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…

Addressing Structural Challenges in the Business of Benefits Through AI Innovation Employer plans, whether self-funded under the Employee Retirement Income Security Act of 1974 (ERISA) or fully funded through a commercial plan, will likely have a proactive mindset that will lead to greater coverage modeling scenarios, plan accountability, and a focus on outcomes to successfully…

AI isn’t failing because it lacks capability. It’s failing because it isn’t consistently reaching the moments where decisions are made. Healthcare isn’t struggling to adopt AI. In fact, the industry has moved quickly from early experimentation to widespread investment in tools designed to improve clinical decision-making, reduce administrative burden, and drive financial performance. Many health…

Value-based care runs on a simple bet: an organization takes financial responsibility for a population’s health and keeps the savings if it can hold costs down. The organizations making that bet, physician-led IPAs, ACOs, Medicare Advantage groups, and the health plans they contract with, all run the same kind of back office to deliver on…

Healthcare’s data isn’t missing. It’s everywhere. We talk about value-based care like it’s a contracting problem. Get the attribution and quality measures right, and performance follows. But the real work of winning under risk happens inside a 15-minute visit, with a physician rebuilding a patient’s story from records scattered across the EHR, an HIE, a…

When physicians describe the forces reshaping medicine, they increasingly point not to a new device or a breakthrough drug but to the economics underneath their work. The move from fee-for-service to value-based payment is no longer theoretical. For a growing number of specialists, it is starting to feel personal. That change in perception is worth…

During 2025, the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMS) announced seven new value-based payment models. Among these new models is the Ambulatory Specialty Model (ASM), which is specifically focused on improving efficiency in care for two chronic conditions—lower back pain and heart failure. Another new model, the Long-term Enhanced…

Despite its increasing use, artificial intelligence integration is lagging at healthcare systems and organizations across the U.S., according to a new survey from Arcadia. Fifty-two percent of respondents report that AI can fundamentally transform healthcare in correct applications, though about half (53%) of AI insights are “only partially embedded” into decision-making processes and only 14% report full…