Health plans and providers have long operated in tension, but a growing chorus of payer and health system leaders believe the adversarial model is no longer sustainable — financially, clinically, or for the patients caught in the middle. Becker’s asked executives across the payer landscape what successful payer-provider collaboration looks like to them, and the answers point toward a fundamental rethinking of the relationship: away from transactional, volume-driven arrangements and toward shared accountability for outcomes, simplified administrative processes, and aligned incentives that put patients at the center of every decision.
The responses below reflect a range of perspectives — from national insurers and regional Blues plans to value-based care innovators and specialty health plans — but a clear consensus emerges. The strongest partnerships are built on transparency and trust, powered by shared data, and structured around value-based models that reward providers for improving health rather than generating volume. Whether the goal is reducing administrative friction, redesigning specialty care, or addressing the social determinants driving the highest-cost patients, leaders agree that the path forward requires both sides to commit to something bigger than their own organizational priorities. Below, 12 payer executives share what that partnership looks like in practice.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: What does successful payer-provider collaboration look like to you?
Paul Markovich. President and Chief Executive Officer of Ascendiun (Oakland, Calif.): America is spending 18% of our Gross Domestic Product on healthcare, but it isn’t delivering the same level of quality as other countries and almost everyone — patients, providers, and payers — are dissatisfied. Today, we reward physicians and other healthcare providers for the volume of care they deliver, not for the value of that care for their patients, and we’ve made the billing system so complex that most of their earnings go toward the administrative costs of running a practice.
An ideal payer-provider relationship should be a partnership where everyone shares the same goal: improving patient care and outcomes while maximizing value and controlling costs. If payers incentivize better outcomes, cost efficiency, and patient satisfaction, and simplify the billing systems, providers can focus on how to get and keep patients healthy including engaging them in shared decision-making about their best course of treatment. To get there, we must have a comprehensive, real-time digital health record that is fully available in real time to patients, providers and payers alike.
Ken Cohen, MD. Chief Medical Officer for Optum Health (Eden Prairie, Minn.): To me, successful payer-provider collaboration means moving beyond a transactional
relationship to a shared accountability for quality and cost of care. It incorporates two key attributes.
The first is a shift to a reimbursement model where the providers are accountable for both cost and quality of care. Our recent suite of five peer-reviewed value-based care studies all unequivocally demonstrated that this model significantly outperforms a fee for service reimbursement model. Moreover, these studies also showed a “dose response” relationship whereby the greater the degree of financial risk at the provider level, the greater the improvements in quality and efficiency outcomes.
The second attribute is a clear delineation of clinical responsibilities. Our studies suggest that a medical management infrastructure that is embedded within a provider group outperforms that of a health plan as the “touch points” are much closer to the patient. However, many groups don’t have or cannot afford the necessary data, tech, and medical management infrastructure, and it is here where the health plan plays a crucial role in supporting these relationships by providing these services.
Additionally, a redesign of specialty care is essential to achieving any quantum improvement in patient outcomes. Close to 85% of the healthcare spend is directed by specialists and they have been largely disenfranchised by VBC. Provider groups can work with health plans to create a specialist measurement framework to transparently report quality and efficiency, and from this develop new models of specialist VBC compensation that can deliver strong improvements in quality and cost of care.
Ultimately, the goal is to create true alignment around a shared goal: delivering optimal and cost-efficient care for every patient. When payers and providers work as partners, clinicians can be supported to deliver high-value care, and proactively address the medical, behavioral, and social factors that influence health. The result is better health, a better patient experience and a more sustainable healthcare system.
Ben Lerer. Chief Executive Officer of Longevity Health Plan (Tampa, Fla.): One of the things I’m most proud of at Longevity Health is the strong partnerships we’ve built with both payers and providers. What makes us unique is our ability to build successful partnerships from both perspectives. We believe the strongest partnerships are built on trust, transparency, and a shared vision: improving patient outcomes while creating sustainable financial performance. As a provider, we work closely with leading national health insurers to improve outcomes, reduce unnecessary utilization, and deliver value-based care for nursing home residents.
As a payer, we seek provider partners who understand the complex needs of the skilled nursing facility population and share our commitment to coordinated, resident-centered care. Together, we’ve built integrated models that combine clinical expertise, data-driven insights, and aligned incentives to improve care for nursing home residents while creating value for all stakeholders. Our partnerships demonstrate what is possible when organizations unite around a shared purpose—delivering better outcomes and achieving results that would not be possible alone.
Chris O’Donnell. Vice President of Provider Network Innovation and Strategy for Lifetime Healthcare Companies (Rochester, N.Y.): Successful payer-provider collaboration results in both parties working together to improve clinical outcomes and accessibility, while driving an increase in quality and affordability. This can only be accomplished through the alignment of incentives outside of the standard fee-for-service arrangements such as those found in value-based care (VBC) agreements. Patients should be placed at the center of all decision making and feel like the payer and provider are part of a single integrated clinical delivery system rather than separate organizations.
Beth Roberts. President and Chief Executive Officer of Blue Cross Blue Shield Vermont (Berlin, Vt.): Successful payer-provider collaboration is built on true partnership founded on the shared goal of greater access to quality, affordable care. It means sharing data, resources, and accountability so we can solve problems together instead of pointing fingers and leaving patients holding the bag. The future is value-based care, where we’re rewarding better outcomes — not more services — and working side by side to deliver the right care at the right time.
Harlon Pickett. President of Eagle Care Health Solutions (Austin, Texas): Successful payer-provider collaboration begins when both sides recognize they have a shared customer, the patient, and a shared responsibility to deliver high-quality, affordable care. For too long, the relationship has been shaped by opposing incentives. Providers are focused on delivering care, while payers are often perceived as controlling costs. The result is administrative friction, delayed decisions, and frustration for everyone involved, especially the patient.
True collaboration requires transparency, trust, and accountability. Payers should provide meaningful data on quality, outcomes, and cost, while providers should be willing to measure and improve performance based on evidence. Both sides should commit to reducing unnecessary administrative burdens, simplifying prior authorization, and creating processes that enable clinicians to spend more time caring for patients rather than navigating bureaucracy.
Most importantly, success should be measured by shared outcomes rather than competing objectives. When providers are rewarded for improving health, payers are rewarded for supporting better outcomes, and patients receive timely, affordable, high-quality care, everyone benefits.
Uche Olekanma, MD. Vice President of Clinical Operations for Blue Cross Blue Shield Arizona (Phoenix): The strongest payer-provider partnerships are aligned around the Triple Aim: improving health outcomes, enhancing the care experience and lowering the total cost of care. Achieving this requires a shared commitment to delivering affordable, accessible and evidence-based care while maintaining a focus on better patient outcomes.
Effective collaboration also streamlines administrative processes, allowing providers to spend less time navigating operational barriers and more time caring for patients. At their best, payer-provider relationships move beyond transactional interactions and become true partnerships built on transparency, trust, and aligned incentives that support shared goals.
Ty Wang. Co-Founder and Chief Executive Officer of Angle Health (San Francisco): Successful payer-provider collaboration starts with transparency. Both sides need a shared view of patient needs, costs and emerging risks so they can make better decisions together. The goal is to reduce friction, improve care coordination and ultimately deliver better coverage, outcomes and experiences for patients.
Meredith Duncan. President and Chief Executive Officer of Texicare (Austin, Texas): Successful payer-provider collaboration starts with both parties sharing a commitment to the health and wellbeing of the people they serve, along with ensuring that financial incentives are aligned. After more than 20 years in healthcare, I’ve seen that shared starting point generate genuine investment in community health and mutual accountability to connect people with the care they need.
Jennie Nowak. Director of Population Health Activation for Priority Health (Grand Rapids, Mich.): In today’s rapidly changing healthcare landscape, successful payer-provider collaboration requires a deliberate focus on aligning payer-identified opportunities with provider priorities and initiatives. As both organizations face increasing cost pressures, workforce constraints, and limited resources, it is critical to focus efforts on the areas with the greatest potential impact. By sharing data, insights, and performance goals, payers and providers can jointly prioritize interventions that improve outcomes, enhance the patient experience, and reduce avoidable costs. This coordinated approach minimizes duplication of effort, maximizes the value of available resources, and enables both organizations to respond more effectively to evolving population health needs. Ultimately, alignment creates a stronger partnership that drives measurable results and supports long-term sustainability in value-based care.
Nebeyou Abebe. Senior Vice President of Highmark Health (Pittsburgh): Successful payer-provider relationships are built on a shared commitment to improving the health of the communities we serve. While payers and providers bring different expertise to the table, we are united by common goals: better outcomes, a better patient experience, and more affordable, accessible care. Through our close collaboration with hospitals and clinicians, Highmark is uniquely positioned to align perspectives, share insights, and advance meaningful improvements in care delivery. We make faster progress when we work together by sharing data, aligning incentives, and coordinating care to address both clinical needs and the social factors that influence health. That collaboration is critical to building a more connected, effective, and sustainable healthcare system.
Martina Lee Strickland. Head of Marketing, PR, and Brand for Clever Care Health Plan (Huntington Beach, Calif.): Successful payer-provider collaboration should always start with the basics: transparent data sharing, regular communication and aligned incentives with shared accountability. But the real breakthrough happens when both groups sit down and commit to goals that go beyond their own organizational priorities and put the members first, like committing to better managing chronic conditions. The conversation doesn’t have to tackle everything at once, but identifying one focused, shared goal puts each group on the same team and opens a dialogue where they better understand what the other wants and why. This is critical because at the end of the day, the measure of success is what’s best for the patient.
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.