Payer executives are focused on staying adaptable in 2025. 

In an interactive session at Becker's Fall Payer Issues Roundtable, Sri Palanisamy, Principal at ZS, led a discussion on unique opportunities and challenges of provider partnerships, particularly for Blue Cross Blue Shield (BCBS) plans. The panel included Jason Hover, vice president of care delivery transformation at BCBS of Michigan; Jennifer Atkins, vice president and chief network officer at BCBS of Kansas City; and Jim Brown, vice president of strategy and operations at Highmark Health.

Sanford Health Plan is expanding its Medicare Advantage offerings to more rural communities. 

Premera Blue Cross recognized the need for strong ethical commitments around AI even before the rise of ChatGPT and other easily accessible generative AI models. 

Payer business operations are often cumbersome due to siloed departmental management. This fragmentation creates friction for navigating customer service and addressing complex inquiries across the enterprise.

Florida's recent ranking of #39 on the State Scorecard on Women's Health and Reproductive Care is a wake-up call. As a Black mother of four in Florida, I find the recent Commonwealth Fund findings disappointing.

Payer executives are focusing their attention on affordability, value-based care and regulatory changes for the coming year. 

Managing provider data is a significant challenge for many payers, due to frequent changes and inaccuracies in directory listings. Recently, generative AI and automation technologies have been identified as promising solutions. Research has shown these tools can meaningfully reduce payers' administrative and medical costs, while increasing revenue.

Healthcare leaders from across the country expressed shock and sadness following the death of UnitedHealthcare CEO Brian Thompson. 

It’s time to shift from GenAI experimentation to meaningful implementation in healthcare with a strong focus on data integrity. The last decade has seen its fair share of volatility in the healthcare industry. From the rise of value-based payment models to the upheaval caused by the pandemic to the transformation of technology used in everything from risk stratification to payment integrity, radical change has been the only constant for health plans.

Humana CFO Susan Diamond will step down after 18 years with the insurer. 

A diabetes management program has saved Capital Blue Cross employer group customers $20 million since 2021. 

Payer executives shifted their focus to population health and implemented new strategies in 2024. 

Weight loss management is a common component of many corporate wellness programs. Health plans often offer such programs as a way to encourage plan members to lead healthier lives, while simultaneously helping reduce outlays for costly health services.

In recent years, healthcare executives and providers have faced growing expectations to address health inequities that affect diverse populations across the country. But what does health equity truly mean in practice? 

What do you do when there’s an oligopoly controlling an industry, inhibiting price competition and consumer choice? You break it up. The three dominant pharmacy benefit managers (PBMs), CVS Caremark, Cigna’s Express Scripts and United’s OptumRx are drug-pricing middlemen, increasing costs and limiting choice for more than 200 million Americans. Collectively, they process more than 80% of prescriptions in the U.S., up from 50% in 2012. It’s time for their hold on employers and consumers to end.

Cigna directly confirmed on Nov. 11 that it is not pursuing a merger with Humana and said it "continues to deliver shareholder value through focused execution against stated operational and financial targets, and via disciplined capital deployment including dividends and share repurchase." 

CVS Health named Steve Nelson as president of Aetna, effective Nov. 6. 

Aetna's SimplePay plan cut healthcare costs for employers while encouraging members to seek out higher quality care. 

Payer executives are looking forward to investing in AI, improving equity and new care models in 2025.