Becker’s connected with more than a dozen executives at payers across the country to learn what their top growth opportunities are in 2025.
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Editor’s note: Responses have been lightly edited for length and clarity.
Question: What is the most exciting growth opportunity for your organization in 2025?
David Agler, MD. Chief Medical Officer at First Choice Health: In short, case management. We differentiate ourselves through a member-centric approach, focusing on genuinely impacting care. Strong collaboration between us and members, providers and hospitals is essential for high-quality, cost-effective care. Through effective case management, particularly upstream of high-cost needs, we drive meaningful improvements. Our 2025 growth strategy includes significantly increasing case management services to members, expanding our staff to meet this demand. However, we strategically leverage case management only where it can make a tangible impact on cost and quality of care. We see substantial potential, as we haven’t yet maximized the positive impact our team can have on members. This targeted, proactive engagement ensures appropriate care at the optimal time and location, a key differentiator.
Margaret Anderson. Interim President at Health Alliance Plan: Our growth strategy is built on advancing value-based care, expanding our provider network, and deepening our strategic partnerships to deliver affordable, high-quality care. At the core of our approach is a strong connection to our community and stakeholders, ensuring we’re responsive to their needs and improving the health and well-being of those we serve in a sustainable, meaningful way.
Eric Cannon, PharmD. Chief Pharmacy Benefits Officer at SelectHealth: This year, I am most excited to grow Scripius’ customer base even more. It has been thrilling to see our customers — employers, health systems and health plans — embrace our truly transparent business model. By actively sharing information, ensuring that information is understood and being forthright and honest in our communication and actions, we are leading the much-needed change within the PBM industry through ethical and transparent business practices.
Louis DeStefano. Senior Vice President, Growth at Oscar Health: Oscar’s mission is to make a healthier life affordable and accessible for everyone. Since our inception, we have consistently sought innovative ways to turn this vision into reality for more individuals. In recent years, we have been vocal in our support for expanding the individual market and introducing a consumer-centric healthcare model to Americans. The ACA already enables 24 million people to purchase high-quality plans that fit various budgets, preferences and health needs. 2025 is the year when we will continue to grow that market and redefine healthcare experiences.
Angie Kalousek Ebrahimi. Senior Director, Lifestyle Medicine at Blue Shield of California: One promising area of growth that we are pursuing at Blue Shield of California is driving our members into high value condition management programs through our digital app. Blue Shield of California has been working to deliver a member health record for each member which provides information about things like preventive screenings that are due, medications that need to be filled as well as relevant clinical programs that are available. The programs offered, both digital and in person, have been proven to improve outcomes and cost of health care. Members will receive in app messages about programs that meet their personalized needs, as well as information within the member health record. By driving members to these programs, we can simultaneously solve for improving access and quality, as well as reducing cost.
Nancy Klotz, MD. Chief Medical Officer, Brighton Health Plan Solutions. My team and I are actively enhancing our comprehensive in-house care management solutions to meet the growing demands of our clients. Recently, we’ve implemented advanced algorithms to proactively identify more members in need of additional support, introduced targeted strategies to improve member outreach and strengthened coordination across care gaps, social determinants of health, behavioral health, maternity care and other health programs. Our dedicated team of registered nurses and licensed clinical social workers is committed to increasing member engagement, improving access to high-quality providers and ultimately driving better health outcomes and overall well-being.
Candice Michaelson. General Manager and Vice President, Cigna Pharmacy: We are focused on advancing condition-specific innovations to drive better health outcomes for the customers we serve, with a particular emphasis on expanding our differentiated GLP-1 solutions. As these medications continue to shape healthcare trends with new implications beyond Type 2 Diabetes and weight management, we continue to evaluate and evolve our approach to ensure affordability, access and appropriate use. At the beginning of the year, we launched EncircleRx for Cigna Healthcare clients, which is a new program that provides customers personalized lifestyle coaching along with medication management and clinical safeguards to optimize care, manage costs, and prevent misuse. With our expertise in clinical drug management, predictive analytics and integrated care, I’m excited about the growth of this program so that we can help more customers safely and affordably access these medications, and help clients navigate the growing complexity of GLP-1 utilization.
Ria Paul, MD. Clinical Associate Professor, Stanford University School of Medicine; Chief Medical Officer of Santa Clara Family Health Plan: In this changing healthcare landscape, it is imperative that organizations are in alignment with the innovations that are upcoming or already in the implementation phase. As CMO of Santa Clara Family Health plan, my primary goal is to integrate AI in various clinical pathways that integrate with the care delivery side. First and foremost, risk stratification of members and streamline interventions accordingly utilizing AI in both areas.Utilizing AI for various chronic disease management along with a model incentivizing members and providers, keeping them healthy. As every payer and health system are navigating the pros, cons and security issues associated with AI, the future is promising as we strive to improve the care of members across the care continuum.
Harlon Pickett. President, Eagle Care Health Solutions: In 2025, the most exciting growth opportunity for Eagle Care Health Solutions lies in expanding our partnerships with employers seeking innovative, cost-effective healthcare solutions. As businesses grapple with rising healthcare costs and limited access to quality care, our tailored alternative health plans offer a sustainable path forward. By leveraging direct contracting, value-based care models and enhanced transparency, we empower employers to provide better benefits at lower costs. This year, our focus is on scaling these solutions nationwide, demonstrating that high-quality, affordable healthcare is not just possible — it’s within reach.
Philip Randall. Director, Population Health & Community Programs at Banner | Aetna: We’re growing this year with a strong focus on scaling our population health programs. By further integrating and streamlining these initiatives, we can deliver proactive, coordinated care to more high-risk and rising-risk members. By doing so, we aim to improve health outcomes, reduce avoidable costs and create a more sustainable, patient-centered healthcare system.
Chandni Sud-Thavakumar. Senior Vice President, Health Plan Performance Operations at MassAdvantage: The most exciting growth opportunity in 2025 is implementation of a holistic approach to member experience across the entire organization. This is inclusive of engagement of the network, service recovery and collecting real-time survey data from the various touchpoints to remain agile in understanding areas of opportunity and effectiveness of any interventions put into place.
Anthony Thompson. Senior Vice President, Healthcare Network Strategy at CDPHP: There is a myriad of exciting opportunities on the horizon in healthcare between technological advancements and new ways of doing businesses. With that said, one of the most exciting opportunities still exists simply in the strengthening collaboration between payers and providers to drive value based care. Working together, we can enhance our interpretation of data in designing programs, streamline operations and develop innovative care models that continue to raise the bar on improving member outcomes. As the industry shifts towards value based reimbursement, this collaborative approach positions us for sustainable growth and long term success.
Ty Wang. Co-Founder and CEO of Angle Health: We built Angle Health with AI-powered, human-in-the-loop workflows at the core of our operations. So as an AI-enabled health plan and healthcare technology company, we are most excited about doubling down on our investments in AI. One of our core competencies at Angle Health is our ability to build highly engaging, AI-driven experiences that deliver seamless, operationally efficient processes that enhance member access to care. As we move through 2025, our growth will be driven not only by continued rapid market and topline revenue expansion, but also through launching innovative, value-based products and partnerships that democratize access to healthcare services and redefine personalized healthcare delivery for Angle Health members and patients.
Meredith Williams, MD. Vice President, Clinical Affairs at Oscar Health: At the Office of Clinical Affairs, we are focused on building out the clinical products and services that meet the needs of individuals. We continue to build innovative and culturally competent solutions around our members – more tailored to care drives better outcomes. We know the best way to get these types of solutions in the hands of more Americans is through an expanded individual market. Innovations like ICHRA will help continue to bring more people into the market creating more competitions and better healthcare for all.