceptions about value-based care implementation. - Why accurate care gap data is essential for improving quality outcomes. - How social determinants of health impact the success of value-based care. - Where artificial intelligence can and cannot improve value-based care operations. - What changes are needed to make value-based care simpler, more transparent, and more effective. TIMESTAMPS: 00:00 – Teaser 01:35 – Introduction to Mahrukh Saif 02:40 – Mahrukh Saif's Background and Work in Value-Based Care 03:30 – Why Value-Based Care Was Created? 07:55 – What Value-Based Care Actually Looks Like Inside Healthcare Practices 11:56 – Why Operational Complexity Is Holding Value-Based Care Back 17:12 – Should Payer Quality Incentive Programs Be Audited? 23:52 – How Incentive Design Influences Provider Behavior 25:49 – Why Social Determinants of Health Are Critical to Better Outcomes 30:30 – Can AI Solve Value-Based Care's Biggest Challenges? 36:24 – How Healthcare Organizations Prioritize Quality Measures 38:33 – What Needs to Change to Make Value-Based Care Work 41:52 – Improving Collaboration Between Providers and Actuaries 44:39 – Final Thoughts and Future Conversations Follow Guest Mahrukh Saif & her Company: LinkedIn: https://www.linkedin.com/in/mahrukhsaif/ [https://www.linkedin.com/in/mahrukhsaif/] Company LinkedIn: https://www.linkedin.com/company/hqi-strategies/ [https://www.linkedin.com/company/hqi-strategies/] Company Website: https://hqistrategies.carrd.co/ [https://hqistrategies.carrd.co/] YouTube: https://www.youtube.com/@qualitymoralityhealth [https://www.youtube.com/@qualitymoralityhealth] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

Healthcare Leaders Struggle with Social Care ROI to Turn Impact into Profit with Christina Y. Rodriguez

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest Christina Y. Rodriguez [https://www.linkedin.com/in/cyrodr8/], Founder & Publisher at Pull [https://pullindex.substack.com/] and Podcast Host & Producer of Outcomes - Podcast. to explore one of healthcare's most debated topics. The conversation looks into Medicaid waivers, value-based care, financial accountability, program measurement, attribution challenges, and why many social interventions fail to become embedded in health plan operations. Christina shares a practical framework for turning social care from a community service into a defensible healthcare investment. Christina Y. Rodriguez is a healthcare strategist focused on transforming Food as Medicine from a community service into a fundable healthcare product. Drawing on her background as a licensed medical social worker and her executive MBA in healthcare leadership, she helps health plans, vendors, and investors design social care programs that are measurable, contract-ready, audit-ready, and built to scale. She is the founder of Pull, an independent decision platform evaluating which social care models are financially defensible and sustainable within modern healthcare financing systems. Expect to Learn: - Why social care still sounds vague to healthcare decision-makers. - How to measure Food-as-Medicine programs beyond meals delivered. - The difference between mission-driven outcomes and finance-grade outcomes. - How to move a social intervention from pilot to health plan infrastructure. - What success should look like at 6, 12, and 24 months. - Why many social care programs fail despite good intentions. - How health plans can think about social care as a risk-management strategy. TIMESTAMPS: 00:00 – Teaser 02:02 – Meet Christina Rodriguez and the Mission Behind Pull 03:21 – From Medical Social Worker to Healthcare Strategist 05:28 – Why Social Care Still Struggles to Gain Credibility 07:55 – Defining Social Care Through Financial Impact 09:46 – Why Better Health Outcomes Don't Always Create Cost Savings 12:20 – The Metrics That Matter: Moving Beyond Activity Tracking 13:09 – Turning Social Care from Pilot Programs into Infrastructure 14:56 – The 6-, 12-, and 24-Month Roadmap to Sustainability 18:40 – Navigating Short-Term Financial Pressures and Long-Term Value 22:14 – Which Social Interventions Can Deliver ROI Quickly? 23:50 – Why Social Care Programs Break Down 27:34 – Building Fundable Programs and Solving the "Wrong Pocket Problem" 36:33 – The Gap Between How Programs Operate and How Healthcare Pays for Them 39:50 – Why Some Social Care Vendors Fail to Demonstrate Value 43:58 – How Actuaries and Frontline Teams Can Work Better Together 47:16 – Final Thoughts and Closing Remarks Follow Guest Christina Y. Rodriguez: LinkedIn: https://www.linkedin.com/in/cyrodr8/ [https://www.linkedin.com/in/cyrodr8/] YouTube: https://www.youtube.com/@christinarodriguez4979 [https://www.youtube.com/@christinarodriguez4979] Website: https://christinar.media/ [https://christinar.media/] Company Website: https://pullindex.substack.com/ [https://pullindex.substack.com/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

AI Bias in Healthcare for Health Plan CEOs to Avoid Lawsuits & Increase Revenue with January Montaño

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest January Montaño, MPS [https://www.linkedin.com/in/januarymontano/], CEO and Founder at January's Advisory Group [https://www.linkedin.com/company/januarysadvisorygroup/], to explore one of healthcare’s most urgent questions: Can AI improve outcomes without deepening inequities? The conversation dives into AI governance, vendor accountability, algorithmic bias, and the widening gap between healthcare organizations with robust AI infrastructure and those struggling to keep up. January shares why governance not technology alone will determine whether AI becomes a force for health equity or reinforces existing disparities. January’s Advisory Group, a Denver-based AI governance consultancy specializing in equitable, auditable, and revenue-generating AI systems. With nearly three decades of experience in healthcare policy, Medicaid, public health, and healthcare operations, January has advised health plans, hospitals, and government agencies on healthcare transformation, algorithmic accountability, and health equity. January has testified before the Colorado General Assembly on AI bias and serves as a leading voice on responsible AI adoption in healthcare. Expect to Learn: - Why AI governance is becoming a healthcare necessity, not a compliance exercise - Who is legally accountable when AI-driven healthcare decisions go wrong - How algorithmic bias can impact access to care, housing, and employment - Why rural hospitals face a growing AI divide - How health equity can drive financial performance and better outcomes - The role of social determinants of health in AI-powered healthcare - What healthcare leaders should do before deploying AI systems TIMESTAMPS: 00:00 – Teaser 01:26 – Why Healthcare AI Needs More Than Efficiency 00:59 – Setting the Stage: Healthcare’s AI Inflection Point 02:15 – January Montaño’s Journey Into AI Equity 05:22 – Who Is Accountable When AI Makes the Wrong Decision? 06:16 – Why Health Plans Carry the Legal Risk 09:24 – Defining Real AI Governance in Healthcare 10:41 – Building Governance Beyond Policies and Paperwork 13:03 – The Reality of AI Adoption Across Health Systems 16:30 – The Growing Digital Divide Between Large and Rural Providers 18:46 – AI, Social Determinants of Health, and Equity 19:43 – How Biased AI Restricts Access to Care and Services 22:06 – Examples of Responsible AI in Healthcare 23:22 – Introducing the ROI Equity Framework 24:31 – Why Equity Should Be Treated as Revenue 26:02 – Turning Equity Gaps Into Business Opportunities 27:09 – The Mount Sinai Food Insecurity Case Study 29:07 – Early Intervention and Better Patient Outcomes 30:50 – Connecting Food Security to Lower Healthcare Costs 33:08 – Stable Patients Create Sustainable Health Systems 35:04 – Rethinking Incentives in Healthcare Financing 37:20 – Long-Term Investment vs Short-Term Healthcare Economics 49:39 – A Practical Six-Month AI Roadmap for Health Plans 50:22 – The First 90 Days of Building AI Governance 51:11 – Auditing Existing AI Systems and Vendors 57:24 – Reporting AI Risk and Performance to the Board 58:47 – Creating a Defensible and Compliant AI Strategy 59:07 – Why Actuaries Must Move Beyond Accuracy 01:00:13 – Auditing Models for Fairness and Bias 01:02:42 – Closing Remarks Follow Guest January Montaño, MPS: LinkedIn: https://www.linkedin.com/in/januarymontano/ [https://www.linkedin.com/in/januarymontano/] Instagram: https://www.instagram.com/january.montano/ [https://www.instagram.com/january.montano/] Company LinkedIn: https://www.linkedin.com/company/januarysadvisorygroup/ [https://www.linkedin.com/company/januarysadvisorygroup/] Company Website: https://www.januarysadvisorygroupllc.org/ [https://www.januarysadvisorygroupllc.org/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

AI in Healthcare Is Quietly Denying Care and Making Biased Decisions with January Montaño

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest January Montaño, MPS [https://www.linkedin.com/in/januarymontano/], CEO and Founder at January's Advisory Group [https://www.linkedin.com/company/januarysadvisorygroup/], to unpack the foundations of artificial intelligence in healthcare. From understanding the difference between automation and AI to exploring algorithmic bias, liability, governance, fraud detection, and patient impact, this conversation examines both the promise and the risks of AI adoption across health plans, providers, and healthcare operations. January explains why equity auditing is becoming a critical component of AI governance and what healthcare leaders must do before deploying AI at scale. January’s Advisory Group, a Denver-based AI governance consultancy specializing in equitable, auditable, and revenue-generating AI systems. With nearly three decades of experience in healthcare policy, Medicaid, public health, and healthcare operations, January has advised health plans, hospitals, and government agencies on healthcare transformation, algorithmic accountability, and health equity. January has testified before the Colorado General Assembly on AI bias and serves as a leading voice on responsible AI adoption in healthcare. Expect to Learn: - The difference between automation, machine learning, generative AI, and agentic AI - How AI is currently being used by health plans and healthcare providers - Why algorithmic bias occurs and how it impacts patient care - The role of AI in prior authorization, claims adjudication, and risk adjustment - How AI is helping detect fraud, waste, and abuse in healthcare - The growing legal and regulatory risks surrounding AI-driven healthcare decisions - What CEOs, CIOs, compliance teams, and actuaries should evaluate before implementing AI solutions Timestamps: 00:00 – Teaser 01:05 – Introducing January Montaño, MPS and the AI Equity Challenge 04:42 – Why Healthcare Needs a Strong Foundation for AI Governance 07:37 – Understanding Automation vs. Artificial Intelligence 10:12 – The Rise of Agentic AI and Multi-Agent Healthcare Systems 15:23 – Will AI Replace Jobs or Reduce Workforce Burnout? 19:59 – Where AI Is Already Operating Inside Health Plans and Hospitals 23:07 – How Algorithmic Bias Impacts Minority and Underserved Populations 31:23 – Is Managed Care Actually Managing Care in the AI Era? 33:06 – Understanding the Root Causes of AI Bias 35:07 – What AI Is Already Doing to Patients Behind the Scenes 41:38 – Can AI Improve Outcomes While Advancing Health Equity? 50:03 – AI’s Role in Fighting Fraud, Waste, and Abuse 55:10 – Who Is Liable When AI Makes the Wrong Decision? 57:08 – Questions Every CIO Should Ask Before Buying AI 58:09 – Governance Structures Every CEO Must Have in Place 01:06:58 – Why Actuaries Are the Last Line of Defense 01:13:45 – Measuring Differential Error Rates and Equity Risk 01:14:22 – Final Thoughts Follow Guest January Montaño, MPS: LinkedIn: https://www.linkedin.com/in/januarymontano/ [https://www.linkedin.com/in/januarymontano/] Instagram: https://www.instagram.com/january.montano/ [https://www.instagram.com/january.montano/] Company LinkedIn: https://www.linkedin.com/company/januarysadvisorygroup/ [https://www.linkedin.com/company/januarysadvisorygroup/] Company Website: https://www.januarysadvisorygroupllc.org/ [https://www.januarysadvisorygroupllc.org/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]

AI could transform the healthcare system by predicting risk and fixing inefficiencies - Parul Mistry

In this episode of When Health Freezes Over, Host Omar Haq [https://www.linkedin.com/in/omar-haq1/]is joined by guest Parul Mistry, MD, MA [https://www.linkedin.com/in/parulmistrymd/], a physician executive with more than 20 years of leadership experience. The conversation explores the evolution of medical management in health plans, the limitations of traditional disease management, and the growing importance of whole-person care, social determinants of health (SDOH), interoperability, and AI-driven population health strategies. Parul Mistry provides an insider’s perspective on how health plans, providers, actuaries, and medical management teams can better collaborate to improve healthcare outcomes while addressing rising healthcare costs and administrative complexity. Parul Mistry has more than 20 years of leadership experience across various aspects of healthcare including Medicaid managed care, provider systems, payment integrity, and digital health. She has led enterprise efforts in population health, utilization management transformation, quality improvement, clinical operations, with a strong focus on improving outcomes for vulnerable populations. Expect to Learn: - What a Chief Medical Officer (CMO) actually does inside a health plan - The difference between traditional care and population health - Why disease management programmes are fading out - How complex case management evolved from disease management - The future role of health plans in 2026 and beyond - How AI and predictive analytics can improve population health - The pros and cons of point solution vendors - Why primary care and SDOH remain underfunded - How actuaries and medical management teams can collaborate more effectively Timestamps: [00:00:00] - Teaser [00:01:07] - Introduction of Parul Mistry [00:04:31] - What does a Chief Medical Officer actually do? [00:06:38] - Population health vs traditional reactive healthcare [00:11:48] - The evolution and decline of disease management programmes [00:15:21] - Why healthcare is shifting toward complex case management [00:26:19] - What utilisation management was originally designed to do [00:28:48] - Improving payer-provider relationships and reducing friction [00:32:12] - Why population health struggles to bend the healthcare cost curve [00:40:59] - The massive impact of social determinants of health (SDOH) [00:44:06] - Why healthcare ROI cannot be measured in one-year cycles [00:46:05] - What role health plans should play in modern healthcare [00:52:28] - AI, predictive analytics, and the future of population health [00:57:16] - How technology can personalize member engagement [01:06:09] - Why social determinants of health remain chronically underfunded [01:08:06] - The need for stronger investment in primary care [01:09:16] - Collaboration between actuaries and medical management teams [01:12:01] - Closing thoughts and final takeaways Follow Guest Parul Mistry: LinkedIn: https://www.linkedin.com/in/parulmistrymd/ [https://www.linkedin.com/in/parulmistrymd/] Follow Host Omar Haq: LinkedIn: https://www.linkedin.com/in/omar-haq1/ [https://www.linkedin.com/in/omar-haq1/] Company Website: https://www.mushincg.com/ [https://www.mushincg.com/] Instagram: https://www.instagram.com/mushincgllc [https://www.instagram.com/mushincgllc] Tiktok: https://www.tiktok.com/@uberactuary [https://www.tiktok.com/@uberactuary] Follow Us On: YouTube: https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/ [https://www.youtube.com/channel/UC7CR1wzokjtVdyyWHLziUJQ/] Spotify: https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2 [https://open.spotify.com/show/3bRobaBZlM3IbCJ5334PJV?si=41aa6416371e4bc2] Apple Podcast: https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951 [https://podcasts.apple.com/pk/podcast/when-health-freezes-over/id1887501951]