In 2025, health plans put emerging tech to use, but also had to discover and utilize workarounds for government regulations from the current administration. For many payers, navigating the past year has helped them plan ahead for 2026.
Becker’s connected with 17 health plan leaders to find out what they learned in 2025 that will affect how they will operate in 2026 and beyond.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: What’s one lesson your organization learned in the past year that will impact how you will operate going forward?
Saria Saccocio, MD. Chief Medical Officer, Essence Healthcare (Maryland Heights, MO): It’s simple but imperative to “pull the thread” from beginning to end. Strategic initiatives often start with an action plan, yet escalating when the first or second iteration fails is not always part of the roadmap. Whether closing gaps in quality care or managing service recovery for a disgruntled member, empowering team members to problem solve to closure or resolution is a lesson we have learned or have been reminded of that will carry forward into 2026. If first you don’t succeed, try, and try again…another way.
Kristen Recker. Executive Director of Provider Relations, Health Care Service Corporation (Chicago, IL): One lesson our organization learned this past year is the importance of building adaptable, cross-functional processes. We saw firsthand that when teams collaborate early, share information openly, and align on goals, we move faster, reduce work, and improve outcomes. This has reinforced the need for more intentional communication, clearer ownership, and stronger cross-team integration as we move forward.
Jennifer St. Thomas, Senior Vice President of Commercial and Medicare Markets, Mass General Brigham Health Plan (Sommerville, MA): One key lesson we learned this past year is the importance of staying agile and responsive amid significant market changes. We’ve seen that keeping our solutions and services centered on the member requires building flexibility into our processes so we can quickly incorporate feedback from both members and the market. This approach strengthens our ability to translate learnings into best practices that drive meaningful solutions for our members. I’m proud of our teams for embracing this mindset and ensuring we remain adaptable and member-focused as we move forward.
Gretchen Wagner. Associate Vice President of Risk Management, Humana (Louisville, KY): Over the past year, our organization has learned the critical importance of adaptability and proactive risk management in a rapidly evolving healthcare landscape. By fostering a culture that encourages cross-functional collaboration and data-driven decision-making, we are better equipped to anticipate challenges and respond with agility. Going forward, we will continue to prioritize these principles, ensuring that our strategies remain resilient and responsive to both market dynamics and the needs of those we serve.
Ilan Shapiro, MD. Chief Health Correspondent and Medical Affairs Officer and Senior Vice President, AltaMed Health Services (Commerce, CA): Our organization learned that thoughtful AI integration strengthens quality of care when you evaluate every tool through the lens of patient impact. We saw that efficiency alone is not enough. You need to measure accuracy, safety, workflow fit, and how each innovation supports clinical judgment. This year taught us to adopt technology with intention, test it with clear metrics, and keep patients at the center of every decision.
Howard Brill. Senior Vice President of Population Health and Quality, Monroe Plan (Pittsford, NY): The landscape of healthcare – the relationships between payers, providers, reimbursement structures, and regulatory frameworks are radically different from the previous twenty years. In particular, the margins available for public programs to providers and payers will be minimal. These are further shaped by a high-level of uncertainty in governmental policy. The rapid emergence of AI creates significant opportunities and risks for operations, which are not well understood. These changes are driving a product diversification strategy and examination of where technology can support productivity improvements and product differentiation. It is important to consider the impact on employees of rapid and disruptive change to maintain engagement.
Emily Durfee. Director of Corporate Venture Capital, Healthworx (Baltimore, MD): As the innovation and investment arm of a payer, the last year has brought a lot of focus on how Artificial Intelligence can transform healthcare. As we have dug into the space, we have learned that there are lots of opportunities for AI, especially in backend operations and streamlining relationships with partners. However, there is also need in healthcare for humans to see, heal, and support each other. Leveraging this learning, we are focused on finding ways that AI can supplement and automate certain processes, while trusting physicians to continue caring for their patients.
Dave Agler, MD. Chief Medical Officer, First Choice Health (Seattle, WA): The most profound lesson we learned this past year was the necessity of completely dismantling the historic firewall between behavioral and physical health management to deliver true holistic care. We realized that quality patient care requires a ‘whole-person risk’ operating model, where no condition is treated in isolation. This strategic commitment has forced us to invest significantly in the seamless integration of specialized case management with our entire continuum of chronic disease programs. Going forward, our operating model is centered entirely on eliminating these clinical gaps, ensuring every member receives the comprehensive, coordinated care they truly need.
Stacy Edgar. Founder and Chief Executive Officer, Venteur Inc. (San Francisco, CA): This year reinforced that an ICHRA business depends on a stable ACA — and political volatility has made that harder. We doubled down on scenario planning to keep employers anchored in facts rather than reacting to headlines. At the same time, momentum around ICHRA codification showed how quickly tailwinds can emerge. Our path forward is clear: anchor in facts, stay agile, and give clients a stable path forward no matter the external conditions.
Rebekah Hughey, MD. Medical Director, Highmark Health (Pittsburgh, PA): We are seeing more people use healthcare services, which is putting increased pressure on state Medicaid programs and the budgets that fund them. With H.R.1, new work requirements and twice-yearly eligibility checks for people in Medicaid expansion programs will likely lead to a sicker, more complex group of our members staying enrolled—similar to what we saw when continuous coverage protections ended after the COVID-19 public health emergency. What we learned during redetermination and beyond is that it’s critical that we proactively support our members—identify risk early, help them stay eligible for Medicaid, and keep them connected to the care they need.
Rob Andrews. Chief Executive Officer, Health Transformation Alliance (Westmont, NJ): At HTA, we’ve learned that gene therapies aren’t just a future challenge, they’re here now, reshaping how employers must think about benefits. Traditional pharmacy models built on hidden rebate flows and volume incentives just don’t hold up when treatments cost millions. That’s why our member companies are turning to pass-through PBMs, value-based drug agreements, and cross-carrier and cross-provider data insights to align pharmacy strategies with the one real goal: delivering high-quality, affordable care that improves health outcomes for employees and their families.
Jay Nakashima. President, eHealth Exchange (Vienna, VA): In the past year, eHealth Exchange has increasingly realized that for payer/provider data exchange to successfully scale nationwide, the patterns and solutions eHealth Exchange deployed for providers to electronically exchange electronic medical records with one another must be leveraged. Providers are able to exchange over 25 billion transactions annually across eHealth Exchange each year because we have secured trust, we require use of industry standards, and we provide a hub and spoke solution so participants only need to create one technical connection.
Krista Schonrock, MD. Associate Vice President and Senior Medical Director, Select Health (Murray, UT): Reflecting on the past year, a crucial lesson we have learned is the imperative to remain adaptable in our decision-making processes and organizational frameworks. As the environment continues to evolve at a rapid pace, we have had to become more agile than ever before. While the concept of adaptability is not entirely new, the speed at which we have had to make these adjustments has been unprecedented.
We have placed a renewed emphasis on implementing clear and meaningful processes, ensuring that we have precise data to inform our decisions, and maintaining streamlined decision-making procedures. These measures have enabled us to make the swift adjustments necessary to stay competitive and relevant in this ever-changing landscape. Furthermore, we have focused on fostering a culture of continuous learning and innovation, encouraging our teams to embrace change and seek out new opportunities for improvement.
Richard Greene. President, Clever Care Health Plan (Huntington Beach, CA):
During the past year, we’ve continued to deepen our understanding of what we’ve known from the beginning: our members’ cultural needs are a critical consideration when it comes to designing benefits and providing health care that keeps them living healthier, more fulfilling lives. From opening a new community center in Rowland Heights to increasing our membership base, 2025 demonstrated the culturally sensitive approach that we’ve embedded throughout our model produces measurable improvements in both health outcomes and member satisfaction. As we look ahead to the New Year, we’re doubling down on this principle across every aspect of our operations, from network development to member engagement, because meeting people where they are is what makes our model work. We look forward to serving the Southern California community for many years to come.
Michael Kobernick, MD. Senior Medical Director of Commercial Markets, Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan (Detroit, MI): Affordability is a crucial issue impacting the health care industry. People can’t access quality medical care without affordable health insurance and we know increasing health insurance costs are becoming more of a strain on the budgets of the businesses and people we serve. Blue Cross Blue Shield of Michigan will continue to focus on tackling health care affordability in the year ahead.
Howard Weiss. Vice President of Government Affairs, EmblemHealth (New York, NY): This year reaffirmed that collaborations with community-based organizations (CBOs) are vital if health plans are to meet the needs of the communities we serve. For example, in September 2025, EmblemHealth launched a food security initiative and partnered with food justice organizations, including The Campaign Against Hunger, City Harvest, and The New York Common Pantry, to expand our reach throughout New York City, providing healthy, nutritious food at no cost to people in need. Health plans like ours must continue recognizing the value of working closely with trusted organizations that play a critical role in addressing the social and health-related needs and shaping health outcomes.
Heather Tamborino. Chief Financial Officer, EmblemHealth (New York, NY): Over the past year, we’ve been reminded that the most effective way to navigate an ever-changing healthcare landscape is to remain firmly rooted in our mission. EmblemHealth’s mission has kept our attention where it belongs – on the evolving needs of our members and communities as they navigate a complex and often challenging healthcare system. We’re leaning in, staying agile, and taking action with programs and supports that meet people where they are. For us, the path forward is clear: continue centering our mission and let the needs of our members and the communities we serve guide the way.
