Summary
The evolving dynamics of the payer-provider relationship are highlighted as organizations navigate the complexities of value-based care, prior authorization reforms, and increasing affordability pressures. Executives at Becker's 5th Annual Fall Payer Issues Roundtable will engage in discussions on benefit design, network strategy, and the financial and regulatory factors reshaping healthcare payments.
Dr. Jeremy Wiginton, Chief Medical Officer at Capital Blue Cross, shares insights from the company's recent data on behavioral healthcare and employer costs. The findings indicate that earlier access to behavioral health services significantly reduces the need for emergency care, with Capital reporting a 9% decrease in behavioral health-related emergency department visits in 2025. This improvement follows the establishment of an in-house behavioral health model and a 40% expansion of their network, which included both traditional and virtual providers.
Dr. Wiginton emphasizes the importance of collaboration and communication with healthcare providers to address barriers to joining the network, such as reimbursement strategies and administrative burdens. He notes that successful outreach and engagement with both existing and new providers have led to enhanced access to care for members, ultimately benefiting employers by reducing healthcare costs associated with unmanaged behavioral health issues.
Looking ahead, Dr. Wiginton identifies opportunities to apply similar models to other specialty areas, including autoimmune and gastrointestinal care, as well as perimenopausal health. He advocates for ongoing dialogue with healthcare networks, clients, and members to understand needs and improve care delivery, underscoring the importance of listening before seeking solutions.
Show Notes
In this episode, Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross, discusses expanding behavioral health networks, improving access and navigation, and using integrated care strategies to reduce costs and emergency department utilization.
More from Becker’s Healthcare Podcast
In this episode, Penny Jefferson, RN, Director of Clinical Documentation Integrity Services in the HIM Division of Patient Financial Services at UC Davis Medical Center, joins the podcast to discuss whether AI is truly improving workflows and the importance of supporting the entire patient journey. She also shares insights on the growing need for clinical documentation integrity within workflows and how she defines success as a leader.
In this episode, Kevin Neese, MD, Co-owner, Helix Advanced Medicine, discusses building a prevention focused primary care model, improving healthspan, and using early risk detection to keep patients healthier and out of the hospital.
In this episode, Dr. Daniel Sun, Orthopedic Surgeon at Tufts Medical Center, discusses advances in hip replacement, implant longevity, robotics and AI, and the growing shift toward outpatient procedures. He also explores balancing faster recovery and cost savings with patient safety and complication prevention.
In this episode, Tieraona Low Dog, MD, ABOIM, Founding Director of the Integrative and Functional Medicine Fellowship and pioneer in integrative medicine, and Shaista Malik, MD, PhD, MPH, Executive Director of the Susan Samueli Integrative Health Institute and Vice President of Integrative Health at UCI Health, join the podcast to discuss acupuncture and the integration of integrative and functional medicine into patient care. They also share insights on addressing skepticism, fostering an open-minded approach to healthcare, and the leadership principles that guide the fellowship.
This episode recorded live at the Becker's 11th Annual Health IT + Digital Health + RCM Conference features Marola Kraczek, MA, Senior Change Enablement Specialist, HCA Healthcare, who discusses the role of change management in turning healthcare data into actionable insights, reducing workflow fragmentation and supporting clinician adoption.