Last week, influential voices in healthcare attended AHIP 2025, where speakers offered a glimpse into where the insurance industry is headed.
Topics included affordability concerns, the future of agentic artificial intelligence and food as medicine against a backdrop of uncertainty as Medicaid cuts wind through Congress.
Below are some of the major takeaways Fierce Healthcare covered from the three-day conference.
And, take a look at other stories from the event:
- Insurer coalition vows to fight Trump budget bill to final hour
- A look at the current policy environment around Medicare Advantage
- Why Cigna is making a ‘pledge to better’ to its members
Aetna simplifies prior auth requirements
During an opening keynote, new Aetna President Steve Nelson said the insurer is taking steps to help its members access care.
Those changes are important, he said, as payers face up to customer complaints and reckon with general distrust from other healthcare organizations.
“On the consumer side, trust is really driven by [a belief that] we’re incompetent,” said Nelson. “On the provider side, they think we’re deliberate. Well, I can tell you as a person that’s been in this industry a long time, we are not incompetent and we are not deliberately trying to make things harder.”
He then played a video of where the industry is headed, in which an AI voice alerted a family to health concerns in real time. The AI detected flu contagions as the family’s young child entered the home, recommended next steps of care and suggested the family send diagnostic data to a primary care doctor.
In prior authorization, he said the industry has “overused and misused” the tool, so Aetna is striving to “be more thoughtful” about the role it plays. They’ve started to bundle prior auth for some conditions, like breast cancer, where it’s common to have up to six imaging procedures that all must have prior auth approved.
Following the conference, nearly 50 insurers including Aetna, UnitedHealthcare, Blue Cross plans, Humana, Cigna and Centene committed to reducing services subject to prior auth by the beginning of next year.
Nelson also hit upon a theme prevalent through the conference’s sessions: improving the consumer experience. Only in healthcare, unlike other industries, is the motto “satisfaction guaranteed” not descriptive to how Americans feel, he lamented.
The Aetna app includes now includes real-time information about the status of a prior auth claim journey. Similar to a restaurant tracking the food delivery process for a hungry customer’s pickup order (received order, in the oven, out for delivery, etc.), Aetna says it applies the same concept for individuals seeking care. Enrollees can see whether the prior auth is pending, denied and other statuses.
Nelson highlighted Aetna One Advocate, a concierge platform for plan sponsors, helping providers engage with members. He also noted a collaboration model with providers where Aetna partners and embeds in hospitals to help with discharge planning. The goal is to provide better transportation, food planning and caregiver support to members.
Advancing from ‘food as medicine’ to ‘nutrition as medicine’
The "food as medicine" movement has gained momentum in healthcare of late, but experts say it’s critical to continue advancing this model.
Dariush Mozaffarian, M.D., director of the Food is Medicine Institute at Tufts University’s Friedman School of Nutrition Science and Policy, said during a panel at AHIP 2025 that poor nutrition is a major factor in increasing risk for death and disability.
As such, the conversation should move from “food as medicine” to “nutrition as medicine” to better support patients in finding nutritious options that meet their personal health needs.
Food as medicine initiatives often seek to address food insecurity and access challenges, as those can have a serious impact on health. However, Mozaffarian said he thinks about food in a more clinical way.
“The way I think about food use medicine is integrating food-based nutritional solutions into healthcare as a treatment,” he said.
Nutrition as medicine means going beyond a grocery benefit or assistance with transportation to the grocery store, Mozaffarian said. Patients need personalized nutrition counseling and education, and doctors should have the ability to prescribe medically based meals that fit those specific challenges.
Making this work also means the payment processes and vendors need to be in place, enabling those prescription meals and other interventions.
“It's probably not one-size-fits-all, but different solutions for different people,” Mozaffarian said.
Why cybersecurity needs to be embedded in company culture
Cybersecurity has been a consistent challenge in healthcare, and it took center stage for insurers following the hack of Change Healthcare last year.
Industry leaders said during a panel at AHIP 2025 last week that, while it’s crucial to have technological know-how on the team to address cyber threats, treating this issue with the urgency it requires needs to become core to an organization's culture.
Kate Musler, chief financial officer for Highmark Health Plan, said the goal is to reach a point where every member of a team or organization feels that they are a part of the cybersecurity equation, even if they’re not a tech expert.
She used phishing attacks as an example. In this case, given how sophisticated some of these scams can be, it makes every person within the company a potential vulnerability or target.
“It is also the mindset of thinking about cybersecurity as part of our commitment to our customers,” Musler said.
Rob Suarez, vice president and chief information security officer at CareFirst Blue Cross Blue Shield, said during the panel that in addition to organizational buy-in, governance structures are becoming more important than ever with the advent of AI—especially given that healthcare is still early days with the potential for this technology. To date, most organizations are finding administrative uses for AI platforms, but its use in a clinical setting remains nascent.
He added that healthcare’s complexity means cybersecurity teams need the input of experts in the field to really complete the picture. Having a full understanding of where an organization sits in their local community and in the healthcare ecosystem makes it easier to identify the most pressing threats, Suarez said.
“I think what cybersecurity needs is people with real-world experience in healthcare, and understanding the types of business and the type of value that we provide on a daily basis to communities,” he said.
“Why? Because that's how we prioritize the work that we're going to do,” Suarez said.
Ascendiun CEO to healthcare companies: You don’t have a sustainable business
Paul Markovich is the CEO and president of Ascendiun, the new nonprofit parent company of Blue Shield of California.
Ascendiun oversees physician services company Altais and health services and pharmacy business Stellarus.
In a fireside chat at AHIP, Markovich described the U.S. healthcare system as a “negative productivity” economy, where the country spends more money on healthcare, yet satisfaction and quality stagnates. And nearly everyone—from federal and state governments to employers to consumers—don’t have the funds to continue operating in this manner.
“There’s a cliff out there,” he warned. “We don’t know how far away it is … and we just don’t know when we’re going to fall over the edge. Let me put it another way: Your business in healthcare is not sustainable if the industry is not sustainable.”
He also spoke of a pharmacy distribution system that incentivizes selling a higher volume of more expensive drugs. That’s why Blue Shield of California ditched CVS Caremark as its pharmacy benefit manager and is purchasing a biosimilar for Humira directly from a manufacturer that is one-fourth the net price of a normal monthly dose. But he conceded the pace of securing contracts with manufacturers has been slow
“We don’t want rebates; we don’t want fees,” said Markovich, before likening rebates to a kickback. “We’re going to create a distribution administration system where all the players only get paid for their service, not for selling or administering more expensive drugs.”
Increasingly, he said he is an advocate for top-down government reform of healthcare to enact bigger change. Every American should have a digital health record, because “it’s been technology feasible for 20 years.”
AI should make prior authorization obsolete
It’s time for healthcare to eliminate prior auth wholesale, said CEO Abdel Mahmoud, M.D. of Anterior, an AI platform dedicated to helping payers administer prior auth more effectively, in an interview on-site. Mahmoud was a former infantry officer for the British Army and worked for tech companies Meta and Google before founding Anterior.
“The more humans you take out of the [prior auth] process, the more you can make it feel like a background activity that just happens and no one needs to worry about it—except when it gets flagged and there could be a discussion about it,” he said. “But candidly, I don’t think it’s going to go away for another 10 years.”
One of the conference’s leading sponsors, Mahmoud led a short demonstration on Day 2 to show off the company's AI platform. He pitched a future where highly skilled specialists in medicine are no longer bogged down with the drudgery of replaceable tasks, instead complemented by AI agents.
“Maybe instead of doing the work, they should be able to supervise AI doing the bulk of that work,” he told the audience.
He showed how a collection of Anterior agents can parse through medical information, pull data from numerous sources and compile information for medical assistant reviews into a report about the member and prior auth request. Information is automatically cited, allowing a medical professional to click and refer back to original fax documentation in seconds. The AI bot spells out its decision-making process to determine whether a claim should be approved, and it will say if there is gray area or missing information requiring extra human decision-making.
No claim is automatically rejected without human oversight, he added. Also in the pilot phase: a voice AI agent to call providers about prior auth reviews, alleviating time on the phone for physicians.
Successful health plans understand their members the best, but rich data about members are often unstructured and in the clinical record, said Mahmoud. Large medical record reports are utilized quickly for prior auth determinations but then are stored in a data warehouse and only infrequently accessed by various teams. But if the data are instead structured immediately, better care can be delivered, he proposed.
This could help members receive care proactively. In turn, that improves plan star ratings, and healthcare organizations can redeploy more staff to care management and away from monotonous tasks.
Even if, or when, prior auth disappears, the company is looking forward to future revenue streams that can’t be fully envisioned yet until AI is more broadly adopted.
“I feel like a lot of the problems in healthcare start with and end with payers,” he said. “It feels like every startup that comes out of Silicon Valley just goes straight to the provider side. There’s a bit of a trope that health plans just want to deny. No, they have a medical loss ratio. They’re mandated to spend 85% of premiums of the right claims. They’re just doing a pretty terrible job of finding out what’s the right ones.
“But we have to pick a wedge,” he added. “I think you can’t just be here to make money off the prior auth.”