Disruptive Business Models in Healthcare
"We're bankrupting our country, and the entire sector's answer to this unsustainable situation is 'give me more money' or 'don't cut my money'." With that fiery statement, Paul Markovich, CEO of Ascendiun (parent company to BS CA) led us into our fireside chat at AHIP 2025 on disruptive business models in healthcare, which included several calls to action:
💨 If the private sector doesn't fix it, the government will try and do it for us - can't have it both ways.
💨 While payment models are important drivers, it's difficult to effect change solely as an insurer (because you only control so much of the value chain); business model diversification creates more levers to launch and try new operating models for managing total cost of care and consumer experience.
💨 If there's no off-the-shelf solution, channel your inner Voltron and assemble it - as BSCA did with its Pharmacy Care Reimagined initiative, through which a new kind of PBM was built by combining the unique superpowers of multiple partners.
We acknowledged that incumbent payors have been under siege from multiple angles over the last year - e.g. MA v28, shrinking premium pools in Medicaid, shakiness of ACA subsidies, lawsuits, etc. This is reflected in the declining aggregate market cap of the publicly-traded managed care players.
Will incumbents figure out how to protect market share and restart growth? Or will this be the moment in which the challengers take advantage of the uncertainty to gain scale and win in specific categories / regions / populations?
