Bright Spots in Healthcare

Why Health Plan Innovation Fails, And What Actually Scales | Healthworx

Why do so many healthcare innovation efforts stall after pilots? In this Bright Spots in Healthcare episode, host Eric Glazer sits down with leaders from Healthworx, the investment and innovation arm of CareFirst, for a candid discussion on what actually allows innovation to scale inside complex healthcare organizations. As health plans invest heavily in AI, digital transformation, startup partnerships, and new care models, many still struggle to operationalize innovation in meaningful ways. This conversation explores why innovation often breaks down between idea and implementation, and what organizations can do differently. Guests include: * Emily Durfee, Director, Corporate Venture Capital, Healthworx * Soo Jeon, Head, Healthworx Accelerator * Mike Batista, Managing Partner, Healthworx Studio Together, they explore: * Why health plan innovation efforts often fail to scale * The operational barriers that prevent ideas from gaining traction * Why healthcare struggles to move beyond pilots and experimentation * What startups misunderstand about working with health plans * Why incremental operational evolution often beats transformational change * How Healthworx approaches innovation through investing, accelerating, and building * What separates organizations that successfully scale innovation from those that don't This episode offers a practical look at the operational realities of healthcare innovation and what it takes to turn new ideas into measurable impact Panelist Bios: https://www.brightspotsinhealthcare.com/events/why-health-plan-innovation-fails-and-what-actually-scales-healthworx/ [https://www.brightspotsinhealthcare.com/events/why-health-plan-innovation-fails-and-what-actually-scales-healthworx/] About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com [http://www.brightspotsinhealthcare.com].

The Moment of Influence: How Leading Medicare Advantage Plans Turn Insight Into Action

In this Bright Spots in Healthcare episode, host Eric Glazer brings together Medicare Advantage and operational leaders to explore a growing challenge facing health plans: why identifying risk is no longer enough to improve outcomes. As organizations invest heavily in HRAs, predictive analytics, and member insight platforms, many still struggle to convert those insights into timely, coordinated action. This discussion focuses on where execution is breaking down between identification and intervention, and what leading plans are doing differently to reduce friction, align teams, and engage members while the opportunity to act still exists. This is a candid discussion for executives navigating increasing pressure around Stars, affordability, member engagement, and operational efficiency, while trying to turn insight into measurable performance improvement. Our guests include: * Vanita Pindolia, PharmD, MBA, Vice President, Stars Program, Blue Cross Blue Shield of Michigan * Chuck Palermo, Vice President, Operations, Health Alliance Plan * Linda Isham, Former Vice President, Operations & Clinical Support, Humana * Cory Busse, Vice President, Strategic Solutions, Icario Together, they explore: * Why insight without operational coordination often fails to improve outcomes * How leading plans are identifying the small populations that disproportionately impact performance * What changes when organizations shift from retrospective reporting to real time intervention * How plans are reducing friction by coordinating Stars, quality, operations, and engagement efforts around a shared action plan * Why understanding behavioral, social, and operational barriers is becoming critical to improving adherence, experience, and quality outcomes * How organizations are designing outreach and engagement strategies that reflect real member behavior, not just clinical gaps This episode offers a practical look at how leading organizations are closing the gap between insight and action, and what it takes to operationalize engagement in a way that consistently improves quality, cost, and member experience. Panelist Bios: https://www.brightspotsinhealthcare.com/events/closing-the-gap-between-insight-and-action-data-informed-tech-enabled-strategies-for-health-plans/ [https://www.brightspotsinhealthcare.com/events/closing-the-gap-between-insight-and-action-data-informed-tech-enabled-strategies-for-health-plans/] Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/Final_May7_Episode_Guide.pdf [https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/Final_May7_Episode_Guide.pdf] Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/May_7_2026_KIS.docx.pdf [https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/May_7_2026_KIS.docx.pdf] Resources: Report: Health Plan Playbook for 2027, Part 1: From HRA Completion to Real Action This first report in Icario's Health Plan Playbook for 2027 series examines why Medicare Advantage plans need to rethink the HRA as more than a requirement or data collection exercise. The issue is not that plans lack information. It is that the handoff between what members report and what happens next is often too slow, fragmented, or manual to drive meaningful action. The report focuses on a core shift facing plans heading into 2027: completing an HRA is no longer the goal. Acting on it is. When a member is engaged, self reporting, and open, plans have a short window to intervene. If nothing happens in real time, that moment is lost. Drawing on practical examples, the report shows how real time intervention, automatic enrollment into barrier removal programs, and proactive identification of risk patterns can help plans reduce delays, support care teams, and close the gap between insight and action. Inside, you'll find insights on: * Why HRAs should be treated as a moment of influence, not just a compliance requirement * Where plans lose momentum between member reported needs and follow up action * How automatic enrollment can reduce manual handoffs and connect members to support faster * Why delayed intervention creates hidden costs across ED utilization, inpatient stays, Stars performance, and unresolved care gaps * How plans can act on SDoH, ADL, and behavioral signals while members are still engaged * What changes when real time decisioning is embedded directly into the member experience The broader lesson is operational: plans that improve performance are not just collecting better data. They are reducing the time between signal and action, removing broken handoffs, and helping members get to the right support while the opportunity still exists. To request your copy of the report, please contact show producer Nicole Roberts at nroberts@brightspotsventures.com [nroberts@brightspotsventures.com]. Thank You to Our Episode Partner, Icario: Icario is a healthcare engagement platform designed to help health plans move beyond disconnected outreach and fragmented member experiences toward more coordinated, action oriented engagement. By combining behavioral science, real time data, and personalized engagement strategies, Icario helps plans identify where members are most likely to disengage, what barriers may prevent action, and how to intervene at the right moment to drive meaningful outcomes. Rather than simply increasing touchpoints, the focus is on reducing friction, improving coordination across teams and programs, and helping members take the next best step. The result is stronger performance across quality, adherence, cost, and member experience. Schedule a Meeting with a Senior Leader at Icario: To explore how Icario is helping health plans improve engagement, reduce friction, and drive more coordinated action across the member journey, reach out to show producer Nicole Roberts at nroberts@brightspotsventures.com [nroberts@brightspotsventures.com] to schedule a conversation with a member of the Icario leadership team. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com [http://www.brightspotsinhealthcare.com].

The Care Model Hospitals Can't Ignore: Sinai Chicago's Community Health Worker Playbook

What if the most effective care model isn't built inside the hospital at all? This episode features the opening presentation from the recent Home Care Innovation Summit, a half-day virtual summit produced by Bright Spots Ventures in partnership with TytoCare, focused on how leading organizations are redesigning care to reach patients where they are. Kelly McCabe, Director of Community Health Innovations, Sinai Chicago and the Sinai Urban Health Institute (SUHI) shares a practical, equity-driven model: clinically integrating community health workers (CHWs) into care delivery to bridge the gap between hospital, home, and community. She's joined briefly by Jeanette Avila, Manager of Community Health Innovations at SUHI offering a frontline perspective on what this model looks like in practice and how it builds trust with patients day-to-day. Serving one of the most complex patient populations in the country, with roughly 90% uninsured or covered by Medicare/Medicaid, Sinai Chicago has built a model that doesn't just acknowledge social needs, but operationalizes them. You'll hear how Sinai Chicago: * Integrates community health workers directly into clinical teams, not as an add-on, but as core infrastructure * Extends care beyond hospital walls through home visits and community-based engagement * Tracks social determinants and community interactions to shape real-time interventions * Builds trust with patients in underserved neighborhoods through culturally aligned care * Uses a hybrid model of in-person outreach and centralized coordination to improve outcomes while reducing burnout Key topics covered: * Why community health workers are essential, not optional, for high-need populations * Turning social determinants from "insight" into actionable care interventions * How to operationalize a community-based care model inside a hospital system * The role of trust, proximity, and lived experience in improving engagement * Blending home-based care with clinical oversight to scale impact If you're a health system leader, population health executive, or payer/provider partner working to close equity gaps and deliver care beyond traditional settings, this is a real-world blueprint for making it work. Presentation Link: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/Kelly-McCabe_Sinai-Chicago_2.19.26.pdf [https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/05/Kelly-McCabe_Sinai-Chicago_2.19.26.pdf] About Our Presenters: https://www.sinaichicago.org/en/suhi/suhi-staff/ [https://www.sinaichicago.org/en/suhi/suhi-staff/] Thank You to Our Episode Partner, TytoCare: TytoCare enables health systems and plans to deliver high-quality remote exams anytime, anywhere. Their FDA-cleared devices and AI-powered diagnostic platform support virtual specialty care, school-based programs, and home health models—reducing unnecessary ED visits and improving patient experience. To learn more, visit tytocare.com [http://tytocare.com]. Schedule a Meeting with a Senior Leader at TytoCare: To explore how TytoCare can help your organization expand virtual specialty access and improve care coordination, reach out to jtenzer@brightspotsventures.com [jtenzer@brightspotsventures.com] to schedule a meeting. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com [http://www.brightspotsinhealthcare.com].

MD Anderson Emergency Physician: AI Isn't Enough Without a Digital Health Ecosystem

In this episode of Bright Spots in Healthcare, recorded live at the ViVE 2026 conference, Eric Glazer sits down with Dr. Pavitra Krishnamani from MD Anderson Cancer Center to explore what it actually takes to build scalable digital health systems. As both a practicing emergency physician and digital health innovator, Dr. Krishnamani brings a frontline perspective to one of healthcare's biggest challenges: why so many digital health tools fail to scale, and what separates technologies that succeed from those that don't. While the industry continues to invest heavily in AI, wearables, telehealth, and other digital tools, many health systems are still struggling with fragmented solutions, low adoption, and limited real-world impact. The path forward isn't more tools, it's better systems. In this episode, you'll learn: * Why workflow integration matters more than features in digital health adoption * How AI, wearables, telehealth, VR, and EHRs must work together as a connected ecosystem * What health systems should evaluate before bringing in new technology, including ROI, maintenance, and unintended consequences * The role of human-centered design in building solutions clinicians will actually use * Why adoption fails without clinician buy-in, flexibility, and cultural alignment * How to design more effective pilots and avoid common implementation pitfalls * Why education and mindset are critical to scaling AI and digital health * What it takes to move from siloed tools to scalable, system-level transformation Key Takeaway: "Education begets innovation" - Pavitra P. Krishnamani, MD. Scalable digital health isn't about deploying more technology, it's about aligning technology, workflows, and people into systems that actually work in practice. Learn More from Dr. Krishnamani: http://pavitramd.com/ [http://pavitramd.com/]. Dr. Krishnamani expands on many of these ideas in her upcoming book: Home is Where the Health Is: How Digital Innovation and Technological Advances are Transforming Healthcare and Wellness. The book explores how technologies like AI, wearables, telehealth, and data systems are coming together to reshape healthcare delivery and move care closer to where patients live their daily lives. Connect with Dr. Krishnamani: * Instagram: https://www.instagram.com/docpavitra [https://www.instagram.com/docpavitra] * LinkedIn: https://www.linkedin.com/in/pavitra-krishnamani [https://www.linkedin.com/in/pavitra-krishnamani] Partner with Bright Spots Ventures: If you are interested in speaking with the Bright Spots Ventures team to brainstorm how we can help you grow your business through credibility building content and trusted executive relationships, email hkrish@brightspotsventures.com [hkrish@brightspotsventures.com] About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com [http://www.brightspotsinhealthcare.com].

EmblemHealth, Doctors HealthCare Plans, Security Health Plan, & MedOrion: Rethinking CAHPS & Member Experience

In this Bright Spots in Healthcare episode, host Eric Glazer brings together payer and strategy leaders to explore a fundamental challenge in Medicare Advantage: why improving experience is not about measuring more, but managing better. This conversation focuses on where performance is actually being lost across the member journey, not within individual programs, but in the gaps between them. Plans continue to invest in outreach, pharmacy, provider engagement, and member services, yet still struggle to translate those efforts into consistent member action and measurable outcomes. This is a candid discussion for executives navigating rising expectations around experience, increasing pressure on Stars performance, and the need to deliver results through coordination, not just activity. Our guests include: * Dan Knecht, MD, Chief Medical Officer, EmblemHealth * Stacey Friedman, Senior Director, Quality & HEDIS/Stars, Doctors HealthCare Plans * Paula Jacobson, Director, Quality and Population Health, Security Health Plan * Dave Burianek, Chief Strategy Officer, MedOrion Together, they explore: * Where member experience breaks down across the journey, especially in the moments immediately following enrollment * Why campaign-based outreach is no longer sufficient to drive engagement or outcomes * How leading plans are shifting from volume to sequencing, focusing on the next best action rather than multiple simultaneous asks * What it takes to align pharmacy, quality, and member experience into a coordinated system * How organizations are improving performance by reducing friction, increasing clarity, and guiding members toward action This episode offers a practical look at how leading plans are rethinking CAHPS as a reflection of the full member journey, and what it takes to design that experience in a way that consistently drives performance. Panelist Bios: https://www.brightspotsinhealthcare.com/events/beyond-the-survey-how-medicare-advantage-plans-are-rethinking-cahps-and-member-experience/ [https://www.brightspotsinhealthcare.com/events/beyond-the-survey-how-medicare-advantage-plans-are-rethinking-cahps-and-member-experience/] Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/April_16_Episode_Guide.docx.pdf [https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/April_16_Episode_Guide.docx.pdf] Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/04-16-26-KIS-Beyond-the-Survey-Session.pdf [https://www.brightspotsinhealthcare.com/wp-content/uploads/2026/04/04-16-26-KIS-Beyond-the-Survey-Session.pdf] Resources: Report: Redesigning Experience: Why CAHPS Performance Is Won or Lost in the Member Journey This report examines why Medicare Advantage plans often see CAHPS results that don't reflect the effort they put in. The issue is not a lack of activity. It's that CAHPS reflects a year's worth of member experience, shaped by care access, coordination, navigation, and follow-through, not isolated interactions or last-minute interventions. Drawing on real-world examples, the report shows how improving underlying care events like annual wellness visits, redirecting care to the right setting, and strengthening member understanding directly influences CAHPS performance, and why results cannot be changed at the end of the measurement year. Inside, you'll find insights on: * Why CAHPS questions act as proxies for clinical events like annual wellness visits and care coordination * Where campaign-based engagement models fall short in shaping member experience * How friction accumulates across touchpoints and impacts perception long before the survey is fielded * What changes when plans shift from disconnected outreach to coordinated, journey-based design * How aligning Stars, quality, and care delivery reduces fragmentation and improves outcomes * Why understanding member barriers, including access, confusion, and behavioral factors, is critical to driving action The broader lesson is operational: plans that consistently perform on CAHPS are not doing more outreach. They are designing member journeys that reduce friction, coordinate care and communication, and naturally produce better experiences over time. To request your copy of the report, please contact show producer Jessica Tenzer at nroberts@brightspotsventures.com [nroberts@brightspotsventures.com]. Thank You to Our Episode Partner, MedOrion: MedOrion helps health plans move beyond static segmentation by using real-time clinical, situational, and behavioral signals to drive meaningful member action. By identifying who to engage, what barriers exist, and when to intervene, MedOrion enables more precise prioritization and coordination of outreach. This approach helps close care gaps, improve adherence, reduce avoidable utilization, and drive more consistent performance across cost, quality, and experience. Learn more at medorion.com [http://medorion.com]. Schedule a Meeting with a Senior Leader at MedOrion: To explore how MedOrion can support your organization in moving from campaign-based outreach to coordinated, signal-driven engagement, reach out to show producer Nicole Roberts at nroberts@brightspotsventures.com to schedule a conversation with a member of the MedOrion leadership team. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation. We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the "bright spots" in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com [http://www.brightspotsinhealthcare.com].