The past year has forced health plans to nimbly adapt to the demands of a global pandemic, including massive spikes in demand for telehealth and new therapies—and soon, vaccines—coming to market.
These changes, especially the now-larger market for virtual visits and digital care, are likely to carry on beyond COVID-19. As such, health plan executives who play a key role in advancing these technologies will be major players to watch in the coming months.
Other industry trends include the growing verticality of the insurance market: Major payers now largely own and operate their own pharmacy benefit manager arms, and plenty have a growing stable of providers who treat patients directly.
That means players at the top much account for an increasingly diverse slate of businesses.
As we enter the downhill slide into 2021, here are just a few of the insurance executives we’ll be keeping an eye on.
Karen Lynch, president of Aetna and incoming CEO of CVS Health
When longtime CEO Larry Merlo steps down in February, Aetna chief Karen Lynch will ascend to the top job at CVS Health’s sprawling enterprise. Lynch joined CVS as part of its acquisition of the health plan in 2018.
Beginning in March, Lynch took the lead on CVS’ response to the COVID-19 pandemic. She has spoken publicly multiple times over the past several months about the way the pandemic is impacting mental health and behavioral health services.
Lynch has more than 30 years of experience in the healthcare industry that also include stints at Cigna and Magellan Health Services.
CVS spokesman T.J. Crawford said in a tweet that when Lynch becomes the company’s CEO, she’ll be the world’s highest-ranked female CEO.
Wyatt Decker, CEO of OptumHealth
UnitedHealth Group’s Optum subsidiary has accounted for much of the insurer’s growth over the past several quarters, with no business segment growing more than OptumHealth.
OptumHealth, which is headed by CEO Wyatt Decker, M.D., encompasses the healthcare giant’s provider services, including specialty and primary care, and it serves 98 million customers.
To illustrate just how quickly this business line is growing: In the third quarter of this year alone, revenue per patient was up 25%.
Decker joined Optum in 2019 from Mayo Clinic, where he served as chief medical information officer and CEO of Mayo Clinic in Arizona. During his tenure, Mayo Clinic in Arizona earned a slew of accolades including the safest teaching hospital in the U.S. and the top hospital in Arizona as ranked by U.S. News and World Report.
Tim Wentworth, CEO of Evernorth
Much like UnitedHealth, Cigna has seen a notable boost in its finances from its acquisition of Express Scripts, the nation’s largest pharmacy benefit manager.
Building on that deal, Cigna announced in September that it would rebrand its health services business, which includes Express Scripts, as Evernorth and launch a slew of new solutions under that umbrella.
Tim Wentworth, who helmed Express Scripts at the time of the acquisition, has been tapped to lead Evernorth and the subsidiary's ambitious goals for research and innovation. Wentworth joined the PBM following its merger with Medco in 2012.
Evernorth launched in October one of its first new solutions: FamilyPath, an integrated fertility solution. Cigna CEO David Cordani said that Evernorth is tackling the development of these platforms with transparency in mind to avoid merely prescribing solutions to the market.
Cheryl Pegus, president of Cambia Consumer Health Solutions
Cheryl Pegus, M.D., has worn multiple hats at Pacific Northwest Blues insurer Cambia Health Solutions and currently serves as president of Cambia Consumer Health Solutions.
But later this month, she will depart the insurer to become executive vice president of health and wellness at Walmart, playing a key in the retail giant's ongoing push into the healthcare space. At Walmart, Pegus will spearhead expansion of the company's "bold healthcare vision."
In the role, Pegus will oversee 4,700 pharmacies, 3,700 vision centers, Walmart Health's clinics, digital health platforms and Walmart Insurance Services, the company's newly launched insurance brokerage.
At Cambia, she also played a key role in driving the insurers' response to the COVID-19 pandemic, and she was recently honored by Fierce Healthcare as one of our 2020 Women of Influence.
Rajeev Ronanki, chief digital officer at Anthem
Technology has proven critical in the face of COVID-19, both as demand for virtual care options skyrocketed and as the need for data to track the spread and impact of the virus grew.
At Anthem, Rajeev Ronanki and his team quickly joined up with artificial intelligence startup CloudMedx to launch C19 Explorer, an analytics tool that tracks and predicts the effects of COVID-19.
And it's available for free to public health officials and community leaders who need access to the data. Clients can also purchase a paid version of the platform that allows for more personalized analytics reports based on internal data that is uploaded into the system.
While the platform does include data on positive cases and mortality rates, it also examines the social determinants of health and other data sets to measure the impact of COVID-19 beyond merely physical health.
Mike Mikan, president and CEO of Bright Health
Startup insurer Bright Health has made a notable splash in the market with its growing geographic reach and significant venture capital backing.
The company most recently closed a $500 million funding round, bringing total investment in the company to over $1.5 billion since early 2016.
In addition, Bright Health also announced plans to acquire Brand New Day Health Plan, expanding its footprint in Medicare Advantage. Financial terms were not disclosed, but leaders at both companies said that the deal would allow for a combination of Bright Health's tech-enabled approach and Brand New Day's local and community ties.
The company operates in 43 markets across 13 states and brings in $1.2 billion in annual revenue.