Registered Nurse Post-Anesthesia Care Unit

Health insurers turn to technology, preventive care to contain rising costs. Health insurers are looking beyond traditional plan design to help employers contain rising health care costs, turning to technology, preventive care, mental health programs and new approaches to how members access care. "Employers continue to face increasing cost pressure," said Ed Shellard, DMD, president and CEO United Concordia Dental. "They know that benefit plans are something that can make them more competitive in attracting employees, but they also want to ensure that they're offering plans that are not only affordable for the business, but also for employees." "We hear it across all segments-everybody wants to ensure affordability," added Joe Haddock, Eastern Pennsylvania Market President Highmark Inc. Preventive care becomes a cost-control tool Shellard said employers are taking a more balanced approach with the health care plans they're offering. "Rather than continuing to increase the employee share of health care, employers are encouraging preventive care to help manage costs," he said adding that dental care is a bit ahead of the curve since traditionally, dental is focused on cleanings every six months. "Employers today are looking for more than a health plan," said Dr. Jeremy Wigginton, Chief Medical Officer at Capital Blue Cross. "They deserve to work with a trusted partner that can help them navigate rising healthcare costs while supporting the health and well-being of their workforce. That's where Capital is focused. We continually invest in care models, technology, and personalized support that make it easier for employees to access care, stay engaged in their health, and address issues before they become more serious and costly." Shellard and Haddock, along with Capital Blue Cross President and CEO Todd Shamash, are among the insurance executives featured in the Central Penn Business Journal's 2026 CPBJ 300. Shellard said controlling costs is about engaging consumers and educating employers about the importance of dental health and preventive care so that care is delivered earlier. It may also need to be more frequent for people with ongoing health issues such as diabetes. "It's less costly to take care of an issue with a cavity; delayed treatment could result in more costly issues such as root canal and/or a crown," he said. "The mouth is not a separate entity. Oral health contributes to good health overall and it also relates to productivity." he said. According to information published by the U.S. Centers for Disease Control and Prevention in May 2024, over $45 billion in US productivity is lost each year due to untreated dental disease. Insurers invest in technology, new plan options Haddock said for Highmark, helping employers contain costs centers on a few areas such as providing great service, adding new options and programs and finding ways to increase engagement with our members. We've also invested significantly in technology to enhance our member platform and app," he said. For Highmark, one of the new options is CopayGo, a co-pay only health plan designed to help businesses control costs. The plan features no deductibles-members pay a flat fee at the time of service; a tiered provider network with providers in Enhanced and Standard tiers based on quality, appropriateness, and cost efficiency; and access to digital tools. Haddock said Highmark has also worked with providers, who meet certain criteria, to streamline the pre-authorization process for medical services. "For providers, there's less paperwork, and for members, it means they often leave the provider's office with an appointment for further care," he said. Wigginton said Capital Blue Cross's approach combines value-based care arrangements that reward quality and outcomes, digital health solutions, whole-person care programs, and data-driven insights that help connect members to the right care at the right time. "We also recognize that every workforce is different, so we work closely with employers to tailor the right mix of coverage, resources, and support for their employees," he said. "Ultimately, our goal is to help employers get greater value from their healthcare investment by improving health outcomes, enhancing the member experience, and helping manage costs over the long term." Virtual health visits such as telehealth are also part of the mix for both Capital Blue Cross and Highmark. Wigginton said virtual health visits have become increasingly important and, in many cases, are now an expectation among employers looking to make healthcare more accessible, convenient, and engaging for their employees. "It's not just about clinical visits; it's also about giving people more ways to manage their health between appointments and outside the traditional health care setting," he said. "That's why Capital offers a range of digital solutions. The common thread is helping people access care, stay connected to their health, and address concerns earlier, which can lead to better outcomes and lower costs over time." Mental health gets a bigger role in cost containment Both Highmark and Capital Blue Cross have increased the focus on mental health. Haddock said two years ago Highmark launched its partnership with Spring Health to offer mental health services for members age six and up. "We have a whole suite of programs we launched to try to meet the members where they are," he said. Highmark's program covers a variety of issues including substance abuse. Members typically have an appointment in two- to three- days, and there's 24/7 crisis support through the Highmark app." "We know mental health affects not only a person's health, but often their work, family, and overall quality of life," Wigginton said. Since early 2025, Capital has expanded its our behavioral health provider network by 40%, making it easier for members to find care and support. He said the insurer has seen promising results, including a 9% decline in behavioral health-related emergency department visits in 2025 compared with 2022 through 2024. "To us, that's a strong reminder that when people can get help earlier, they often avoid more serious health challenges later, which benefits both employers and employees," he said. One other component to containing costs is helping to identify and prevent fraud. Haddock said Highmark has invested in technology and training to ensure payment integrity-ensuring that the right level of service is reimbursed at the right amount. Rochelle A. Shenk is a freelance writer This is the first in a monthly series of in-depth stories on specific topics featuring insights from leaders featured in our CPBJ 300.

Wider Circle joins with Highmark Wholecare to launch peer-led community health program. - Neighbor-to-Neighbor Model Aims to Improve Health Outcomes for Medicaid Members PITTSBURG (August 31, 2026) - Wider Circle, a company focused on building communities to improve health and quality of life through trusted connections, recently joined with Highmark Wholecare to launch a proven peer-led, community-based health program for its Medicaid members. The initiative launched Aug. 3 in six counties in the Lehigh-Capital and Southwestern regions of the Commonwealth - Beaver, Lancaster, Lehigh, Washington, Westmoreland and York. Approximately 5,000 Highmark Wholecare members are expected to be supported by the program. At the heart of the program is Wider Circle's proven peer-led model, Connect for Life(R), which is powered by people and enabled by technology. Connect for Life links members to their neighbors through facilitation by community health professionals to enhance adherence to preventive and primary care services and improve long-term health outcomes. The company recruits and trains trusted members of the community to lead engagement efforts in neighborhoods, connecting members effectively, and identifying those most at risk of disengagement or preventable health events. This approach has demonstrated measurable results nationally, including higher adherence to care plans and retention rates, along with a reduction in hospital stays and the total cost of care. Wider Circle currently operates Connect for Life in 14 states. Wider Circle will be supporting Pennsylvanians as they navigate the health care system, address health-related social needs, and connect with the preventive and primary care services they need before a health issue becomes a crisis. "Technology will play an increasingly important role in the next generation of health care, helping us identify needs earlier, coordinate care more effectively, improve affordability, and reach members in new ways," said Victor Fields, president, Highmark Wholecare. "But real change still happens through human connection. Through our work with Wider Circle, we are investing in trusted, person-to-person relationships that help members feel seen, supported, and empowered to take charge of their health. By combining innovation with meaningful human interaction, we can deliver better outcomes for the communities and the people we serve." "Our model is built on a simple but powerful belief that health starts with trust, and that trusted local leaders are the most effective force for connecting people to the care they need," said Brett Zelkind, Chief Business Officer, Wider Circle. "This expansion reflects not only the strength of our relationship with Highmark, but the growing recognition that community-based care is one of the most powerful tools we have to improve health outcomes at scale." The Pennsylvania expansion comes on the heels of a successful launch of Connect for Life with Highmark Health Options West Virginia, which has seen strong initial results. About Wider Circle Wider Circle builds communities to improve health and quality of life through trusted connections. Its peer-driven model recruits local community members to lead health engagement programs, supported by advanced data science and technology. Wider Circle's approach has been actuarially validated and shown to improve health outcomes, reduce costs, and increase member retention for Medicaid and Medicare Advantage plans across the country. About Highmark Wholecare Highmark Inc. believe in caring for the whole person in all communities where the need is greatest. Highmark Inc. see a future in which everyone has equal opportunity to achieve their best health. Through its leading Medicaid and Medicare programs, Highmark Inc. is coordinating health care that goes beyond doctors and medicine that helps members achieve not just physical health but also delivers whole person care. Its team members are helping to drive this new kind of health care for its 325,000 Medicaid and Medicare members in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, and other ancillary providers. Highmark Inc. is also committed to supporting its neighbors through its many community outreach and engagement programs. Jennifer St. Clair Wider Circle 323-481-6841 [email protected] John Pepper Highmark Wholecare 412-951-1533 [email protected]