Becker’s connected with 17 health plan leaders to see how their organizations are shifting their priorities in response to continued medical cost trend and affordability concerns.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are your 2026 priorities shifting in response to continued medical cost trend and affordability concerns?
Jay Nakashima. President, eHealth Exchange (Vienna, Va.): eHealth Exchange enables providers and federal agencies to securely share electronic medical records at national scale, supporting more than 25 billion clinical transactions annually. Building on this foundation, eHealth Exchange is eliminating outdated, manual data exchange methods currently used in payer-provider exchange such as fax, spreadsheets, and legacy interfaces—by delivering a trusted, scalable, standards-based solution. By convening stakeholders to ensure trust, compliance, and shared governance, eHealth Exchange provides a unified forum where payers and providers can collaborate and shape the future of interoperable health data exchange.
Rob Andrews. Chief Executive Officer, Health Transformation Alliance (Westmont, Nj.): At HTA, our 2026 priorities are based on what we’ve seen work. Some of our most engaged member companies held average annual cost growth at just 2.9% from 2021 to 2024. They’ve done it by staying close to the fundamentals: keeping people healthy and staying directly involved in how care is purchased and paid for. That means partnering with those who prioritize prevention, reviewing contracts carefully, and using data to make smarter, faster decisions that lead to better health outcomes for employees and their families. This isn’t about adjusting benefits—it’s about doing the basics right, doing them consistently, and staying accountable for how every dollar is spent.
Jeff Bak. President and Chief Executive Officer, Imagine360 (Wayne, Pa.): As employers face another round of cost increases that surpass expectations, there is a renewed focus on containing healthcare spend and enhancing affordability for both companies and their employees. In 2026, Imagine360 continues our mission to provide innovative and alternative solutions that address rising healthcare costs head-on and meet the diverse health needs of employees. Last year, we launched Complete Care, including Imagine360Rx, to help employers control rising healthcare and pharmacy costs which currently represent about a quarter of healthcare spend. These solutions are already showing significant savings, and they provide a practical and effective solution for employers struggling with high renewal rates. This year, we’re focused on helping employers break from the status quo and adopt sustainable, affordable health plan alternatives.
Alexander Ding, MD. Deputy Chief Medical Officer, Humana (Louisville, Ky.): Complexity drives inefficiency, consumer frustration, and ultimately, adds to cost. At Humana, we are doubling down on expanding access to preventive services, making healthcare simpler to navigate, investing in coordinated care models, and greater incentive alignment across payer and provider. We’re accelerating efforts to personalize care and close gaps early. Everything comes back to our anchor in helping people achieve their best health by simplifying the path to preventive, proactive, and personalized care.
Rob Hitchcock. President and Chief Executive Officer, Select Health (Murray, Ut.): In 2026, our organization will begin to realize the benefits of strategic investments made over the past few years to control administrative costs. During this period, we have focused on retooling, upgrading, and retrofitting our operations, all while remaining committed to our mission. We have essentially been in “Dry Dock” but the investments in technology, data, and process improvements have positioned us to compete effectively with national organizations and support regional expansion. As we move forward, we will maintain a rigorous focus on administrative efficiency, ensuring that technological advancements enable us to deliver enhanced services without increasing costs.
Furthermore, we have cultivated a strong collaborative reputation with our clinical partners. These partnerships are essential for managing utilization, which not only reduces costs but also improves the health outcomes of our members. Looking ahead to 2026, we anticipate an increase in proactive care arrangements, driven by our ongoing investments and our reputation as a trusted partner to providers.
Alan Silver. President of ICHRA, Ambetter (St. Louis, Mo.): Against a backdrop of rising healthcare costs, ICHRA (Individual Coverage Health Reimbursement Arrangements) offer flexible, personalized and dependable healthcare options, empowering people to take control of their coverage.
As we move beyond 2026, our commitment to innovation remains unwavering. We’re redefining what it means to deliver healthcare outside of traditional group-sponsored insurance, putting members at the heart of every decision. By removing barriers and simplifying the experience, we’re creating a more consumer-friendly approach to care. Our evolving plans will offer tailored solutions designed to meet the unique needs of every individual.
Steve Yurjevich. CEO of Payer Market, Optum Insight (Eden Prairie, Mn.): The health care system continues to face affordability pressures, fragmented processes, and rising expectations for a simpler experience. Payers and providers are working through these challenges while trying to reduce avoidable denials and administrative work. At Optum, our focus in 2026 is practical modernization. We’re moving interventions upstream with real‑time claim validation and connecting patients, providers and payers with responsible, human‑centered AI for faster, more accurate decisions. The goal is a clearer, more transparent experience that helps health plans reinvest savings into better benefits and gives members fewer billing surprises.
Brett Bingham. Chief Network Development Officer, Banner Plans and Networks (Phoenix, Az.): As we look to 2026, our priorities are shifting from broad cost containment to more targeted, root-cause cost reduction. That means deeply understanding where unit cost, site-of-care decisions, and misaligned incentives are driving unnecessary spend and addressing those issues collaboratively with physicians rather than relying solely on blunt utilization controls. We’re prioritizing operating models that give providers both the data and the financial accountability to manage total cost of care, while sequencing value-based risk carefully so affordability improves without destabilizing provider economics. Ultimately, sustainable affordability will come from aligning incentives, not simply managing utilization through traditional gatekeeping methods.
Ellen Sexton. Executive Vice President and Chief Growth Officer, Blue Shield of California (Oakland, Ca.): Addressing rising costs in health care is a major focus for Blue Shield. We are committed to making health care worthy of our family and friends – and we can’t do that if it’s not affordable. In 2026, we’re continuing our work to advocate for stronger policies and implement initiatives to address significant cost drivers like prescription drugs. We are also collaborating with providers on solutions that focus on value for our members and partners, delivering high-quality care and outcomes for patients at a sustainable price.
Michael W. Cropp, M.D. President and Chief Executive Officer, Independent Health (Buffalo, Ny.):
- Rather than shifting priorities, we will continue to expand on our successful alternative payment models – we have a long history of leading the way in the Western New York market with our pay-for-performance and value-based care models – these models have enabled us to consistently achieve 5-Star ratings from CMS and NCQA for quality and service.
- We will continue to work collaboratively with our primary care physicians to improve access to quality care, because in the long run, providing the right care, at the right time, and in the right setting, costs less.
- Engaging our members will remain a priority. We will continue to leverage technology and digital platforms, such as our Brook Health Companion, to empower our members and put them in control of their health journey with the tools, access, and confidence they need to live healthier lives.
Caroline Carney. President of Behavioral Health and Chief Medical Officer, Magellan Health (Frisco, Tx.): Magellan specializes in behavioral health care, and our country’s need for care continues to drive overall cost of care. We are doubling down on clinical programs that promote higher quality care while saving money, including those in behavioral health medication management, ABA management, and disability supports. Our programs support individuals and programs, while achieving clinical outcomes and a ROI.
Harlon Pickett. President, Eagle Care Health Solutions (Austin, Tx.): Our 2026 priorities are shifting from managing cost increases to actively restructuring how care is purchased and delivered.
For years, much of the industry’s response to rising medical costs has been reactive. We adjust contributions, increase deductibles, narrow networks, or introduce another point solution and call it progress. That approach is no longer sustainable. Continued cost trends and affordability pressures are forcing leaders to confront the system’s underlying design.
In 2026, the priority must be moving upstream. That means redesigning benefit structures around early access to primary care, mental health, and chronic disease management. It means aligning incentives with outcomes instead of volume. It means eliminating administrative friction that adds cost without improving care. Most importantly, it means equipping employers and employees with real transparency and practical tools to make better healthcare decisions before problems become expensive crises.
Affordability will not be solved through incremental adjustments. It will only be achieved through structural change, disciplined purchasing, and the courage to move away from models that have proven they no longer work.
Ceci Connolly. President and Chief Executive Officer, ACHP (Washington, D.C.): At ACHP, our Board made a commitment to issue an annual Report on Affordability detailing concrete steps nonprofit regional plans have taken to deliver greater value for the healthcare dollar. Our focus this year is on enacting federal policies that control drug prices and excessive MA risk coding, which can save billions each year.
Rebekah Hughey, MD. Medical Director, Highmark Health (Pittsburgh, Pa.): The shift for Highmark Wholecare isn’t a shift at all … it’s a doubling down on our commitment to preventive care. Our goal is to empower members to actively manage their own health journey. While it may sound simplistic, keeping people healthy is indeed the most effective way to make healthcare affordable for both organizations and individuals. Although other factors certainly contribute, preventive health serves as a fundamental solution to the challenge of healthcare affordability. Building upon this foundation, both Highmark Wholecare and Highmark’s health system, Allegheny Health Network, are dedicated to integrating and implementing emerging technologies.
Krista Hoglund. President, Jefferson Health Plans (Philadelphia, Pa.): In 2026, we’re doubling down on making care more accessible and affordable by working closely with Jefferson Health and other providers to ensure people get the right care at the right time and in the right place.
Being a provider-owned health plan gives us a unique advantage—we can align clinical and financial strategies to manage utilization and drive efficiencies across the continuum of care. One specific area of focus for 2026 is lowering total spend through smarter processes like prior authorization reform and proven care pathways for high-cost conditions
We are also expanding integrated care models such as remote patient monitoring and home-based assessments to keep people healthier and address issues before they escalate. It’s all about leveraging the strength of an integrated system to deliver better outcomes and value for the communities we serve.
Heather Tamborino. Chief Financial Officer, EmblemHealth (New York, Ny.): As medical costs continue to rise, our 2026 priorities focus on addressing the underlying drivers of healthcare costs. That includes a continued focus on blended value-based arrangements and a multi-year view of contracting, especially in areas like chronic care, where sustained attention is critical. We are also focused on strengthening relationships with providers to reduce systemwide administrative burden and better align on access, quality, and cost. This alignment is important for delivering the access and quality our members and patients are seeking.
Ty Wang. Co-Founder and Chief Executive Officer, Angle Health (San Francisco, Ca.): Our 2026 priorities are increasingly centered on affordability, predictability, and proactive cost management as medical trend pressures continue to intensify. With employer healthcare costs projected to see their largest increase in 15 years, we’re doubling down on using AI to get ahead of risk rather than reacting to it after costs have already materialized. That means further investing in our vertically-integrated platform to deepen predictive underwriting, tighter medical–pharmacy integration, and more personalized, early interventions that reduce high-cost events.
Howard Weiss. Vice President, Public Policy and Government Engagement, EmblemHealth (New York, Ny.): At EmblemHealth, we see how affordability pressures are shaping the way our members and communities engage with care and how its impact extends far beyond health care. As these pressures grow, we remain focused on ensuring access to clinically appropriate, cost-effective care. This work is ongoing, and we’ve taken meaningful steps to address both consumer and provider concerns, including reducing the number of services for which we require prior authorization. Ultimately, real affordability can only be achieved through collaboration with health care providers and drug companies to address the underlying costs of care. As we move into 2026, EmblemHealth looks forward to working with them and with policymakers to develop solutions that help people afford the care they need.
