Transformation and Growth: Key Insights from Becker’s Payer Issues Roundtable
By Brian Berkowitz, Chief Product Officer, Lyric
The hallways of Chicago's Swissotel hummed with energy as healthcare leaders gathered for the Becker's Payer Issues Roundtable. Many health plan veterans and industry luminaries shared deep, sophisticated discussions that unfolded throughout the day, marking what many attendees recognize as a pivotal time for digital transformation and mindset shift for payers.
Day 1
The energy was palpable at the Becker's Payer Issues Roundtable in Chicago, where healthcare leaders gathered to explore the industry's most pressing challenges and emerging opportunities. As a veteran of health plan innovation and strategy, I was struck by the depth of panel discussions spanning market differentiation, technological transformation, payer-provider partnering, and identity-centered healthcare delivery.
Morning Insights: Market Differentiation and Growth
The day kicked off with a powerful session featuring Casey Hossa (Health New England), Joanne McFall (AmeriHealth Caritas), Robert Groves (Banner|Aetna), and Vijay Kedar (Tomorrow Health). The panel delved deep into the challenges of differentiation in an increasingly competitive landscape. As consumer-driven market dynamics continue to evolve, the discussion emphasized the growing importance of sustainable Medicare Advantage growth strategies amid rising cost pressures.
A significant portion of the conversation centered on translating social determinants of health initiatives into measurable outcomes while meeting the evolving demands of employer-sponsored coverage. The panel particularly emphasized the delicate balance required between advancing health equity initiatives and maintaining market growth.
Technology Transformation and AI Innovation
The mid-morning session brought together Mike Treash (HAP), Pankhuri Sharma (Humana), Michael Todaro (Magnolia Health), and Murali Kashaboina (Health New England) for an exploration of AI's transformative potential in healthcare. Recent McKinsey research was discussed among the panelists, in its suggesting potential savings of 13-25% on administrative costs and 5-11% on medical costs through AI implementation.
The discussion examined how AI's role in administrative tasks continues to evolve as regulations mature, while acknowledging current implementation barriers. Particular attention was paid to digital solutions advancing health equity and strategic priorities for AI investment in 2025.
Breakthrough Approaches to Growth
I was honored to be included on a keynote panel on health plan growth and expansion opportunities. Co-panelist Karen Schulte of SCAN Health Plan shared how data analytics are driving their targeted network strategy, particularly evident in their innovative provider network serving LGBTQ members. This approach not only demonstrates the impact of analytics-driven network design but has also yielded significant engagement and business outcomes.
Our other panelist, Dennis Hillen, showcased Oscar Health's success in nontraditional market expansion through their "Buena Salud" program—a culturally authentic plan connecting Hispanic and Latino members with an Oscar care team, primary care provider, and healthcare community that share their cultural heritage. This Spanish-first experience has achieved an exceptional Net Promoter Score of 87, demonstrating how personalized care models can transform member engagement.
As Chief Product Officer at Lyric, I shared my perspective on how technology partnerships are evolving in response to changing consumer expectations. We're seeing a fundamental shift from "building for" to "building with" healthcare organizations, creating more collaborative approaches to digital transformation. The discussion highlighted how our industry is moving beyond traditional vendor relationships to form strategic partnerships that can accelerate innovation and enhance personalized care delivery. Schulte reinforced this theme, emphasizing SCAN's approach to sustainable growth through strategic provider partnerships, particularly in how they're leveraging technology to create more convenient and personalized Medicare Advantage experiences.
Payer-Provider Collaboration
The afternoon's semi-keynote panel on payer-industry collaboration featured compelling insights about transformative change. Tom Grote of Banner|Aetna addressed one of healthcare's most pressing challenges: managing the rising demand for expensive treatments like GLP-1s and genetic therapies. In the past, Grote noted "As these interventions become more common,
finding a sustainable path will mean navigating the tension between cutting-edge treatments and affordability." This sparked discussion about evolving payer-industry collaborations to balance access with cost management.
Rushil Desai highlighted how Aetna Better Health of Illinois has built one of the state's largest value-based care footprints, emphasizing how strong provider partnerships have been crucial for addressing health inequities. Blue Cross NC's Sonny Goyal brought attention to a critical gap in current value-based payment models: the lack of financial incentives for whole-person care, particularly in behavioral health integration with primary care. And Dr. Katherine Hobbs of Author Health built on this theme, exploring specific challenges that often discourage payers and providers from pursuing value-based agreements for behavioral and primary care integration, while offering strategies to foster stronger collaboration between these key stakeholders.
Leadership Insights: Chris Webber's Closing Keynote
The day concluded with an unexpected highlight as NBA legend Chris Webber brought fresh perspective to healthcare innovation and leadership. His engaging presence and willingness to connect with attendees offered a perfect complement to the day's technical discussions. Webber shared powerful insights about maintaining focus as a fundamental strength and finding fulfillment within the growth process.
His concept of "appropriate fear" as a guide for measured risk-taking resonated deeply with the audience, as did his unique perspective on criticism, noting that "It's an honor to be booed - they're clapping for you in reverse." His observation that "If you honor the moment, you'll put the work in" perfectly captured the day's emphasis on thoughtful, dedicated approaches to healthcare transformation.
Key Themes
The day's discussions revealed several critical themes shaping the future for payers:
Strategic Growth Evolution: Health plans are moving beyond traditional metrics to focus on sustainable, value-driven expansion strategies.
Technology Integration: AI and digital tools are becoming fundamental to operations, with a focus on practical implementation.
Identity-Centered Care: Success increasingly depends on creating experiences that authentically reflect and serve member identities and communities.
Partnership Models: Sophisticated collaboration across the healthcare ecosystem is crucial for success.
Value-Based Care Maturity: Organizations are finding innovative ways to align incentives while maintaining focus on quality outcomes.
The sophisticated discussions and forward-thinking approaches shared during Day 1 suggest that despite the complexity of healthcare transformation, the industry is actively developing innovative solutions. The convergence of technology, identity-centered care, and strategic partnerships points to a new era where success depends not just on operational excellence, but on authentic engagement with member communities and strategic deployment of emerging technologies.
DAY 2
Prior Authorization and Consumer-Driven Healthcare
Healthcare's most pressing challenges – from skyrocketing GLP-1 costs to AI integration – took center stage during the final day of Becker's Payer Issues Roundtable. As consumer expectations evolve and technology reshapes care delivery, industry leaders shared insights that revealed an industry not just adapting to change, but actively driving transformation.
The day began with a compelling examination of prior authorization transformation. Robert Groves, Chief Medical Officer of Banner|Aetna, who had identified this as his number one trend to watch in 2024, led a discussion on how automation and AI are revolutionizing the process. The panel explored upcoming legislative reforms and their potential impact on prior authorization processes, while examining how these changes align with value-based care models. A key focus emerged: balancing automation efficiency with appropriate clinical oversight as regulatory landscapes evolve.
Consumer-driven healthcare took center stage mid-morning, with Stephen Anderson of BlueCross BlueShield Michigan sharing how consumer preferences are directly reshaping provider contract negotiations. Peter Nakhla highlighted Oscar Health's digital-first model and their ambitious goal of reaching 4 million members by 2027. In addition, Peter shared more on the actions of Oscar to better align consumer expectations with payment options.
The discussion turned particularly interesting when panelists explored how social media has influenced GLP-1 awareness and demand, forcing plans to reconsider traditional approaches to benefit design and member engagement.
Chief Medical Officers on Specialty Medications and Technology
A distinguished panel of Chief Medical Officers, including representatives from Cleveland Clinic Employee Health Plan and UCare, tackled the pressing challenge of specialty medication costs. Their discussion centered on evolving coverage strategies for GLP-1 drugs over the next three to five years, while exploring how AI and emerging technologies are reshaping coverage determinations. Regulatory considerations emerged as a critical factor in these decisions. Additionally, the panel discussed how emerging technologies, including AI, are helping to shape their overall strategy.
Advancing Health Equity Through Innovation
The afternoon's health equity session brought together Shannon Wilson of Priority Health, Yvette LeFebvre of Evernorth Health Services, Dr. Devon Zoller of Cleveland Clinic Employee Health Plan, and other experts to explore fundamental questions about implementing effective health equity initiatives.
The panel explored the vital role of community partnerships in fostering health equity, with leaders discussing which partnerships and initiatives their organizations have found most effective. The conversation then turned to transformative approaches for addressing social determinants of health, examining how these efforts translate into improved care access and
outcomes. Digital health solutions and telemedicine emerged as key topics, with panelists considering how these technologies can bridge healthcare access gaps in underserved populations while acknowledging potential barriers that need to be overcome. Rounding out the discussion was a focus around ensuring the long-term sustainability of health equity initiatives, with panelists examining which strategies prove most effective in creating lasting impact.
Data Analytics and AI Transformation
The intersection of data, AI, and healthcare delivery sparked intense discussion as Mac Davis of Belong Health and other technology leaders explored how AI is personalizing the Medicare Advantage experience. The conversation delved into practical challenges of scaling these technologies while maintaining data security and member trust. Population health management emerged as a key use case, with leaders sharing specific strategies for managing at-risk populations through predictive analytics.
Future Vision: Disruption and Growth Through 2030
The day's final session brought leaders from major organizations together to examine disruption and growth through 2030. Panelists shared diverse perspectives on industry disruptors: BCBS Illinois's Shelley Turk highlighted a fundamental shift in approaching obesity care through enhanced member tools and benefits, while Inland Empire's Edward Juhn emphasized technology utilization and future healthcare system design, noting that the challenge isn't data volume but extracting valuable insights.
GEHA's Alexis Rolloff identified three key disruptors: AI and Gen AI for member experience enhancement, demographic shifts toward seniors, and strategic partnerships. UCare's Dr. Tenbit Emiru stressed balancing affordability with access, emphasizing that obesity management transcends "just a number on a scale," while also touching on her concerns around Medicaid redeterminations' impact on risk pools.
When discussing growth opportunities, Turk emphasized that payers' value proposition must extend beyond paying for care to better balance access, network adequacy, and cost. Juhn stressed making quality central to every decision while cautioning against complacency, memorably noting "there's a lot of motion in healthcare, but very little motion forward." Emiru reinforced the importance of keeping value at the center of value-based plan design, completing a session that revealed both the challenges and opportunities ahead for health plans.
Several critical themes emerged throughout the day. Prior authorization transformation is moving from aspiration to reality, driven by both technological advances and regulatory pressure. Consumer preferences, particularly around digital access and transparency are reshaping traditional payer-provider relationships. Health equity has evolved from a separate initiative to become integrated into core strategic planning, with measurable outcomes and sustainable approaches taking center stage.
The Path Forward: A New Era of Health Plan Innovation
As the Becker's Payer Issues Roundtable concluded, it became clear that the industry stands at an inflection point where traditional approaches to growth, technology, and member engagement are being fundamentally reimagined. The convergence of discussions across both
days – from Oscar Health's culturally authentic engagement strategies to Edward Juhn's call for extracting meaningful insights from abundant data – points to an industry recognizing that sustainable transformation requires more than incremental improvements.
The sophisticated interplay between AI implementation, value-based care evolution, and identity-centered healthcare delivery suggests that successful health plans will be those that can simultaneously navigate regulatory pressures, harness technological capabilities, and authentically serve diverse member populations.
As health plans tackle pressing challenges like GLP-1 management and prior authorization transformation, the path forward demands not just operational excellence but a fundamental rethinking of the payer's role in healthcare delivery. The insights shared throughout the conference suggest that while the complexity of healthcare transformation remains daunting, industry leaders are moving beyond theoretical frameworks to implement practical, sustainable solutions that could fundamentally reshape the healthcare landscape.
About Lyric
Lyric, formerly ClaimsXten, is a leading AI healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated, expert teams, and top technologies help deliver up to $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric is investing in AI driven technology to ease implementation and speed to value for customer savings, while offering enhanced and newly available solutions through internal product development and strategic partnerships, including recently announced partnerships with Concert Genetics, Autonomize AI, and now, Codoxo. Discover more at Lyric.ai.
