Sustainability has become less about cutting costs and more about redesigning how healthcare delivers value. Becker’s asked several health plan leaders how they’re thinking about long-term sustainability, and the responses point to a shared shift away from volume-driven models toward outcomes, accountability, and member-centered design. From shifting social health programs toward measurable, evidence-based interventions to redesigning the consumer experience around choice and transparency, leaders are converging on the idea that sustainability isn’t a single initiative — it’s a durable operating model built for the long haul.
The answers below reflect a range of strategies, from strengthening payer-provider partnerships and embedding AI into clinical decision-making to balancing financial discipline with health equity and community trust. Common threads emerge around reducing low-value care, building data infrastructure that supports proactive rather than reactive management, and designing systems flexible enough to adapt as member needs evolve. Below, healthcare leaders share how they’re positioning their organizations for what’s next.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are you thinking about long-term sustainability in today’s environment?
Nebeyou Abebe. Senior Vice President of Highmark Health (Pittsburgh): For social health programs to be sustainable in today’s environment, we have to move from community-oriented programs that rely on grant funds to more clinical programs where there is a clearly defined population of focus, time-bound intervention, and measurable outcomes that align with strategic value levers, such as cost savings, reduced hospitalizations and IP lengths of stay, reduced ED visits, and improved outcomes. That way, programs can generate the evidence needed to either make the business case for the health plan to invest in the program or to inform policy sustainability pathways such as an in lieu of service (ILOS) pathway in Medicaid. Social health programs should start with the end in mind when designing a program to ensure sustainability and scalability.
Mark El-Tawil. Chief Administration and Finance Executive for Blue Cross Blue Shield Arizona (Phoenix): We have definitely hit some headwinds that would challenge long-term sustainability absent some changes.
So we have everything on the table, from how we approach administering our business and opportunities to streamline, automate and reduce work faster; to which markets we engage in and how we are focusing on partners and products that will enhance our long-term sustainability.
Some things we can control directly, so we are turning a critical eye toward everything we do that adds cost, complexity or risk; some things we do with partners who help us serve our customers. So that is where we are, evaluating those partners and in some cases, making the difficult decision to change things up relative to who we partner with in serving our customers.
Lastly, there are regulatory forces that pressure our long-term sustainability, so we are working to educate legislators and others who can influence those factors.
Uche Olekanma. Vice President of Clinical Operations for Blue Cross Blue Shield Arizona (Phoenix): Long-term sustainability requires a disciplined focus on reducing total cost of care while protecting clinical appropriateness and member outcomes.
At AZ Blue, we are embedding sustainability through structural levers — stronger utilization management, payment integrity, and redesigned site-of-care strategies — to ensure we consistently remove low-value care.
Equally important is building operational efficiency through automation and AI, enabling scalable clinical decision-making while reducing administrative burden and improving consistency.
We are also investing in long-term capabilities — data transparency, predictive analytics, and value-based partnerships — to shift from reactive management to proactive population health.
Ultimately, sustainability for us is not a single initiative but a durable operating model that aligns cost discipline, clinical integrity, and provider partnership to deliver better outcomes at a lower total cost of care.
Audrey L. Tanksley, MD. Chief Medical Officer of CountyCare (Chicago): In today’s healthcare ecosystem, sustainability is more than reimbursement. This environment is about building systems that can adapt, endure, and continue to meet the needs of the people they serve. That means investing in prevention, strengthening partnerships with community organizations, and supporting the overall wellbeing of the healthcare workforce. The organizations that will be successful long-term are those that can improve outcomes, reduce unnecessary utilization, and earn the trust of the community. To me, true sustainability happens when financial responsibility, health equity, and innovation come together to create healthier patients, stronger communities and a more resilient workforce.
Meredith Duncan. President and Chief Executive Officer of Texicare (Austin, Texas): Healthcare costs for businesses have risen year after year. The downstream effects are businesses cutting coverage, reducing benefits or restricting access just to keep offering something. Providers, payers and pharmacy benefit managers all have a responsibility to ensure businesses can continue to provide coverage for employees. At Texicare, we’ve built plans around how our members live and work to encourage use. Plans that get used keep costs affordable for our members, and affordability keeps coverage sustainable.
Louis DeStefano. Senior Vice President of Growth for Oscar Health (New York City): At Oscar Health, creating long-term sustainability in healthcare means redesigning the system around the consumer — so they have the freedom to choose the coverage, benefits, and doctors that fit their lifestyles. Technology, AI, and consumerism are changing the way we live today — and it’s time healthcare catches up. By building a single marketplace where consumers drive innovation and transparency, we make shopping for healthcare as easy as any other online marketplace: where you can compare cost, evaluate features, and read reviews to make the best purchase for you. When consumers choose how and where to spend their money, they exploit inefficiencies in the market and lower costs.
David Mao. Divisional Senior Vice President of AI, Transformation and Project Management Office for HCSC (Chicago): Long-term sustainability in health care starts with acknowledging a fundamental imbalance: costs continue to grow at an unsustainable pace while outcomes and consumer experience have not kept up. That gap is forcing a shift from volume-driven models toward value, accountability, and transparency. For payers and providers alike, the question is no longer incremental improvement — it’s how we fundamentally realign incentives to reward member outcomes and the quality of care delivered, while helping to lower costs, raise quality, and improve the member experience.
We see two critical levers to move the system forward. First is deeper payer-provider partnership, where shared accountability for cost and quality is paired with aligned incentives and more timely sharing of data. Second is the scale deployment of AI and advanced analytics to improve clinical outcomes, reduce administrative burden, and create a more personalized, seamless health care experience. If done well, these capabilities can help lower overall costs while improving both access and quality.
Ultimately, long-term success depends on shifting from fixing isolated problems to improving the whole system — where collaboration, technology, and aligned incentives come together to deliver better health outcomes at a price people can afford.
Tiffany Kobashigawa. Director of Strategy Sales and Service for LA Care Health Plan (Los Angeles): We are intentional about rapidly balancing enhancements with strict data governance, ensuring our systems remain secure, compliant with high efficiency for long-term sustainability. Updating our enrollment and retention workflow models for example, involves first focusing on proper data scrubbing and implementing simple and often overlooked automated processes. Only then do we integrate AI enhancements as a feature of our ability to provide services. Ultimately this approach will keep our workflows agile as we continue to pivot and evolve around member needs.
Martina Lee Strickland. Head of Marketing, PR, and Brand for Clever Care Health Plan (Huntington Beach, Calif.): Strategic decision-making and growth, financial stability, and staying within compliance are the foundational priorities for Clever Care to position itself for long-term stability. These are closely followed by high-member engagement and satisfaction because our members are at the heart of our operations. Clever Care was founded in response to underserved communities — we don’t force them to adapt; we meet them where they are — and this sustains our longevity.
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