What actually happens inside health plans?
In this episode of the Advancing Health Innovation Show, host Michael Stamatinos sits down with Mike McCabe, CEO of On Advisors and a seasoned health plan executive who has spent his career inside health plans, not just advising them from the outside.
Mike pulls back the curtain on what actually happens inside health plans when things go sideways...from network breakdowns and outdated claims systems to the administrative avalanche drowning primary care providers. He shares why the payer-provider relationship is, in his own words, "cantankerous," and what it would take to fix it.
The conversation covers the three core systems every health plan must have working in harmony, why population health management means something different to almost everyone in the industry, and how AI is creating both real opportunity and dangerous blind spots for organizations that aren't ready to govern it properly. Mike also challenges some of the most common misconceptions about health plans, including the myth that they're simply printing money.
Drawing on decades of work across 30+ states, thousands of provider meetings, and high-stakes board rooms, Mike brings the kind of grounded, candid perspective that rarely makes it into headlines. Whether you're a healthcare innovator, a health plan operator, or someone trying to break into the space, this conversation is packed with insights that cut straight to what actually matters.
Topics covered in this episode:
* Where health plans actually break and why no one talks about it
* The three systems that must work together for any plan to succeed
* Why primary care scarcity is quietly driving up costs across the system
* Value-based payments: when they work and when they don't
* The real decision-making structure inside a health plan
* How to evaluate and trust technology vendors in a market full of vaporware
* What structural change would have the biggest downstream impact
Timestamps
00:00 Intro and why health plans are misunderstood
03:40 Mike’s early story, sports, family, and military background
07:40 Where health plans actually break first
12:50 Why payer-provider relationships become cantankerous
20:40 Patterns re-emerging across healthcare
25:35 How decisions really get made inside health plans
28:15 How innovation and AI get adopted
32:50 The one structural issue Mike would fix tomorrow
36:20 Why healthcare is always local
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About the Show
The Advancing Healthcare Innovation Show is hosted by Michael Stamatinos, a nationally recognized connector, strategist, and advocate for innovation with purpose. Each week, Michael interviews healthcare leaders who are driving meaningful change—highlighting stories of access, resilience, equity, and transformation.
The AHI Show started with the idea of wanting to highlight stories of what healthcare innovation truly looks like in action. Our mission, highlight real people who are really innovating within healthcare. Guests include healthcare entrepreneurs, providers, payers, and professionals from the investment community. We showcase little wins as well as valuable lessons learned from setbacks through these interviews. The real innovators in healthcare are often the ones in the trenches doing the work with razor-sharp focus. We find these innovators and bring their stories to light.
🔗 Michael’s LinkedIn: https://www.linkedin.com/in/michaelstamo
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Apr 29 202630 mins