The Totally Adequate Podcast

About this Episode: Provider data accuracy and network strategy are strategic priorities for health plans to consider. With heightened regulatory scrutiny, evolving network adequacy standards, and rapid AI adoption, data integrity sits at the center of compliance, member experience, and innovation. Steve Levin and Scott Westover deliver a high-level, executive-focused discussion on the forces reshaping provider data and network strategy. They break down:  Key regulatory and market trends that are influencing provider data and network management  The growing role of AI in provider data management  How government perspectives around consumer-facing data are changing  Strategies for leadership teams focused on aligning systems with modern member expectations in 2026 and beyond  Guests:  Steve Levin, CEO of Quest Analytics   Scott Westover, Chief Network Solutions Officer, Quest Analytics  April Beane, VP of Marketing, Quest Analytics 

About This Episode Join a candid conversation about the realities of navigating healthcare today. Hear how system-level gaps can delay care, and how industry innovators are using AI and technology to improve the patient experience. Shanna's journey brings the stakes to life, showing why care before crisis must become the new standard. Guests:  Shanna Adamic, Director, Oracle Health Executive Content and Oracle Video Executive @ Oracle | Oracle TV Co-Anchor, AI World | Keynote Speaker | Published Author of Audacious Optimism | Former NFL KC Chiefs Cheerleader   Barbara Dumery, Chief Product Officer, Quest Analytics® An engineer by training, Barbara has more than 20 years of experience bringing innovative technology solutions to the market that address key challenges in healthcare. She has a track record of driving value to customers and clients that drive exceptional growth to the business. At Quest Analytics®, Barbara helps drive the expansion of current solutions as well as new innovations off of Quest Analytics' core offerings. Previously, she has served in leadership roles in companies across all facets of healthcare – from population health analytics, medical devices, speech recognition, and radiology imaging. Barbara holds Bachelor's and Master's Degrees in Electrical Engineering from Tufts University.   April Beane, VP Marketing, Quest Analytics  

About This Episode  In this episode, we share a technical-to-operational playbook that covers data quality issues and AI-driven network design. Join our guests as they break down a data-first approach that enables success.   How to identify and fix data issues that break analytics and ML.  How to use real-world data to inform design and contracting.  How executives evaluate AI proposals and the artifacts that accelerate approval.  Guests:  April Beane, VP Marketing, Quest Analytics   Stephen Gold, Senior Advisor at Vestar Capital Partners and former Chief Information Officer (CIO)  James Lamb, Vice President of National Payers at Quest Analytics®

Guests:  Bob Tavernier, Solutions Executive, Quest Analytics | Connect on LinkedIn  Joshua Abraham, Director of Network Strategy, CommonSpirit Health   Host: April Beane, VP of Marketing, Quest Analytics | Connect on LinkedIn   About This Episode  Affiliation intelligence is transforming the development and optimization of healthcare networks, offering payers new pathways to enhance operational performance and member outcomes. April Beane sits down with industry leaders Bob Tavernier and Joshua Abraham to discuss how payers are using affiliation data to build high-performing and sustainable networks. Hear about practical, data-driven approaches to overcoming complex network challenges, including:  Identifying hidden contracting relationships that influence network performance.  Uncovering strategic opportunities for market growth and expansion.  Recognizing entities that can address multiple network adequacy gaps.  Aligning provider and facility participation to reduce out-of-network costs.  

About This Episode  Texas has introduced some of the most stringent network adequacy requirements in the country that reshapes how health plans design, monitor, and report on provider networks. Join expert Stephanie Stephens, a former Texas regulator, as she sits down with the Quest Analytics team to unpack HB 3359, explore compliance best practices, and look forward to national trends and the changing landscape to evaluate network sufficiency. Guests:  April Beane, VP Marketing, Quest Analytics | Connect on LinkedIn   Zach Snyder, JD, MPA, VP Government Affairs, Quest Analytics | Connect on LinkedIn   Stephanie Stephens, Former Texas Regulator, Stephens Consulting, LLC 

In this special bonus episode, Sophia Timmermeyer sits down with April Beane, VP of Marketing at Quest Analytics, to share an exclusive behind-the-scenes look at Vision Quest 2026. Hear the story about the strategic pause in 2025 and learn how that time was used to refine and redesign the experience for even greater impact.  Vision Quest has always been a favorite among attendees, and we're excited to deliver an even more tailored event that brings you the insights, connections, and value you love.  Key Highlights:  The intentional break and how it shaped a more focused, community-driven event  New small-group formats designed to deepen learning and foster meaningful connections  Fresh networking opportunities that spark innovation and collaboration  Expert-led sessions tailored to elevate your skills and expand your influence  Event Details:   📅 Dates: May 19–21, 2026   📍 Location: Chicago, IL  🔗 Learn More: https://visionquest.questanalytics.com 

In this episode host April Beane, VP of Marketing at Quest Analytics, is joined by Bob Tavernier, Sales Solution Executive at Quest Analytics, and Dr. Luke Hansen, Chief Medical Officer for Arcadia. Together, they discuss strategies and insights for improving healthcare provider network performance through data intelligence. The conversation highlights key factors driving network development, the growing influence of member consumerism, and the impact of regulatory pressures on payer-provider relationships.    

Discover the intricate world of network adequacy for dual eligible populations—those who qualify for both Medicare and Medicaid—and the unique challenges they face in accessing comprehensive care. Join experts Zach Snyder, JD, MPA (Quest Analytics), Tricia Beckmann, JD (Faegre Drinker), Kacey Dugan, MPA (Faegre Drinker), and our host, April Beane, as they delve into this crucial topic.  On the Docket:  Overview of Network Adequacy  Defining Network Adequacy for Dual-Eligible Beneficiaries What Do Requirements and Unique State Practices Mean for Plans Serving Dual-Eligibles? Current and Future Trends in Network Adequacy   Strategies for Navigating Network Adequacy Compliance        YouTube Link: https://youtu.be/a7Z9XASbkc8 

Are health plans prepared for the sweeping changes proposed under the REAL Health Providers Act? In this episode, Kate Deiters and Zach Snyder break down the legislation's key provisions and explore how it could transform the way Medicare Advantage Organizations manage provider directories, verify provider information, and report on provider data accuracy.  Discover how the Act builds on elements of the No Surprises Act and introduces compliance requirements like removing unverified providers from the directory, conducting annual accuracy assessments, and maintaining a public Accuracy Score.   Related Articles  The Requiring Enhanced & Accurate Lists of Health Providers Act https://questanalytics.com/news/requiring-enhanced-accurate-lists-of-health-providers-act/ 

In this episode, host Kate Deiters sits down with Zack Snyder, VP of Government Affairs at Quest Analytics, to discuss the Executive Order Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information. Tune into this episode, to hear:  What the Executive Order means for health systems and health plans  How this could lead to further amendments under the No Surprises Act  What future network adequacy and provider directory requirements may be impacted  Actionable tips for staying compliant with new regulations  Don't forget to subscribe and hit the notification bell so you're the first to know when we release a new episode.    Webpage: https://questanalytics.com/the-totally-adequate-podcast/health-policy-updates/april-2025/   YouTube: https://youtu.be/qMqYpGFNb3g?si=INCnrw-6hLNcXbjU 

In this episode of The Totally Adequate Podcast, we delve into the proposed rules for Medicare Advantage organizations and the new California Assembly Bill. Join Kate Deiters and Zach Snyder as they discuss the key aspects of these policies and their potential impact on healthcare provider network management.  Proposed Rule for Medicare Advantage Organizations: Gain insights into what updates could be coming to network adequacy and provider directory requirements.  California Assembly Bill: Learn about the new bill that aims to set provider directory accuracy benchmarks for health plans, requiring a 95% accuracy rate by 2029.  State Legislative Actions: Discover how other states are exploring similar initiatives and the implications for provider directory accuracy programs. 

The Final Notice of Benefit and Payment Parameters for 2026 is out, and we're here to break it down for you. Kate Deiters and Zach Snyder discuss the key changes in network adequacy requirements. Tune in to learn how these changes will impact Qualified Health Plans (QHPs) Certification for issuers on the federal and state exchanges.  Topics Covered  New Network Adequacy Calculations: Learn about the shift to using geographic distance for network adequacy evaluations.  Implications for State-based Exchanges: Find out about the requirements for state-based exchanges to meet federal standards by January 1, 2026, and potential legislative and regulatory shifts.  State-Specific Legislative Actions: Get an overview of how states like Nevada and Oregon are aligning their standards with federal requirements and the legislative processes involved. 

Get ready for 2025 with the latest insights on major health policy changes! Join Kate Deiters and Zach Snyder as they break down federal policy updates related to network adequacy and provider directory accuracy. Discover what's changing and how you can start preparing for the new requirements. Highlights: Proposed Notice of Benefit and Payment Parameters for Plan Year 2026: Learn about the new Geographic Distance measurement and rollover changes from last year.   Managed Care Final Rule: Understand the updated provider directory accuracy and network adequacy requirements, and their impact on Medicaid RFP bids. Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule: Dive into the new comparative analysis standards and their implications for your network evaluation strategies. CMS National Provider Directory Pilot: Explore the pilot program aiming to improve provider directory accuracy nationwide. Trends and Predictions for 2025: Get insights on upcoming trends in healthcare policies and understand how these changes could affect your organization. Tune in to stay informed and prepared for the shifting landscape of health policies!

Get an Exclusive Preview of Vision Quest 2024 with April Beane! In this episode, guest host Kate Deiters, sits down with April Beane, VP of Marketing at Quest Analytics, to discuss what makes Vision Quest the premier forum for professional development in healthcare provider network management and performance. Key Highlights:  - How Vision Quest fosters an inclusive, collaborative atmosphere for professionals at all career stages. - Insights into multi-track sessions designed to enhance your skills and knowledge. - Unique networking opportunities that drive innovation within your organization. - Expert-driven learning experiences that broaden your understanding and capabilities. Event Details: 📅 Dates: September 10-12, 2024 📍 Location: Austin, TX  Learn More About Vision Quest: https://visionquest.questanalytics.com/ Learn More About Quest Analytics: https://questanalytics.com/

Big changes are coming to Medicare Advantage and Marketplace policies! April Beane and health policy expert Kate Deiters dig into the CMS Contract Year 2025 Medicare Advantage and Part D Final Rule and HHS Notice of Benefit and Payment Parameters for 2025 Final Rule. Discover what these updates mean for network adequacy and provider accuracy at both federal and state levels. Get ahead with key trends and actionable insights that every healthcare professional and policymaker needs to know. Resources Mentioned CMS Contract Year 2025 Medicare Advantage and Part D Final Rule Policy Brief: https://questanalytics.com/cms-mao-medicaid-resource-hub/medicare-advantage-final-rule/ HHS Notice of Benefit and Payment Parameters for 2025 Final Rule Policy Brief: https://questanalytics.com/qhp-marketplace-resources/qhp-legislative-brief/  

Leaders from Quest Analytics and Highmark Health join April Beane to discuss the future of provider network performance. As strategies evolve, how we build networks is critical in achieving member and payer outcomes that drive business success. Finding the path to "right-sized" networks is also vital to providing quality and equitable care to all members. And, as our guest will tell you, connecting benefit design and network structuring is the goal we should all have the courage to achieve.  Panelists:  Steve Levin, CEO, Quest Analytics Jim Brown, Vice President for WPA Markets Operations and Strategy, Highmark Health  Hosted by April Beane, VP Marketing, Quest Analytics    Enjoyed this episode? Help spread the word by leaving a review and rating.   

The national talk track in healthcare tends to focus on cost, utilization management, serving underserved and high-cost populations, benefit design, and consumer engagement. Underappreciated, or even ignored, is the underlying platform on which everything rides: the health network. In this episode, two Healthcare IT executives who have spent decades in healthcare around financial management, cost analytics, and provider performance share their takeaways on understanding provider network management since joining Quest Analytics®. Both have been astounded by the sophistication of network development and the opportunities to bring the network into the current national debate. Join us for a fireside chat between these experts as they reflect on their past knowledge and explore the future of provider network management. Panelists:  Steve Levin, CEO, Quest Analytics  Subhash Seelam, SVP, Applied Network Analytics, Quest Analytics  Host:   April Beane, VP Marketing, Quest Analytics   

What a difference 10 years makes! In this episode, host Kate Deiters talks with Eliza Hoffman, VP of Regional Payers at Quest Analytics, about the last decade in healthcare provider network management. From what's changed to aha moments to the current hot topics, Eliza shares her perspective on the evolution of provider network management and what she's most excited about for the future. Sit back, relax and enjoy this episode!

Host Kate Deiters sits down with Anita Shields, Director of Client Support & Training at Quest Analytics. We talk about Anita's experience in the insurance industry and how she got her start at Quest Analytics. Anita shares some tips for keeping up with the industry and what it takes to stay on top of your game in this ever-changing landscape. She also talks about her excitement about the advancement of technology in the insurance software space and how that is helping to make things easier for clients who are looking for new ways to streamline their operations.

Kate Deiters and Zach Snyder discuss the current state of telehealth. The crystal ball is glowing bright as Zach and Kate peek into the future of telehealth credits and how states could be impacted.  Guest: Zach Snyder, VP of Government Affairs, Quest Analytics Host: Kate Deiters, Marketing Specialist, Quest Analytics