Rebuilding Medicare Advantage Member Engagement: Inside Highmark, Johns Hopkins & More

Описание: In this Bright Spots in Healthcare episode, Medicare Advantage leaders confront a hard truth: high activity does not guarantee high impact. As Stars cut points rise and margins tighten, traditional segmentation and broad outreach strategies are no longer sufficient.

This discussion explores how leading plans are shifting from static stratification to dynamic signal monitoring, identifying which members are realistically movable, and embedding behavioral intelligence directly into operational workflows. The focus is not on doing more. It is on doing what measurably drives lift.

Our guests include:

Amin Serehali, Chief Data and Analytics Officer, Independent Health
Mike Leiper, Director of Government Quality Programs, Highmark
Brendan Generelli, Director of Medicare Stars and Quality, Johns Hopkins Health Plans
David Burianek, Chief Strategy Officer for Health Plans, MedOrion

Together, they explore:
How plans are distinguishing between theoretical risk and practical movability, concentrating outreach on members whose behavior can realistically change within a defined window.

How leading organizations are integrating claims, pharmacy, grievance, complaint, and social drivers data with behavioral science modeling to move beyond rules based campaigns.

Why simultaneous pressure across HEDIS, CAHPS, and Part D often reflects fragmentation in engagement strategy rather than isolated measure failures.

How targeted pilots within defined populations create clarity before scaling enterprise wide changes.

Why timing is emerging as a strategic lever, with continuous signal monitoring replacing annual segmentation refresh cycles.

How embedding intelligence into frontline workflows improves alignment between engagement effort and measurable Stars influence.

Panelist Bios:
https://www.brightspotsinhealthcare.c...

Download the Episode Guide:
Get key takeaways and expert highlights to help you apply lessons from the episode.
https://www.brightspotsinhealthcare.c...

Key Insights Summary:
Find the top six strategic insights from the discussion, including detailed speaker takeaways and moderator notes.
https://www.brightspotsinhealthcare.c...

Resources:
Companion Brief: From Segmentation to Signals
This companion brief expands on the behavioral intelligence framework discussed in the episode, outlining how health plans can identify movable phenotypes, align engagement timing with readiness signals, and measure causal lift against specific Stars drivers.

Inside you will find insights on:
Shifting from annual risk stratification to continuous behavioral signal monitoring
Identifying members whose behavior is realistically influenceable within a defined measurement window
Reducing wasted outreach and improving ROI through precision targeting
Embedding intelligence into operational workflows rather than post hoc reporting

To request your copy, email [email protected].

Thank You to Our Episode Partner, MedOrion:
Medorion partners with Medicare Advantage plans to integrate behavioral science and advanced analytics into engagement strategy. By layering behavioral phenotyping onto clinical and utilization data, Medorion helps plans identify which members are movable, optimize outreach timing, and improve measurable Stars performance. Learn more at https://medorion.com/.

Schedule a Conversation with MedOrion:
To explore how behavioral intelligence can strengthen your engagement strategy and improve measurable lift across HEDIS, CAHPS, and Part D, reach out to [email protected] to schedule a discussion with David Burianek and the Medorion team.

About Bright Spots Ventures:
Bright Spots Ventures helps healthcare leaders separate signal from noise and accelerate the adoption of what works. We bring health plan, provider, and innovation leaders together through curated content and high-trust convenings to build meaningful relationships and turn insight into action. Explore our podcast at www.brightspotsinhealthcare.com.