Payer–provider partnerships have long been a strategic priority in healthcare, but many organizations continue to struggle translating ambition into sustained, scalable results. Insights from industry leaders at Highmark, enGen, and ZS highlight a critical inflection point: success now depends less on vision and more on execution discipline.
Below are four key takeaways from the conversation.
1. Trust has to extend beyond the C-suite
Panelists agreed the most common breakdown between strategy and execution is a failure to extend trust beyond senior leadership.
“When you sit at the strategy level a lot of time goes into building trust,” said Neil Kulkarni, vice president of product management for provider and clinical at Highmark. “You get multiple layers down into every organization and in that context, we don’t spend enough time with the teams rebuilding that same level of trust across areas.”
That gap is why aspirational goals like better outcomes, lower costs and improved efficiency often stall at the operational layer. Hussain Sheikh, vice president of software engineering and transformation at enGen, emphasized translating strategy into specifics for the people doing the work.
“Anytime you start strategy work, the aspirational goals are improved patient outcomes, reduced cost, improved efficiencies — at the strategy level, I think everyone is going to have that. But once that breaks down, our strategies are not going to be executed the way we’ve intended to,” Sheikh said.
Gaurav Tiwari, Principle in ZS’ Health Plan and Provider practice, framed the moment as healthcare’s third wave of partnership. The first wave was experimentation where VBC was the focus. The second wave included attempts to scale, with few success stories driven by top-down leadership. The panelists are optimistic about this third wave, as there are three converging factors driving momentum: financial pressure on both sides, interoperability regulations easing data exchange, and AI advancement.
2. Why pilots fail at scale
A successful pilot doesn’t guarantee scalable success. Panelists pointed to the gap between champion-driven pilots and the business-as-usual processes that take over at scale.
Kulkarni said organizations consistently undercut change management investment in favor of moving quickly to implementation and scaling often requires structural change leaders aren’t initially willing to commit to.
“You might need to make operating model changes. You might need to commit to significant workflow changes and you might need to change how staffing is done,” Kulkarni said. “We didn’t have the fortitude on either side to say, I’m gonna change my operating model.”
Sheikh added that pilot architectures often can’t absorb the variability of the broader market like different EHRs, practice management systems and data standards. Designing only for one EMR environment sets a partnership up to fail at scale.
3. Keys to creating action from data
All three panelists agreed data is the connective tissue of partnership but only when both sides interpret it the same way.
“Sharing the data isn’t enough. Making sure that we have kind of a common understanding on how we interpret that data across organizations is important, too.” Kulkarni said.
Sheikh outlined three pillars that determine whether data becomes actionable: standardization of definitions and protocols, governance covering ownership and access and a shared analytical platform so both parties work from the same source of truth.
As agentic AI takes on more workflows, Tiwari said, these foundations become non-negotiable.
“As humans, we ask, we confirm, we collaborate. As agents, we assume,” Tiwari said. “Without this common terminology, without aligning vocabulary, without having controls around what somebody has access to, we can be in a very challenging state.”
4. The differentiators heading into 2026
Asked what will separate organizations that successfully scale from those that don’t, panelists pointed to a mix of cultural, structural and technical commitments.
Kulkarni emphasized investing in a relationship operating model that extends through revenue cycle and claims teams not just executives and treating interoperability as ongoing infrastructure, not a one-time project.
Tiwari said the differentiator will be moving from siloed processes to end-to-end business process design. Sheikh closed with three principles: co-create with provider partners rather than building for them, adopt adaptable API- and FHIR-driven architecture and keep patient-centric alignment the goal.
“As long as our common goal is ensuring the wellness and the health of our patients and our members, and we are both aligned to that goal, all of that will come,” Sheikh said.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
