Payer executives are expecting AI, integrated care and an aging population to transform the healthcare landscape in the next decade.
The 32 leaders featured in this article, part of an ongoing series, are speaking at upcoming Becker's Payer Issues Roundtable events. The fall roundtable will take place Nov. 4-6 at the Swissotel in Chicago. The spring roundtable will take place April 28-29 at the Hyatt Regency in Chicago.
If you work at a health plan and would like to join as a speaker in April, please contact Randi Haseman at rhaseman@beckershealthcare.com.
Note: Responses have been lightly edited for length and clarity.
Question: What will likely be different about healthcare delivery 10 years from now?
Faris Ahmad, MD. Senior Medical Director and Associate CMO at Blue Cross Blue Shield of Michigan (Detroit): There are many aspects of healthcare delivery that will change dramatically over the next 10 years. Some of these include:
- Personalized medicine: With advances in genomics and other technologies, treatments can be tailored to an individual’s genetic makeup. This could lead to more effective treatments with fewer side effects.
- Artificial intelligence in healthcare: AI has the potential to transform healthcare delivery by assisting with diagnostics, drug discovery, predictive analytics and personalized treatment recommendations. Machine learning algorithms may help healthcare providers make more accurate timely decisions leading to improved patient outcomes.
- Home based care: With an aging population and advances in remote monitoring technology, there will likely be a greater emphasis on providing care in the patient's home. This not only can provide patient comfort but also reduce the burden on hospitals and long-term care facilities.
Abdou Bah. Senior Vice President of Medical Management and Chief Health Equity Officer of EmblemHealth (New York City): With an aging population and rising healthcare costs, we see the future of healthcare delivery continuing to focus on providing affordable, quality care and a better consumer experience. The COVID-19 pandemic accelerated consumer adoption of virtual services, allowing care to be delivered with less wait time and anywhere the patient is: at home, work or within the community. EmblemHealth expects the future of healthcare delivery to become more consumer-centric, with increased access provided through virtual care, digital and telehealth services, especially for those in historically underserved communities. We believe that the advancement of technology in chronic condition management and new medicine, including prescription drugs and other therapies to cure disease, along with the focus on addressing social determinants of health, will lead to improved health outcomes.
Tina Bandekar. Director of Pharmacy Programs at Elevance Health (Indianapolis): With the advent of technology and new developments especially in the machine learning space, healthcare will see significant enhancements in delivery and how care is accessed. It will also improve patient education due to increased accessibility to medical processes and knowledge. Healthcare policies will need to catch up to ensure ethical and regulated use of technology for the betterment of humanity and improving the overall quality of life.
Two areas that will see monumental progress are:
- Interoperability, where there will be seamless information sharing between different health systems to ensure care continuity as well as prevent or minimize redundant use of services. Additionally, it can prevent errors and improve patient experience.
- Machine learning and artificial intelligence use in healthcare will increase many fold, allowing for improved diagnostic tools, early detection, individualized treatment plans and remote monitoring of patients, efficient use of resources and leading to effective care and positive health outcomes for patients. I believe the applicability of technology will open new doors for many new advances in healthcare, such as using advanced genomics to cure rare diseases and using virtual reality to educate patients on health conditions and improve their overall health experience.
Sean Cavanaugh. Chief Policy Officer at Aledade (Bethesda, Md.): As the aging population in the United States inexorably grows — adding to the ranks of Medicare — and the working population contributing to trust funds declines in proportion to this beneficiary growth, Medicare costs to U.S. taxpayers are projected to double to almost $2 trillion per year. With Congress reluctant to reduce benefits, only an acceleration of the move to value-based care can preserve the affordability of this vital program.
Brigid Gast, MSN. Director of Care Coordination at Partnership HealthPlan of California (Auburn): We will continue to see integration of services supporting our population across nontraditional healthcare delivery avenues, particularly in the Medi-Cal space in California. Programmatic initiatives advancing health equity, quality and access will continue to be prioritized and operationalized throughout the continuum of care. Increased mechanisms for data interoperability will improve ability to deliver whole person care and support collaboration in healthcare delivery.
Pankaj Gupta, MD. National Medicare Advantage Medical Director for Clinical Performance at Optum (Eden Prairie, Minn.): We are in a deficit on primary care physicians and specialists. Technology helps to reduce the chasm between supply and demand, but it's not a panacea.
When a healthcare leader is asked to address physician or workforce shortages, they tend to share an extensive list of technological products. Radiology was one specialty that originally felt the benefits of technology via telehealth and, more recently, AI.
EHRs were once thought to save clinicians time, but more time is spent by the clinician — ask anyone.
Telehealth, remote patient monitoring and other tech tools may augment the workforce and help reduce wait times depending on patient need, but the mode of care delivery doesn't sustainably solve for the growing shortage of people who provide it.
The aging population is putting demand for specialized services in fifth gear.
Greg Hanley. Vice President of Health Services Quality and Operations at UCare (Minneapolis): With the continued growth of technology, data exchange, and the need for closer alignment between the payer and provider, the patient can truly be at the center of care. Healthcare delivery will become more flexible to meet the needs of the patient with a focus on prevention to reduce the personal and financial burden of chronic conditions. The healthcare delivery system will need to integrate primary care, mental health, dental, vision and specialty care to serve the consumer and have the flexibility to provide services in the location or format expected by the patient. Overall, healthcare needs to take a patient-centered approach to how care is delivered.
Meghan Hickey, PharmD. Director of Pharmacy at Peak Health (Morgantown, W.Va.): Ten years from now healthcare will likely be more personalized and accessible. We have already seen increased use of telemedicine, artificial intelligence, remote monitoring and advancements in genomics. Advances in genomics will lead to more personalized and targeted therapies, while integrating technology into medicine will likely improve patient outcomes while addressing challenges such as access to care.
Dennis Hillen. Senior Vice President of Market Leadership of Oscar Health (New York City): Bill Gates said: "We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10." It's no coincidence that this insight originated by a pioneer of modern consumer-facing technology. Technology has the ability to affect exponential change, which can be easily understood in the span of two years, but harder to imagine as you extend the much longer time horizon and compound the impact.
We are just on the cusp of a technology-driven healthcare experience, finally enabled by an increasingly digital and interoperable system. No two individual health journeys are the same, a phenomenon exacerbated by a disparate and confusing healthcare financing and delivery system. In 10 years, we'll see exponential growth in AI use cases that allow for a truly personalized and empowering experience. This will be accomplished when consumers and providers are able to be presented with, and understand, the full context of a patient's health status and the decisions that shape their ever-evolving journey toward a full and healthy life.
Jack Hooper. CEO and Co-Founder of Take Command Health (Richardson, Texas): Healthcare delivery is going to be more personal throughout the whole delivery chain. This includes personalized care, tailored prescriptions and pharmacy experiences, and even personalized insurance. A major trend that is picking up steam is the shift from group insurance plans to personalized insurance choice via the defined contribution model.
Ryan Jack, PhD. Vice President Enterprise Strategy and Innovation at Providence Health Plan (Portland, Ore.): Ten years from now, healthcare will have experienced an accelerated digitization of medicine enhancing the way care is delivered. Digitization would include increased utilization of remote monitoring devices, increased integration of health applications with care providers, and more services occurring in a patient's home. Increased data through interoperable electronic healthcare records will strengthen artificial intelligence functionality from a patient engagement and overall care delivery perspective, thereby reducing the overall cost of healthcare.
Neil Kulkarni. Vice President of Customer and Clinician Experience Solutions at Highmark Health (Pittsburgh): I expect healthcare delivery to look different in the next decade focused around a few different themes: 1). Better and more personalization 2). More digital interaction and data collection 3). More flexibility around care delivery and 4). Increased interoperability across all the entire ecosystem (person, provider, payer, ecosystem partners). All four of these themes should help drive more engagement from individuals in the entire healthcare ecosystem and a better experience on how people work with their providers, payers and other "ecosystem partners" to bring the healthcare experience to be more similar to how people experience other industries or other parts of their life. I'm also optimistic about the opportunity for payers and providers to work more closely together in the next decade and streamline and simplify the "back and forth" that people currently experience.
Sylvia Lozano. Vice President, Hospital Relations at Inland Empire Health Plan (Rancho Cucamonga, Calif.): I believe what we are going to see in the next 10 years in the healthcare delivery model is more integration and coordination of care throughout the delivery system. This is going to be in the form of clinical integrated networks with health plans. Also, a marked shift to outpatient/home/asynchronous care driven by technology and remote monitoring with more AI being used in personalized medicine.
Joanne Mizell. COO of Banner|Aetna (Phoenix): When it comes to healthcare and its accelerating evolution, 10 years seems like such a long time. One of the most obvious changes will be the impact of AI in every aspect of healthcare — from how patient care is delivered to how specialized it will be. While AI is essentially in its infancy now, we're moving towards individualized treatment by patient rather than by diagnosis category. I also hope AI advancements will benefit insurance and provider interactions. The technology has the potential to improve prior authorizations, coverage policy application, and cost transparency, leading to better patient outcomes.
Ria Paul, MD. Chief Medical Officer, Santa Clara Family Health Plan (San Jose, Calif.): In 10 years from now the healthcare landscape will change, particularly the patient demographics as we will have an increasingly diverse Medicare population. IT will continue to play a major role in care delivery not only in the form of virtual on-demand visits but also increase in connectivity with patients through remote patient monitoring for managing various chronic conditions. Providers, payers and health systems will utilize AI to improve workflow efficiency in various ways. As CMS focuses on the majority of Medicare beneficiaries being in value based contracts by 2030, health systems and payers will need to work in tandem and not in silos to focus on whole person care with emphasis on the social aspect of care partnering with community based organizations.
Harlon Pickett. President of Eagle Care Health Solutions (Austin, Texas): Over the next decade, healthcare delivery is likely to undergo a significant transformation. Virtual and telemedicine will become even more prevalent. Remote monitoring of chronic diseases will become commonplace. The resulting remote consultations and follow-ups will make healthcare more accessible and convenient. AI will play an increasingly more important role in diagnosis, treatment planning and personalized medicine, enhancing efficiency and accuracy. Additionally, there will be a greater focus on preventative care and holistic approaches, emphasizing lifestyle interventions and mental health support to promote overall well-being.
Bruce Rogen, MD. Chief Medical Officer of Cleveland Clinic Employee Health Plan: Longitudinal patient records on each patient accessible by providers caring for the patient having a complete history of clinical data sourced from multiple EMRs and across payers and over time going back years if not decades.
AI platforms that are able to access the longitudinal patient record to engage the patient in preventive care, filling gaps in care, managing medication refills, enhancing medication compliance, and obtaining prior authorization from payers when indicated.
Teams of healthcare providers using the longitudinal patient record and the AI platforms to provide care anywhere and everywhere (hospital, post-acute, home care, remote, virtual) and focusing on prevention. The team includes physicians, nurses, navigators, care coordinators, pharmacists, social workers, behavioral health psychologists and counselors, community healthcare workers and home care workers.
Ilan Shapiro, MD. Chief Health Correspondent, Medical Affairs Officer and Senior Vice President at AltaMed (Los Angeles): In 10 years, healthcare delivery will likely be more patient-centric and value-based, with AI technology playing a crucial role in both treatment and prevention of illnesses. Patients will be incentivized for proactive wellness steps, fostering a culture of health promotion. Nationwide care coordination will be streamlined, reducing constraints and enhancing accessibility. This transformation will empower patients and healthcare teams, ensuring that care is brought back to the community level.
Pankhuri Sharma. Strategy and Operations Leader at Humana (Louisville, Ky.): In the coming decade, I expect healthcare delivery to witness three key trends. Firstly, with an aging population, there will be a heightened focus on preventive and holistic care to manage costs. This will involve increased emphasis on primary and home-based care as well as on efforts to tackle health inequity and behavioral health issues. Refined predictive analytics tools will play a more crucial role in providing such preventive interventions. Secondly, healthcare delivery will increasingly shift towards patient-centric models, with care plans and services tailored to individual patient needs and preferences. This shift will foster greater shared decision-making between patients and healthcare providers, empowering patients to actively participate in their care journey. Lastly, technology will continue to revolutionize healthcare delivery, enhancing both efficiency and patient experience. Increased data interoperability, necessitated by the continued adoption of risk-based models, and rapid advancements in AI will enable healthcare organizations to derive actionable insights and reduce operational costs. Furthermore, ongoing innovations in diagnostic technology, medical devices, and procedures will lead to improved treatment outcomes.
Jennifer Shermo. Chief Growth Officer of Security Health Plan of Wisconsin (Marshfield): In the next decade, I believe healthcare delivery will be significantly transformed by advancements in technology, personalized medicine and integrated care systems. Telemedicine and AI-driven diagnostics will become mainstream, improving accessibility and efficiency. Furthermore, consumerism in healthcare will continue to shape innovation and push care delivery and insurers to think differently. I see integrated healthcare systems leading this charge by promoting more coordinated care, reducing costs and providing the experiences patients desire.
Shawn Shuman, MSN. Director, Medical Management at Peak Health (Morgantown, W.Va.): Healthcare technology continues to evolve and [I] feel that over the next 10 years, we will see the influence of artificial intelligence. Not only will AI have an impact on care delivery, but it will also have an impact on how payers stratify populations for better health outcomes and automation of processes. AI tools will revolutionize healthcare over the next 10 years, but efficacy and long-term impacts are still unknown.
Michael Smith, MD. Chief Medical Officer, Health Alliance (Champaign, Ill.): American healthcare is in some respects a paradox. It is the best in the world in terms of innovation and technological advancement. Yet considering affordability and equity, the model is fraying and in risk of breaking. Healthcare spending cannot continue to markedly outpace the rest of our economy. It is essential that within the next decade we focus intensely on prioritizing quality outcomes, and funding care that demonstrates meaningful clinical value. If we succeed in that, our society as a whole will reap immense benefit.
Brian Smolich, PharmD. Vice President, Health Alliance Quality and Managed Care Operations at Health Alliance (Champaign, Ill): Ten years from now I see technology playing an even larger role in healthcare delivery compared to today. Of course, AI will play a part, but things like remote patient monitoring, telemedicine and digital tools will provide greater access and increase health literacy with broader adoption. In the future, I believe there will exist a sustainable model for the affordability of innovative and breakthrough treatments.
Don Stiffler. Chief Revenue and Growth Officer at Commonwealth Care Alliance (Boston): I think we'll see a lot of exciting innovations over the next 10 years to support the way we deliver care. I likely won't be alone in this opinion, but I would say the integration of artificial intelligence across multiple payer and provider platforms will prove to be a big change, and has the potential to maximize efficiency and improve the patient experience as well as health outcomes. I'd also point to the exponential growth we've seen in virtual care within the last five years, and I predict we'll continue to see more of this where applicable. It's an exciting time for innovation in healthcare delivery, especially for organizations like CCA, whose mission is built on thinking outside the box for the individuals we serve.
Barry Streit, Senior Vice President of Growth at Essence Healthcare (Maryland Heights, Mo.): Healthcare delivery will be transformed by tech-savvy, control-seeking, late-stage Boomers, who have driven significant industry changes as they age into Medicare. Their sheer numbers and the challenges in attracting, serving and keeping them healthy have led to major changes across the industry. Today, patients expect to look at their records, ask questions, get medical advice, and share data via computers and mobile devices. The same behavior drives their shopping and buying behaviors. The peak of this cohort in 2024 will see them transition from purchasers to utilizers, disrupting and changing processes and services.
Technology advancements, especially AI, will be vital in managing this shift. Value-based care is the evolving model of care that puts the physician, the patient, and the payer (insurance companies, government, or businesses) on the same side, seeking to prevent illness and reduce unnecessary costs. The focus on prevention and daily health is appealing to this generation. Advancements in technology is what is powering this shift as well, allowing stakeholders to see and understand much more data about their patients/members/consumers.
Over the next five to 10 years, there will be another shift as Gen Xers begin to reach Medicare age with their own behaviors and point of view, but as a relatively small generation, it may not have the impact we've seen with Boomers.
Chandni Sud. Vice President of Performance Operations at Mass Advantage (Worcester, Mass.): Healthcare delivery continues to evolve. In the next decade, I believe that new technology and data integrations will allow care to shift more to meet the patient's needs. This will include a variety of virtual options, home care and further leveraging community resources. In addition, data transparency and interoperability will allow both providers and payers to understand a holistic view of their panels/membership to better provide care, reduce duplication, and predict needs more proactively on what programs and services will be needed. This will include greater usage of AI or natural language processing to leverage non-standard information in a comprehensive manner without a large administrative burden of gathering that information today. In addition, the shift to value-based care from fee for service will continue with greater prevalence of at-risk models focused on managing the total medical expense of the population without negatively impacting health outcomes. This would include additional specialty driven models as the initial shift has been historically primary care centric. This will further shift healthcare delivery to be population health focused; including not only an emphasis on specific disease management, but inclusive of providing tools and resources for patients to manage their well-being outside of the construct of medical care delivery.
Kelli Tice, MD. Chief Health Equity Officer and Vice President, Medical Affairs at GuideWell (Jacksonville, Fla.): In 10 years, technological advances, improved capture and application of data, and sustained comprehensive health equity solutions which are being implemented now, should produce a healthcare delivery system that can better ensure right time, any place access to care. Note that I say any place, as opposed to right place, because our current system requires an individual to walk through the "right" door to access services, which presumes the elimination of barriers we may not see.
Shelley Turk. Divisional Senior Vice President of Illinois Health Care Delivery at Health Care Service Corp. (Chicago): Predictive analytics in healthcare will be commonplace and understood as essential for optimal patient care through the use of machine learning techniques and statistical algorithms in order to analyze both real-time and historical patient data. Both payers and providers will understand that predicting illness, behaviors, patterns of care and treatment will impact everything from prescription drug utilization to weight regain. Discerning these movements will facilitate more appropriate follow-up, better treatment and faster interventions than ever before. New analytics and automation will not only provide accurate predictions related to a particular individual's health, but also forecast larger public health events, such as infectious disease pandemics.
David Wang, MD. COO of Mass Advantage (Worcester, Mass.): By 2035, American healthcare will have:
- Still not solved the fundamental principal-agent problems.
- Diversified clinician roles and team structures to reflect digital health's potential, workforce challenges and payment reform.
- Shifted — but hopefully not fragmented — care from incumbent brick-and-mortar locations into the home alongside last-mile mobile care solutions.
- Reached escape velocity in value-based care arrangements. Aligned risk models, "payviders" and enablement platforms overtake fee-for-service by a thousand cuts.
- Embraced the existential question: How does healthcare revert from an industry back into an utility?
Mitch Wasden. CEO of Iowa Total Care (West Des Moines): Here are a few things I think will be different 10 years from now:
- Governmental payers such as Medicaid will provide more social determinants of health services as part of the normal benefit.
- AI will have begun to disrupt cognitive based medical specialties, which will accelerate teleheath- and digital app-based medicine.
- Commercial insurance will decline and the healthcare marketplace and governmental payers will continue to grow.
- Patients will become more comfortable with accessing ancillary services and pharmacy through nontraditional providers (at home, mail order, standalone facilities unaffiliated with health systems).
- Interoperability will make members' health information even more portable than it is today, freeing them from large health systems so they can fund more affordable options.
- Digital health will be to outpatient care, what outpatient was to inpatient care over the last 30 years as Gen Z, Gen Y and Millennials use technology as their most frequent healthcare consumption platform.
Darren Wethers, MD. Chief Medical Officer of Atrio Health Plans (Salem, Ore.): I envision a future where automation will have reached a greater presence in the healthcare setting. Most nonemergent care will take place in the outpatient setting, scheduled through bots which direct us to the site best prepared to meet our care needs. Registration will be done with conversation bots, and remote devices for measuring vitals will allow the patients to begin the visit themselves. Physician extenders will provide initial care assessments and, in many cases, manage the care longitudinally, as they do now (only more so). Physicians will provide care oversight and technical assistance as needed. Robotic surgery will have more approved applications. AI-assisted imaging reviews will be standard, and we will see new applications in pathology and laboratory science as well as use of chatbots in behavioral health. Universal healthcare will not have been realized, but more people will have coverage through newly created insurance vehicles (short term contracts, catastrophic care coverage only, digital first contracts) which expand options for those without employer or government-sponsored insurance.
Jeremy Wigginton, MD. Chief Medical Officer of Capital Blue Cross (Harrisburg, Pa.): Ten years from now, the healthcare ecosystem will center much more on personalized care delivery and precision medicine. With the growth of genetic testing, gene therapies and pharmacogenomics, healthcare providers will have a much better understanding of how to treat patients based on individual conditions and genetics instead of broad-based therapies and clinical assumptions. Healthcare providers will be able to treat both chronic conditions, such as high blood pressure, and rarer diseases much more quickly and effectively. Our knowledge and understanding of our personal health will also increase because of these advancements.