RN Care Manager - Oncology

Valley Advantage health plan launch. Capital Blue Cross and St. Luke's University Health Network have joined forces to introduce a new health insurance option designed to improve affordability and access to quality healthcare. The new offering, known as Valley Advantage EPO, aims to help employers manage rising healthcare expenses while providing employees with streamlined access to one of Pennsylvania's leading healthcare networks. This collaboration reflects a growing trend toward value-based healthcare models that prioritize outcomes, efficiency, and patient satisfaction. Capital Blue Cross and St. Luke's partnership. A strategic healthcare collaboration. The partnership between Capital Blue Cross and St. Luke's University Health Network combines the strengths of a major regional health insurer with a highly regarded healthcare provider system. Both organizations share a commitment to improving healthcare access, reducing costs, and delivering better patient outcomes. According to company leaders, the collaboration creates a healthcare solution that balances affordability with quality care. As healthcare costs continue to rise nationwide, employers are increasingly seeking innovative insurance options that can help control expenses without sacrificing benefits. What is Valley Advantage EPO? A new employer-focused health plan. Valley Advantage EPO (Exclusive Provider Organization) is a health plan designed specifically for employers in Pennsylvania's Lehigh Valley region. The plan features rates that are lower than Capital Blue Cross' standard PPO offerings, making it an attractive option for organizations looking to reduce healthcare spending. Unlike traditional plans, Valley Advantage EPO is structured around a value-based care model. This approach rewards quality healthcare outcomes rather than the volume of services delivered. As a result, employers and employees may benefit from more efficient care coordination and improved health outcomes. Key benefits for employers and employees. Lower healthcare costs. One of the biggest advantages of Valley Advantage EPO is its competitive pricing. Employers gain access to lower premium rates while maintaining comprehensive healthcare coverage for their workforce. This can help organizations better manage employee benefits budgets in an environment of increasing medical costs. Simplified access to care. The plan provides streamlined access to St. Luke's extensive healthcare network, which includes multiple hospital campuses and hundreds of provider locations. Employees can receive care from in-network providers without the administrative burden often associated with traditional health plans. No referral requirements. Another significant benefit is that members do not need referrals for in-network services. This feature reduces delays and allows patients to access specialists more efficiently when medical needs arise. Wellness incentives. Eligible businesses with more than 100 employees can also receive wellness credits. These incentives encourage organizations to invest in employee health and wellness programs, which can contribute to a healthier workforce and lower long-term healthcare costs. Value-Based care at the core. Improving outcomes through better care models. Value-based care continues to gain momentum across the healthcare industry. Instead of rewarding providers based solely on the number of services performed, this model focuses on patient outcomes, quality measures, and overall efficiency. Valley Advantage EPO incorporates these principles by aligning incentives between the insurer and healthcare provider network. Consequently, patients may experience more coordinated care, fewer unnecessary procedures, and better overall health outcomes. Availability and eligibility. Who can access the new plan? The Valley Advantage EPO is currently available to employers with more than 100 employees located in Lehigh and Northampton counties in Pennsylvania. Smaller businesses are expected to gain access beginning in 2027, expanding the plan's reach to a broader employer base. This phased rollout allows Capital Blue Cross and St. Luke's to scale the program effectively while ensuring high service quality and operational efficiency. Impact on healthcare costs. Addressing rising employer healthcare expenses. Healthcare expenditures continue to increase for employers across the United States. Industry projections indicate that employer-sponsored medical and prescription drug costs are expected to rise significantly in 2026. Therefore, employers are actively searching for solutions that provide quality care at sustainable costs. Valley Advantage EPO directly addresses this challenge by offering lower rates, enhanced care coordination, and wellness-focused incentives. These features can help employers achieve greater cost predictability while supporting employee health. Future outlook. A model for payer-provider collaboration. The partnership between Capital Blue Cross and St. Luke's may serve as a blueprint for future payer-provider collaborations. As healthcare organizations seek new ways to improve affordability and outcomes, integrated models like Valley Advantage EPO are likely to become more common. Furthermore, the initiative demonstrates how insurers and health systems can work together to create innovative products that benefit employers, employees, and healthcare providers alike. Conclusion. The launch of Valley Advantage EPO marks an important step in the evolution of employer-sponsored healthcare. By combining lower costs, simplified access to care, wellness incentives, and a value-based care framework, Capital Blue Cross and St. Luke's University Health Network are offering a compelling alternative to traditional health plans. As healthcare costs continue to rise, innovative partnerships like this could play a significant role in shaping the future of affordable, high-quality healthcare coverage.

AI, community, and the power of slowing down: leadership insights from Todd Shamash. Every morning, Todd Shamash arrives at Capital Blue Cross headquarters and sees a familiar landmark just across the street - his old high school. The headquarters sits on a field he once rode past on his bike as a kid growing up in Susquehanna Township. That local connection isn't just sentimental - it's a daily reminder of the commitment he feels to the community that shaped him. As Capital's President and CEO, Shamash leads a company that serves more than 800,000 members across 21 counties in central Pennsylvania and the Lehigh Valley. Capital Blue Cross is more than just a health insurer - it's also a community partner working to improve access to effective, affordable care. In a recent episode of the C-Speak podcast - titled "Leading with Locally Grown Passion" - Shamash talked with hosts Nell McCormack of WITF and Jim Holmes of PNC Bank about how he balances innovation, regulation, and culture while staying grounded in the region he still calls home. Here are four leadership insights from that conversation: Shamash believes that community engagement and business performance aren't separate goals - they're intertwined. "Even with all the changes, it's still a people business," he said. "It's still about that relationship with employers. Do they trust you?" By investing in local schools and community nonprofits, Capital Blue Cross builds trust with the very people it serves. That trust, Shamash said, can be a competitive advantage. In a fast-paced industry like healthcare, Shamash sees value in pausing to understand the big picture. "Often we get so focused on the tactics that we start missing the bigger picture," he explained. "As a leader, how do you get your teams to think two steps ahead?" he said. "That's why slowing down can sometimes help us move faster and more effectively in the long run." Artificial intelligence is transforming how businesses operate, and Capital Blue Cross is no exception. But Shamash is clear: AI should support the work people do, not replace them. "AI comes up in every boardroom conversation now," he said. "It brings both risk and opportunity, especially in a highly regulated industry like ours." One example: Capital has launched a pilot program in which AI helps summarize conversations between members and customer services so that Capital staff can focus more on follow-up services. "We still need our people making the final decisions," Shamash said. "The key is moderating how you use technology to its best extent, but not going too far, which I think could be detrimental to people and our industry." When asked what skills matter most in today's rapidly changing world, Shamash said: "While it's hard to predict exactly what the future holds, one thing is constant: learning." While technology, regulations, and customer expectations are constantly shifting, Shamash believes staying curious and adaptable is more than a personal strength - it's a business necessity. "I view learning as a journey," he said. "If you're not reading trade publications, no matter what your trade is, you're going to fall behind. Be open to new things." To hear more business and leadership insights, listen to the full episode with Todd Shamash by searching "C-Speak WITF" on Apple Podcasts, Spotify, or TuneIn or visiting the WITF website. BridgeTower Media newsroom and editorial staff were not involved in the creation of this content.

Capital Blue Cross will be the Presenting Sponsor of Lehigh Valley Economic Development Corporation's 2025 Annual Meeting that will be held March 18 at ArtsQuest at SteelStacks in Bethlehem.