Happy New Year from WEDI! Michael offers some quick bites from our top 3 most downloaded episodes of 2025: #3: Rethinking Value-Based Care: Why Children Can't Be Left Behind (Taylor Beery, Imagine Pediatrics, Ep 219) #2: Electronic Health Records- An Integral Partner in Health Care Accessibility (Prerana Laddha, Epic, Ep 189) #1: Bridging the Data Gap- The Role of Standards & Technology in Genomic Data Exchange (Dr Sandy Rolfe, Optum, Ep 188). Be sure to listen to these episodes in their entirety by visiting our podcast page, www.wedi.org/category/podcasts

In this episode (from our National Conference), moderated by WEDI Chair Merri-Lee Stine (Aetna) and featuring Steve Berkow (InterSystems), Anna Taylor (MultiCare), and Stephan Rubin (Optum), we dive into the real-world state of CMS 0057 implementation, bringing together perspectives from payers, vendors, providers, and the HL7 Da Vinci implementer community. Our guests unpack where progress is being made, where complexity has crept in, and why testing, trust, and simplicity are critical to success. From navigating multiple players and messy real-world data to lessons learned from incremental implementation, the conversation highlights practical solutions that can move the industry forward. We close with a look ahead to 2026 and what the 0057 landscape—and broader interoperability environment—may look like as policy, technology, and collaboration continue to evolve.

This episode, from our November National Conference, explores one of healthcare’s most persistent challenges: how hospitals and health plans can move from operating at cross-purposes to truly rowing in the same direction. Our guests are Danielle Lloyd, SVP of Private Market Innovations and Quality Initiatives, AHIP and Molly Smith, Group VP for Public Policy, American Hospital Association. Led by moderator Stephan Rubin from Optum, Danielle and Molly dig into the misconceptions that providers and payers often hold about each other and discuss how better data transparency, shared incentives, and policy alignment — including recent CMS rules such as 0057F — can help bridge long-standing divides. The 3 examine the future of prior authorization, the promise and limits of interoperability initiatives like TEFCA and the CMS Aligned Network, and why value-based care still struggles to scale despite years of policy focus. Finally, they look ahead to the role of AI, automation, and emerging data standards in reshaping care delivery and payment, and ask what real payer-provider collaboration must look like to deliver a more seamless, efficient, and patient-centered healthcare system.

Michael welcomes Todd Van Meter, CEO of Accuity and a 30-year healthcare RCM veteran. Todd shares insights on navigating change in revenue cycle management. From separating AI hype from real ROI to building resilient teams and redefining the patient–provider–payer relationship, Todd offers practical lessons from decades of leading large-scale healthcare operations. A must-listen for anyone shaping the future of healthcare finance.

In this episode, Michael welcomes Lightbeam Health CTO Mike Hoxter to discuss how advanced analytics and social determinants of health (SDOH) data are reshaping population health management. As organizations deepen their commitment to value-based care, Mike explains how modern risk stratification tools help identify at-risk populations earlier, reduce avoidable costs, and drive more equitable, proactive care. With real-world examples and practical insights, this conversation offers a clear look at what’s working—and what’s next—in population health innovation.

Michael welcomes Jaelynn Williams, former CEO of Air Methods and a respected healthcare and business thought leader. Jaelynn has developed the Board AI Governance Index™, a groundbreaking framework that helps boards assess and strengthen their AI readiness—balancing innovation with accountability. They explore how this 100-point model gives leaders a structured way to oversee AI risk, capture opportunity, and ensure responsible use of technology in complex, high-stakes environments like healthcare.

From WEDI’s recently concluded National Conference in Washington DC, co-chairs Emma Andelson from the American Medical Association and Anna Hyde from the Arthritis Foundation introduce WEDI’s newest workgroup, Patient Experience. The workgroup’s primary aim is to embed the patient perspective into healthcare business processes and workflows while elevating the patient voice across WEDI’s broader workgroups and initiatives

Michael sits down with Ben Scharfe, EVP of AI at Altera Digital Health, to explore how artificial intelligence is reshaping healthcare. From ambient listening that lightens documentation load to specialty-trained AI agents enhancing decision-making, Ben shares practical examples of what’s working today—and where challenges like clinician resistance and AI “hallucinations” remain. Hear why he believes AI, when implemented thoughtfully, can deliver what clinicians want most: more time with patients and less time with paperwork.

Michael interviews Julie Johnson, Executive Director of the Center for Research Informatics at the University of Chicago, about synthetic data in healthcare. Julie shares her unconventional career path, which included studying nursing at Georgetown and conducting video game research to improve surgical skills. They discuss the definition, creation, and potential of synthetic data in accelerating research and improving efficiencies, while addressing challenges such as trust and privacy concerns. Julie emphasizes the importance of validating findings with real-world data and explores the future of synthetic data in reshaping medical research and decision-making.

What happens when dental data becomes as accessible and actionable as medical data? Steve Roberts, CEO of Vyne, explores how interoperability can transform the patient experience, equip providers with deeper insights, and strengthen the connection between oral health and overall health.

This podcast is sponsored by MCG Health, which offers evidence-based clinical guidelines and software tools for healthcare providers and payers. These resources aim to optimize patient care and support care management. Learn more about them at https://www.mcg.com/    Michael welcomes Raj Godavarthi, MCG’s AVP of Technology and Interoperability to discuss industry progress on payer-provider compliance work on the CMS Final Rule (CMS-0057-F). After that, Michael addresses artificial intelligence with Dr. Jason Gillman, MCG’s Director of Clinical Informatics. Dr. Gillman is currently involved in the NCQA AI Governance workgroup, and he’s MCG’s representative in the “Clinical Decision Support” workgroup at the Coalition of Health AI (or CHAI).

Michael welcomes  Dr. Sandy Rolfe, WEDI’s Genomics Workgroup Chair Clinical Content Lead, InterQual, Optum Insight Lesley Berkeyheiser, WEDI's Privacy & Security Workgroup Co-Chair, Assessor with DirectTrust Thanh Thien Nguyen, WEDI's Privacy & Security Workgroup Co-Chair, Executive Director, Kaiser Permanente to discuss their workgroups working together to spotlight the intersection between direct to consumer (DTC) genetic tests and some different privacy and security issues associated with these types of tests. The two workgroups collaborated to develop a Fact Sheet to help consumers take action to protect their data, available here- https://www.wedi.org/2025/07/12/direct-to-consumer-genetic-dna-testing-actions-consumers-can-take-to-protect-their-health-data/  Current regulations and requirements Thanh Thien references in the episode HIPAA Privacy Rule- https://www.hhs.gov/hipaa/for-professionals/privacy/index.html HIPAA Security Rule- https://www.hhs.gov/hipaa/for-professionals/security/index.html Genetic Information Nondiscrimination Act of 2008- https://www.govinfo.gov/content/pkg/PLAW-110publ233/pdf/PLAW-110publ233.pdf Federal Trade Commission Act- https://www.ftc.gov/legal-library/browse/statutes/federal-trade-commission-act California Consumer Privacy Act of 2018- https://oag.ca.gov/privacy/ccpa California Privacy Rights Act- https://thecpra.org/ State Privacy Law Tracker- https://iapp.org/resources/article/us-state-privacy-legislation-tracker/

Children make up nearly half of all Medicaid enrollees—37 million nationwide—yet their unique needs are too often overlooked in value-based care models. In this episode, Michael sits down with Taylor Beery, Chief Innovation & Administrative Officer and Co-Founder at Imagine Pediatrics, to explore why pediatric value-based care requires its own distinct strategy. From addressing the needs of 14.5 million children with special health care needs to building trust with families and caregivers, Taylor makes the case that centering children in healthcare reform not only improves outcomes for vulnerable populations but also strengthens the foundation for broader Medicaid and commercial models.

From WEDI's 2025 Spring Conference, Civitas Networks for Health Interim CEO Jolie Ritzo welcomes three HIE leaders to discuss how they are addressing various data exchange use cases from their unique state and regional perspectives. The panelists: Melissa Kotrys, Chief Executive Officer, Contexture (Colorado and Arizona) Phil Beckett, Chief Executive Officer, Texas Health Services Authority Stephanie Brown, Executive Director, CRISP DC Jolie returns to moderate another interesting HIE panel at WEDI's National Conference, November 3-6 in Washington DC and Zoom (virtual pre-conference on October 31). Visit https://members.wedi.org/event-calendar for more information

From WEDI's recently concluded Summer Forum, the association's Prior Authorization Sub Workgorup Co-Chairs- Heather McComas (AMA), Janice Bakos (Aetna) adn Michael Lunzer (Itiliti Health)- offer their thoughts on educational resources and open items related to industry implementation of CMS-0057F. WEDI's Executive Director Robert Tennant moderates the conversation. 

From a WEDI virtual spotlight earlier this summer, hosts and WEDI Privacy & Security Work Group Co-Chairs Lesley Berkeyheiser (DirectTrust) and Thanh-Thien Nguyen (Kaiser Permanente) moderate a conversation with Healthcare Sector Coordinating Council Cybersecurity Leadership and cut through the noise on healthcare cybersecurity. The guests, Healthcare Sector Coordinating Council Executive Director of Cybersecurity Greg Garcia and HSCC Cybersecurity Working Group Chair and Vice Chair Chris Tyberg (Abbott) and Dr. Samantha Jacques (McLaren), share the most valuable resources from HSCC, HHS, and others that every organization should prioritize, with practical advice for small providers on staying vigilant and maintaining strong cyber hygiene. We’ll also explore the current healthcare threat landscape, the biggest opportunities and risks on the horizon, and how new legislative efforts may shape the future. Finally, we’ll highlight the urgent need to grow a diverse pipeline of skilled cybersecurity professionals to protect the sector moving forward.

This podcast episode is sponsored by Edifecs, a Cotiviti Business. For over 25 years, Edifecs has been a market leader in healthcare data interchange. Hundreds of health plans, providers, and government agencies rely on their interoperability solutions to unify, normalize, and exchange clinical and financial data. As the healthcare industry has evolved, Edifecs’ solutions have evolved with it. Their cloud-native, AI-powered solutions are designed to help healthcare organizations thrive in value-based care. Learn more about Edifecs at www.edifecs.com Michael welcomes Matt Spielman, Senior Director of Product Management with Edifecs, to discuss the latest and greatest regarding the industry's ongoing progress with CMS-0057F, the rule aimed at improving prior authorization and interoperability. What is Matt seeing from his customers and others, and what is the present and future of FHIR?

Guest host Denny Brennan (Executive Director, Massachusetts Health Data Consortium and WEDI Board Chair-Elect, welcomes Patrick Lane, President and COO of Health Gorilla. Patrick discusses his recent White House visit for the Make Health Tech Great Again event and addresses the issue of FWA: Fraud, Waste, and Abuse. Patrick sees the solution in the industry embracing LED: Legitimacy, Efficiency, and Development, and offers thoughts on tools and resources that can best be leveraged to achieve this healthcare dream. 

Learn more about the Sequoia Project's CMS0057F Implementation checklist here- https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/  Michael welcomes back (Episode 174, Oct 2024) the co-chairs of the Sequoia Project's Payer to Payer API Implementation Workgroup, Nancy Beavin (Medica) and Bob Oakley (Evernorth), to discuss their new work product, a downloadable tool designed to help payers assess their readiness for compliance with the payer-to-payer components of CMS-0057-F. Along with the workgroup's project manager, Jim Adamson (Point of Care Partners), Nancy and Bob offer updates on the workgroup meetings, the origin of the checklist, and their plans for the future.   

Michael welcomes Dr. Steven Buslovich, MD, Chief Medical Officer for PointClickCare and a passionate advocate for using technology to augment care for seniors. The two discuss how AI is developing intelligent care management for seniors, improving efficiencies in senior care facilities, and what healthcare stakeholders need to consider when implementing AI into the senior healthcare field.