In this episode, Michael Hunn, CEO, and Yunkyung Kim, COO, of CalOptima Health discuss preparing for Medicaid eligibility changes, preventing coverage losses, and supporting providers amid rising uncompensated care risks. They also share plans for a 2027 Covered California marketplace launch and reflect on building community trust through collaboration and mission driven leadership.

In this episode, Jennifer Schirmer, VP of Growth and Community Engagement and interim VP of Duals Program Integration at Blue Shield of California Promise Health Plan, breaks down the sweeping Medicaid changes under HR1 and their impact on California’s Medi-Cal members. She shares how her team is investing in high touch outreach, community partnerships, and duals integration to help vulnerable populations maintain coverage and access to care amid rising administrative complexity.

In this episode, Elizabeth Crawley, Vice President for Clinical and Care Management Solutions at EXL, explores how AI driven workflows and agentic automation are transforming prior authorization. She discusses balancing efficiency with clinical oversight, scaling decision support across the enterprise, and why data readiness and change management are critical to success.

This episode is sponsored by EXL.