One Member, Five Open Gaps: How Leading Medicare Advantage Plans Are Coordinating Member Action
Episode Description
In this episode of Bright Spots in Healthcare, host Eric Glazer brings together Medicare Advantage leaders from Drips, Johns Hopkins Health Plans, MMM Holdings, myPlace Health, and Independent Health to tackle a challenge every plan knows well: what happens when the same member has multiple open needs, and who decides what should happen first?
The conversation moves beyond measure-by-measure outreach to explore how plans can coordinate action around the whole member. Panelists discuss how to weigh Stars, claims cost, risk adjustment, member context, social barriers, provider workflows, and likelihood to act when determining the next best action.
Through practical examples, the group examines how plans are building shared views of the member, connecting plan and provider teams, using technology to recognize moments of influence, and giving frontline teams more room to listen and respond to what members actually need.
Our guests include:
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Kathleen Faulk, Chief Strategy Officer, Drips
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Brendan Generelli, Director, Medicare Stars & Quality, Johns Hopkins Health Plans
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Nilda González, Vice President, Quality Management & Stars, MMM Holdings, LLC
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Rob Schreiber, MD, Vice President and National Medical Director of Care Model Strategy, myPlace Health, part of SCAN Group
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Amin Serehali, SVP, Chief Data and Analytics Officer, Independent Health
Together, they explore:
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How plans can prioritize when one member has multiple legitimate care, quality, pharmacy, and risk needs
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Why enterprise impact, including claims cost and risk adjustment, can change which gap deserves attention first
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How member barriers and personal priorities should shape the next best action
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How MMM Holdings uses INNOV-A MD, Smart Profile, and its Office Advantage Quality Program to connect plan and provider workflows
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How Independent Health built Member 360 to bring fragmented clinical, pharmacy, utilization, and member information into one actionable view
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How plans can use real-time "moments of influence" to reprioritize outreach when a member is most ready to act
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Why frontline listening can sometimes create more value than completing every item on a checklist
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How more deliberate targeting can improve results while using outreach resources more efficiently
Whether you lead Stars, quality, risk adjustment, analytics, care management, member engagement, or Medicare strategy, this episode offers practical ideas for closing more gaps without creating more noise for members.
Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. Download guide: https://docs.google.com/document/d/1pZErXDEfncqTI-1yoB3yJAv7_Ox-JiqNJsmKep2OK4o/edit?tab=t.0
Key Insights Summary: Find key insights from the discussion, guest takeaways, and detailed moderator notes captured by Eric during the conversation, https://docs.google.com/document/d/1V4mxERrmHf_IEWcUWzfPKwuRlY2dVV21/edit
Thank You to Our Episode Partner, Drips:
Drips helps Medicare Advantage and Medicaid plans turn member conversations into completed actions across annual wellness visits, care gaps, medication adherence, and other priority programs.
By helping plans connect outreach across programs, respond to member context in real time, and focus on the next action a member is most ready to take, Drips supports a more coordinated member journey with fewer disconnected touchpoints and greater follow-through.
Schedule a Meeting with a Senior Leader at Drips:
Interested in learning how health plans are coordinating outreach around the member and turning conversations into completed actions? To connect with Kathleen Faulk or another member of the Drips leadership team, contact show producer Jessica Tenzer at jtenzer@brightspotsventures.com to schedule a conversation.
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.
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