Payer executives are focusing their attention on affordability, value-based care and regulatory changes for the coming year.
Becker's connected with 20 executives to learn their top priorities for 2025.
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Editor's note: Responses have been lightly edited for length and clarity.
Question: What is your No. 1 priority for 2025?
Margaret Anderson. Interim President at Health Alliance Plan: In 2025, our No. 1 priority is to focus on growth initiatives to continue the momentum we demonstrated in our 1/1/25 projected results. We will focus on delivering value to the Henry Ford Health enterprise collaborating to create a differentiated consumer experience while delivering best-in-class quality results.
Damanjeet Chaubey, MD. Vice President, Clinical Affairs at Clover Health: My priority for 2025 is twofold — scale our value driven healthcare delivery model to touch more lives and ensure that our workforce has the necessary clinical competencies and skills, including use of AI technology, to manage the needs of our patients.
Jessica Chaudhary, MD. Medical director at Elevance Health: My No. 1 priority for 2025 is helping business leaders in healthcare realize the importance of physician involvement in important health care decisions. Physicians have spent years trying to understand the nuances of clinical medicine through intensive and extensive training. Physicians provide a clinical compass from which health care related business decisions should be made. When decisions are made on solid clinical footing, with the patient at the center, the business results follow suit.
Manu Chaudhry, DDS. President, Capitol Dental Care: As we look toward 2025, the No. 1 priority for our organization is improving access to high-quality dental care for all members. We will focus on enhancing value-based care models that prioritize patient oral and overall health outcomes and integrate SDOH assessments and electronic referral systems. Additionally, advancing digital transformation through AI will streamline processes, reduce administrative burdens and increase provider/member satisfaction. Lastly, we aim to strengthen partnerships with all health and social health providers to create a more integrated and responsive dental care ecosystem.
Shannon Drotning. Market President, Consumer and Specialty at Providence Health Plan: Looking ahead to 2025, my top priority is to continue strengthening our Medicare Advantage business keeping members front and center. We're committed to delivering exceptional care and outstanding service. As a local, non-profit provider-sponsored plan, we have the agility to adapt quickly as healthcare needs evolve. The strong partnerships we've built with members, agents, and community partners are at the core of our success. We're expanding these relationships and continuously enhancing our services to deliver even more value to our community.
Emily Durfee. Director, Corporate Venture Capital at Healthworx: As the leader of Healthworx Ventures, the venture fund of CareFirst, I expect 2025 to be a big year in venture deals. I'm especially excited to dig into deals leveraging AI to solve big challenges in healthcare. And I'm interested to see additional metrics that start-ups use to prove the value they add to healthcare.
Hillary Galyean. Chief Growth Officer at St. Luke's Health Plan: Investing in my team is my top priority for 2025 because it drives both individual and organizational success. By prioritizing the team's development, we will cultivate stronger skills, higher engagement and increased job satisfaction. This leads to improved performance, growth and retention. A well-supported team also fosters a collaborative culture, where trust and empowerment allow individuals to reach their full potential. Ultimately, a thriving team is the foundation for long-term growth and resilience.
Michael Hunn. CEO at CalOptima Health: Notwithstanding budgets, business plans and regulatory compliance requirements, our 2025 focus at CalOptima Health in Orange County, Calif., for our almost 1 million Medi-Cal members, will be awareness about all the healthcare services and programs that are available to them as part of their covered benefits. We will focus on member and provider communications.
Pooja Ika. President and CEO at eternalHealth: Growth. While we see a lot of Medicare plans across the country looking to shrink in size or stay steady, we are actively looking to grow. My belief is that Medicare is a swinging pendulum — and what swings the other way will always swing back and when that does happen we want to be the stable and sustainable plan that Medicare beneficiaries turn to. In the same vein, we want to prioritize the importance of leveraging data and giving everyone in the care continuum access to the same data, because that will lead to a better stakeholder experience and improved outcomes, which in turn will help with growth.
Sachin Jain, MD. President and CEO at SCAN Group: Healthcare policy will change dramatically in 2025 with a new presidential administration and a Republican House and Senate. The work of healthcare leaders will be to work to shape the new policy environment and respond accordingly. Priority No. 1 — beyond the priority of driving growth and innovation — will be to prepare my organization to succeed in this new policy environment.
Dawn Maroney. President of Markets, Alignment Health, and CEO of Alignment Health Plan: In 2025, Alignment Health's top priority is ensuring members feel supported and informed as they enroll or renew, especially with the significant Medicare Part D changes under the Inflation Reduction Act. We'll highlight new protections like the $2,000 out-of-pocket cap, elimination of catastrophic coinsurance, expanded 'extra help,' and no-cost vaccines. By simplifying updates and communicating transparently, we'll empower members, build trust and strengthen Alignment's reputation as a leader in Medicare Advantage while upholding exceptional member care.
Mark Mugiishi, MD. CEO at Hawaii Medical Service Association: Our No. 1 priority is to create more affordable healthcare for the people of Hawaii, which in the coming year will include managing the cost of care (medical and pharmacy), improving administrative and operational inefficiencies and financial integration with our local delivery system. This has always been a priority, but it's become even more critical now due to our aging Medicare population, as well as the expansion of our Medicaid population. These factors have increased our dependence on government revenue, which will most likely decrease in 2025, creating more urgency to find better and more affordable ways to care for our members.
Philip Randall. Director, Population Health & Community Programs at Banner|Aetna: In 2025, our top priority is ensuring our high and rising risk members can more easily access Banner|Aetna's suite of population health programs and services. This 'ecosystem' of complementary offerings is designed to empower people living with chronic diseases, like diabetes or hypertension, to make sustainable lifestyle changes that improve their health.
We do this in two ways: first, we help members fully engage in their initial program or service. When people are engaged, they are more likely to successfully complete the program and realize its full benefits. Second, we make it seamless to transition to the next program, which builds on this engagement and helps sustain positive momentum.
Bruce Rogen, MD. Chief Medical Officer, Cleveland Clinic Employee Health Plan; Chair Cleveland Clinic Quality Alliance: Taking on increasing downside risk in contracts to gain more upside for our network providers, and putting in place the population health systems to ensure that we succeed in downside risk contracts.
Don Stiffler, Chief Revenue and Growth Officer at Commonwealth Care Alliance: I expect that 2025 will be another year of significant change in the healthcare industry, particularly as we see a change in party control in the White House and Congress. As always, at CCA our No. 1 priority remains putting our members at the center of all we do. We are looking forward with optimism to launching the next evolution of our care model in 2025, which leverages our unique ability to engage people with the most significant needs centered on hands-on care coordination and a combination of people, process and technologies focused on addressing unmet medical, functional and social needs.
Ilan Shapiro, MD. Chief Health Correspondent, Medical Affairs Officer and Senior Vice President at AltaMed Health Services: My No. 1 priority for 2025 is to leverage the opportunities presented by the new administration to acknowledge the significant achievements already made in our healthcare system under the ACA while driving innovation in value-based care. My focus will be on underrepresented communities, ensuring equitable access to quality healthcare and advancing impactful solutions that address the community needs.
Saba Syed, PharmD. Vice President, Pharmacy at Aledade: My No. 1 priority at Aledade for 2025 is to advance pharmacy quality initiatives that improve Medicare patient outcomes and to support our independent primary care practice partners so they can succeed in value-based care arrangements. This includes:
- Driving medication adherence: We're intensely focused on improving medication adherence for chronic conditions like diabetes, hypertension and high cholesterol.
- Optimizing medication use: This means ensuring patients with diabetes and cardiovascular disease receive appropriate statin therapy and reducing potentially harmful polypharmacy, such as duplicate anticholinergics and benzodiazepines.
- Improving chronic disease control: Through better medication management and support, we aim to help patients achieve optimal control of their blood pressure and diabetes.
Aledade's technology platform integrates with 100+ EHRs and practice management software systems and puts hospital, lab, pharmacy and claims data all in one place, showing patient insights to drive improved care coordination and quality. 88% of current partners rate Aledade's products and services as high quality.
By prioritizing these pharmacy quality initiatives, we are looking to support primary care in their efforts to serve Medicare patients across value-based contracts. By focusing on quality, Aledade delivers better health, better care and lower costs, creating a healthcare system that is good for patients, good for practices and good for society.
Johanna Vidal-Phelan, MD. Chief Medical Officer, Quality and Pediatrics at UPMC Health Plan: My No. 1 priority for 2025 is successfully navigating leadership changes at organizational, state and federal levels. Change brings with it a wealth of opportunities, allowing us to reassess and refine our strategies at UPMC Health Plan to better serve our members and communities.
As we enter a year of transformation, it's crucial to balance optimism with a realistic understanding of the current and future industry landscape. We recognize the challenges that come with regulatory shifts and evolving healthcare demands. However, these changes also offer the chance to innovate and enhance our services.
Our commitment to our core values remains steadfast. We are dedicated to promoting health equity, ensuring the highest quality of care, and driving innovation in all aspects of our operations. By staying true to these principles, we can navigate the complexities of change while continuing to deliver exceptional value to our members.
Ty Wang. Co-Founder and Chief Executive Officer at Angle Health: At Angle Health, we strive to be a true partner in health for our members and patients, including as a clinical resource and an ear that people often find missing during their care journeys in their most trying times. Angle's integrated technology platform enables us to easily layer on advanced AI capabilities that enhance access to care through personalized engagement. Our intuitive digital tools make it easier for members to understand their benefits and navigate their care journeys, increase transparency around drug pricing and procurement, and provide live resources for members when they need it most. Our top priority for 2025 is to deliver a seamless, member-centric experience through continuing to build upon the Angle technology platform and expanding our portfolio of AI-enabled, hyper-personalized products, resources, and workflows that reduce costs and improve health outcomes for our members.
Meredith Williams, MD. Vice President, Clinical Affairs at Oscar Health: Oscar is committed to helping more Americans access affordable, high-quality healthcare. In 2025, the Office of Clinical Affairs' top priority is supporting the development and launch of plans that help people receive clinically or culturally focused care. Plans like Breathe Easy for COPD or HolaOscar for Spanish-speaking members are prime examples. We are extremely excited to continue developing more plans like these that support clinical and culturally competent care needs.