Payer executives often zero on the same idea regarding innovation: It is less a department than a discipline, and less about the technology itself than what an organization does around it.
Flat org structures that let engineers experiment, governance committees that vet new tools before they touch members, cross-functional teams drawn from business, clinical and technical sides of the house — these show up repeatedly as the actual infrastructure of innovation, with AI and automation serving as accelerants rather than the point.
For today’s health plan leaders, the more difficult work is not building something new, it is building the culture and readiness that let new things succeed once they exist.
That discipline shows up differently depending on where a payer sits in the market. What unites them is a shared instinct that innovation counts only if it is measurable in outcomes patients actually feel: better engagement, lower administrative burden, care that meets employees and members where they are. Becker’s asked payer leaders how their organizations are approaching innovation. Their answers are below.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are you approaching innovation within your organization?
Nishant Anand, MD. President and CEO of Altais (Oakland, Calif.): Innovation is core to our mission to “ignite an exceptional healthcare system,” and we think about it in two ways: disruptive innovation and distributed innovation. Disruptive innovation means pursuing organization-wide strategies that can fundamentally change how care is delivered — including how we use AI to make healthcare more efficient, connected and human-centered. Distributed innovation happens every day, when people across our organization look at their own roles and ask, “How can we make this better?” By creating a culture where everyone is empowered to innovate, we can continuously improve while keeping patients, members and physicians at the center of everything we do.
Jennifer St. Thomas. Senior Vice President of Commercial and Medicare Markets for Mass General Brigham Health Plan (Boston): At Mass General Brigham Health Plan, we are approaching innovation by leveraging technology to help create a more connected healthcare experience and strengthen collaboration between the health plan and care delivery system. Through our integrated care management model, we are using data and digital tools to support earlier interventions, improve care coordination, and help members navigate their healthcare journey more seamlessly. These capabilities enhance our ability to deliver a more personalized experience. Importantly, technology serves as a complement to clinical expertise and human relationships, enabling more coordinated care while keeping people at the center of every decision.
Martina Lee Strickland. Head of Marketing, PR and Brand for Clever Care Health Plan (Huntington Beach, Calif.): At Clever Care, innovation means solving real business and member challenges — not adopting technology for its own sake. Innovation must be practical, culturally relevant, and easy for our members to incorporate into everyday life. That means co-designing solutions with the communities we serve, leveraging behavioral insights and real-time feedback, and rapidly validating concepts through focused pilots before scaling those that demonstrate meaningful impact. We’ve also established an AI Governance Committee that evaluates new technologies, assesses risk and ensures appropriate oversight. We are exploring AI use cases such as call transcription, translation, sentiment analysis, quality assurance automation, and predictive analytics to better serve our diverse Medicare Advantage population. We encourage cross-functional collaboration between business, clinical, operational, and technology teams to identify these high-value opportunities. And finally, we evaluate success using measurable outcomes, including improved member engagement, higher quality performance, greater efficiency, and stronger member satisfaction, because every innovation should lead back to a better member experience.
David Wollenberg. Vice President of Enterprise Data and Analytics for SCAN Health Plan (Long Beach, Calif.): At SCAN, we see innovation as more than technology implementation. Especially when it comes to AI, the value comes from workforce transformation: adoption, process changes and approaching challenges with new mindsets. The business functional teams, the technical teams, and HR are the three legs of the stool ensuring readiness, value, prioritization and ultimately impact.
Ken Cohen, MD. Chief Medical Officer of Optum Health (Eden Prairie, Minn.): Innovation at Optum Health reaches across the care spectrum. The common theme is that AI enablement is driving this innovation in every corner of the organization. At a population health level, we are using large language models for sophisticated risk stratification of all subpopulations of patients to optimally direct care management. Other examples are in direct patient care. AI tools will improve ambient listening technology to reduce 12 million physician clicks over the next year. They also comb the EHR at the time of a referral to surface what care elements need to be completed at the time of the referral. We then use large data sets and AI enabled technology to present to the primary care physicians the specialists with the best patient outcomes and care efficiency metrics at the point of care to drive improvements in value-based care. Lastly, on the back end we are beginning to use AI enablement for program evaluation so that we can rapidly measure how care is being delivered and pivot where indicated to drive maximal improvements in our VBC platform.
Ty Wang. Co-Founder and CEO of Angle Health (San Francisco): We approach innovation by giving people real ownership within a clear framework. We maintain a flat org structure, where employees are trusted to make decisions and improve the way we work, and managers act as thought partners rather than gatekeepers. That freedom and experimentation operates within intentional guardrails, which include clear standards for security, compliance and handling sensitive information. Engineers, for example, are encouraged to explore new tools that could meaningfully improve performance, supported by vetting and review processes that let them move quickly without putting sensitive data or member experience at risk. The result is a culture of trust and accountability, where people bring their best ideas forward, and innovation never comes at the expense of safety or precision.
Uche Olekanma, MD. Vice President of Clinical Operations for Blue Cross Blue Shield of Arizona (Phoenix): At Blue Cross Blue Shield of Arizona, we view innovation as a strategic capability that improves affordability, quality, and the overall healthcare experience for our members. We are embedding artificial intelligence, advanced analytics, and automation into core business processes, including clinical review, utilization management, prior authorization and member service operations, to reduce administrative burden and improve decision-making. Our approach combines responsible governance with workforce enablement, ensuring that new technologies support human expertise while maintaining trust, compliance and accountability. Through our AI Center of Excellence and enterprise-wide digital transformation efforts, we empower employees across all business units to identify opportunities, test solutions and scale innovations that deliver measurable value. Ultimately, our goal is to create a more efficient, data-driven, and member-centered health plan that can adapt quickly to the evolving needs of Arizona communities.
Meredith Duncan. President and CEO of Texicare (Austin, Texas): We have spent a lot of time listening to business owners. We know they are looking for options that are easy to use and attractive to their teams. At Texicare, we designed our plans around how employees actually access care, offering no-copay visits across primary, urgent and mental health so that routine care is accessible. Employees who can get care regularly stay healthier. Healthier employees help keep coverage sustainable for the businesses offering it and affordable for the people depending on it. That philosophy drives how we think about innovation, starting with how people live and work, then designing our plans to meet them there.
Nebeyou Abebe. Senior Vice President of Highmark Health (Pittsburgh): The most meaningful innovations in healthcare are those that address the whole picture of health. While AI, advanced analytics and digital solutions are accelerating transformation across the industry, their greatest impact comes when paired with a deeper understanding of the social factors that influence health outcomes. That is why social health is a strategic priority for Highmark Health, helping connect individuals to essential resources such as housing, nutrition support and transportation that can significantly improve well-being. By combining data-driven insights, innovative technology and strong community partnerships, we are creating a more proactive, personalized and equitable health experience. The future of healthcare innovation is not only about delivering better care, but about building a smarter, more connected system that empowers people to achieve better health where they live, work, and thrive.
Siva Balu. Senior Vice President and Chief Information and Digital Officer for Quartz (Fitchburg, Wis.): Innovation doesn’t belong to one team or one department in any organization. We are approaching this through an enterprise operating model where all initiatives are looking from an enterprise lens, while keeping talent optimization at the forefront. The executive team encourages and supports employees who have innovative ideas, especially when they go above and beyond their role. The enterprise operating model also is an opportunity when more than one employee or more than one team have a similar overlapping idea, we create avenues for them to work together. No matter what the idea is, when the focus is on employee engagement, the benefit of the outcomes is exponential and benefits our customers.
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