As value-based care continues to reshape the health insurance landscape, health plans face mounting pressure to evolve by continuing to become a true partner in care delivery. The shift demands more than operational adjustment — it requires a fundamental rethinking of how plans engage with providers, share data and measure success.
To understand how health plan leaders are navigating this transformation, Becker’s spoke with 15 executives from across the industry. Takeaways from the leaders included: the need for transparent, real-time data sharing; incentive structures that reward outcomes over volume; and a recognition that value-based care will reach its potential only when plans and providers commit to genuine, sustained partnership.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: How must health plans change as value-based care grows?
Krista Hoglund. President of Jefferson Health Plans (Philadelphia): The growth in value-based care requires that health plans truly become partners with their providers and health systems. Health plans have to transform from simply paying claims to managing health outcomes and costs in partnership with providers. We must put more emphasis into our population health muscle rather than traditional claims payment functions. Transparency and data sharing are critical. Analytics becomes a must-have instead of a nice-to-have. We need to evolve analytics and population health management, invest in strong provider relationships and manage patient care to the best outcomes.
Alan Silver. President of ICHRA for Ambetter Health Solutions (St. Louis): As value-based care expands, health plans must evolve from being administrators of benefits to active partners in care delivery. At Centene, that mission carries directly into our ICHRA offering, Ambetter Health Solutions, where we focus on transforming healthcare at the local level. What’s unique about ICHRA is that it puts choice directly in the hands of the consumer.
For us, that starts with building strong, community-based provider relationships and deeply understanding local healthcare needs. By partnering closely with providers, we can develop innovative, value-based models and plan designs that remove barriers to access and support meaningful choice.
Steve Yurjevich. CEO of Payer Market for Optum Insight (Eden Prairie, Minn.): Value‑based care is about moving the system upstream and focusing on what helps people stay healthier longer. That requires payers and providers working together, using timely insights to spot emerging needs, guiding early intervention and coordinating care more effectively. When action is driven by shared data and accountability, it supports better health outcomes while making care more affordable and sustainable.
Dawn Maroney. President of Alignment Health and CEO of Alignment Health Plan (Orange, Calif.): Health plans must evolve from passive fee-for-service payers to compassionate, active partners in care management by embracing advanced, risk-bearing payment models. By thoughtfully leveraging data analytics to support provider collaboration and implementing technology that enables flexible, value-based contracting, they can prioritize improving member health outcomes and advancing quality of care. This shift moves the focus beyond simply reducing costs, toward genuinely supporting the well-being of every individual they serve.
Alignment Health operates a tech-enabled, value-based Medicare Advantage model dedicated to delivering compassionate, proactive and personalized care for seniors and the chronically ill. Through our proprietary AVA technology, Alignment uses data analytics to anticipate patients’ health needs, often providing support before care is needed. Coupled with Alignment Health’s Care Anywhere program, Alignment has created a high-touch, empathetic care experience for high-risk Medicare Advantage members, offering care in the comfort of their homes via telehealth or in person. The focus is on nurturing proactive, coordinated care that reduces hospitalization and supports the dignity and well-being of everyone.
Bryan Waide. Vice President of Provider Contracting of the Western Market for Humana (Louisville, Ky.): Health plans must evolve in ways that support providers through real, system‑level transformation. Providers only unlock the full value of VB when they fully commit: aligning culture, incentives, workflows, analytics and front‑end care around prevention and proactive population health. At the same time, payers must evolve VB models to fit the realities of diverse provider types, including hospitals, specialty groups, academic systems, and rural practices. That means differentiated incentives, reduced administrative friction and interoperability that delivers timely insights directly into daily care. Ultimately, VB will grow only if both sides modernize together — providers by changing how they operate, and payers by changing how they contract, support and enable success.
Jennifer St. Thomas. Senior Vice President of Commercial and Medicare Markets for Mass General Brigham Health Plan (Somerville, Mass.): As value‑based care continues to evolve, health plans must move beyond budget frameworks and ensure value shows up in meaningful ways for members, through greater affordability, access and improved health outcomes. As part of an integrated healthcare system, we believe health plans can play a critical role in partnering closely with providers to support care models that are accountable, coordinated and rooted in service excellence.
Mike Radu. CEO of AbsoluteCare (Columbia, Md.): As value‑based care expands, health plans can’t keep relying on models that were never built for increasingly sick risk pools, like we’re seeing with Medicaid. Traditional primary care and light‑touch care management simply won’t reach people whose most urgent needs are fundamentally social, behavioral, and deeply complex. We are strong supporters of primary care providers as the backbone of the system, but health plans’ outdated reliance on PCP assignment as the primary mechanism for pulling members into risk pools no longer matches the realities of today’s populations or the intensity of support they require.
The path forward requires partners structurally engineered for the members who drive the greatest complexity — providers willing to take full PCP accountability, deliver intensive wraparound support and stand behind outcomes with true downside risk. To make that possible, health plans must democratize their data sharing with value‑based care partners, especially around utilization management and claims. Without transparent, timely data, even the most capable providers are forced to operate with blind spots that limit their ability to intervene early and manage risk effectively.
At AbsoluteCare, we’ve proven that when you flip the model and solve a member’s most urgent life need first, engagement and savings follow — this is the core belief behind our Beyond Medicine care model. If health plans want value‑based care to deliver real results, they must align with providers’ purpose built for the members the system has failed for decades, and modernize the infrastructure — including data access and attribution models — that those partnerships depend on.
Brett Bingham. Chief Network Development Officer for Banner Plans and Networks (Phoenix): Health plans must increasingly move from being claims processors to becoming true partners in care delivery and disease prevention. As value-based care grows, success will depend on aligning incentives with the clinicians actually delivering care while supporting the infrastructure providers need to manage population health effectively. This is especially true in primary care and prevention. Plans that succeed will focus less on managing utilization after the fact and more on enabling coordinated, longitudinal care that improves outcomes and lowers total cost of care. Increasingly, that means working more closely with providers and care models that bring together medical, behavioral and oral health. The plans that adapt fastest will be those that reward providers for preventing illness and managing risk, not just for delivering more services.
Michael Costa. Senior Vice President of Provider Network and Population Health for EmblemHealth (New York City): As value-based care continues to grow, health plans must shift from covering care to governing performance and managing risk over longer, multi-year arrangements. For health plans, that means incentivizing providers up the risk continuum to increase their skin in the game while reaping greater rewards. This requires greater provider accountability, with stronger incentives tied to measurable outcomes and a focus on total cost of care rather than isolated trend-altering initiatives. To achieve this, more sophisticated models such as bundled payments and care pathways need to be developed and implemented. Health plans must also maintain a sharp focus on metrics that reflect quality and performance, such as readmissions, length of stay, and avoidable admissions. As healthcare affordability increasingly impacts how our members and patients experience care, these changes are essential for delivering better outcomes for the communities we serve.
Ty Wang. Co-Founder and CEO of Angle Health (San Francisco): As value-based care grows, health plans will need to shift from a traditional model to an integrated care model to stay competitive in the market. This model can deliver significantly better quality of care and health outcomes for patients, ultimately reducing costs in a value-based system. Members are happier and healthier, leading to stronger customer retention for health plans.
Ali Khan, MD. Chief Medical Officer of Medicare for Aetna (Hartford, Conn.): The growth of value-based care depends on health plans making data more immediate, actionable and embedded in how care is delivered. The reason: without that kind of real-time, reliable data, care delivery organizations cannot — and often will not — shift their day-to-day operations to respond to the work of proactive care coordination inherent to true value-based care. That means getting timely insights directly into provider workflows and modernizing processes to reduce friction and support better decisions at the point of care. At Aetna, we’re focused on establishing deeper integration with electronic health record and data platforms that streamline real-time data exchange. We’re also developing scalable playbooks to help providers progress from foundational data sharing to more advanced, real-time collaboration. These shifts are critical to unlocking the full value of value-based care and improving outcomes at scale.
Rob Andrews. CEO of Health Transformation Alliance (Westmont, N.J.): As value-based care grows, health plans will have to change the basis on which they compete. For too long, plans have competed primarily on rates and discounts, but employers and patients are not only looking for savings, they want the care that makes people healthier. They understand that this is the key to long-term cost savings. Value-based care will require plans to use aggregated data to proactively identify which providers and treatments deliver better outcomes and align payment with those results. It also means greater transparency and a system where more dollars go to the clinicians and care teams doing the actual healing work, not just the intermediaries in the middle.
Jeff Butcher. Senior Vice President and CFO of Quartz Health Solutions (Madison, Wis.): Typically, health plans have done a poor job providing the information and tools necessary for primary care physicians to be successful under value-based contracts.
It is no longer acceptable to hand a physician a contract for quality, coding or cost improvement without providing them with the best opportunity to succeed. Health plans cannot expect improvements by handing providers a report card at the end of the quarter or worse yet at the end of the year telling them that they could have done better.
Health plans must understand how each physician office works and how best to work within their system to close quality and coding gaps or reduce overall costs. The easier health plans make it for the physician to be successful, the better the results will be for everyone.
Health plans must also understand what other incentives the physician has (what other value-based arrangements the physician has with other health plans). The more alignment and standardization of incentives within a provider’s practice the more efficient and effective the physician will be at closing gaps and changing care patterns to lower cost. The more integration with the physician’s EMR and workflow the better.
Finally, health plans may want to reconsider the primary care centered approach to improving quality, outcomes and cost improvements. Assigning care coordinators to high-risk members and reinforcing this relationship will build trust and help members make better medical decisions and gain better access to the care they need. Incentivizing busy primary care providers to do something unique with a small percentage of their patient panel may not be the best path to getting the desired improvements.
Kristie Spencer. Vice President of Provider Partnerships for Elevance Health (Indianapolis): Health plans must accelerate their evolution from contract administrators to performance partners. That means going far beyond managing financial arrangements. It means, equipping providers with actionable data, aligned incentives, and meaningful operational support. The future belongs to plans that reduce friction, simplify models, and create shared benefits and accountability for cost, quality, and member experience.
Howard Weiss. Vice President of Public Policy and Government Engagement for EmblemHealth (New York City): Health plans are continuing to consider new strategies to increase the use and effectiveness of value-based care arrangements. This includes the development of more advanced models that enable meaningful data sharing and improve individual clinical outcomes. However, a significant barrier to broader adoption of value-based care remains the lack of trust between some plans and providers, which hampers the ability to establish arrangements built on cooperation and mutual accountability for outcomes. At EmblemHealth, we have found that arrangements in which that trust is fully developed — supported by aligned incentives and true partnership — lead to improved outcomes for the members and communities we serve. The full potential of value-based care may not be fully realized until these barriers between plans and providers are overcome.
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.
