By Stephanie Fraser
Conference Correspondent, Answers Media Network
LinkedIn: Stephanie Fraser
Event: HIMSS 2025
When: March 2025
Where: Las Vegas NV
At HIMSS25, a distinguished panel of health plan leaders gathered to discuss how payers are moving beyond fee-for-service models and embracing AI, digital health and value-based care to advance patient outcomes and drive system-wide transformation.
Led by Edward Marx, CEO of Marx Advisory, the panel brought together Aric Sharp (Clover Health), Heather Lavoie (Horizon BCBSNJ), Sakshika Dhingra (Humana), and Khin-Kyemon Aung (SCAN Health Plan) to underscore the need for payer-led strategies that enhance care delivery, improve provider performance, streamline workflows and foster member engagement.
AI and Digital Health: Key Drivers of Payer Innovation
AI and digital transformation are at the center of how payers are reshaping healthcare delivery. For example:
- At Clover Health, AI is assisting primary care physicians make more accurate diagnosis and treatment decisions;
- Horizon BCBSNJ’s AI-driven clinical program redesign is helping to improve case routing and patient outreach through more efficient labeling and automation; and
- At SCAN Health Plan, they are using AI for remote patient monitoring to enhance care coordination for seniors in assisted living.
“Now we must move beyond AI experimentation to establishing clear frameworks for adoption, training and governance,” said Lavoie, CIO & EVP of Enterprise Operations, Business & Technology Solutions, Horizon BCBSNJ.
Barriers to Payer Innovation: Culture, Reimbursement and Interoperability
Despite AI and digital health advancements, several obstacles continue to slow the pace of payer-driven innovation. Cultural resistance to change, reimbursement challenges and interoperability gaps continue to persist, with limited data-sharing capabilities among payers and providers, hindering care coordination and digital transformation.
“Without a culture that supports learning and adaptation, innovation stalls before it even begins,” said Sharp, CEO of Value Based Care, Clover Health
Collaboration: The Future of Payer Innovation
A recurring theme shared by the panelists was the importance of collaboration in driving meaningful innovation. Building trust through long-term, transparent partnerships rather than transactional relationships is essential for sustainable success. Avoiding fragmented solutions by integrating digital tools into existing workflows, rather than adding disjointed technology layers, also ensures seamless adoption and efficiency.
Additionally, leveraging real-world insights from frontline providers and patient feedback helps shape more effective digital health strategies that directly address real-world challenges.
What’s Next for Payer Innovation?
The panel closed with a discussion on emerging trends that will define the future of payer-driven healthcare innovation, including:
- Expansion of hospital-at-home models, which are proving to be effective for chronic disease management and post-acute care.
- AI-driven workforce solutions that reduce administrative burdens and streamline care coordination for payers and providers.
- Blockchain and advanced analytics, which are improving data sharing and interoperability across healthcare systems.
As AI adoption accelerates and cybersecurity risks grow, speakers reinforced that payers must take a proactive role in driving sustainable healthcare transformation. Not just implementing new technology but also investing in workforce development and training, supporting vbc models, and prioritizing patient-centric strategies.
“The future of healthcare will be shaped by those who embrace collaboration, adaptability, and a relentless focus on solving real problems,” said Khin-Kyemon Aung, Senior Director of Healthcare Services and Medical Director, Primary Care Physician, SCAN Health Plan.
Speakers also made it clear that health plans are positioned to be at the forefront of digital transformation—if they can successfully align technology, policy, and culture to drive lasting impact.