Becker’s Healthcare Podcast Payer Consolidation, AI Arms Races, and the Future of Prior Authorization with Jakob Emerson
Dec 19, 2025
Jakob Emerson, Associate News Director at Becker's Healthcare, dives into the intricate world of payer dynamics. He discusses the growing trend of consolidation among Blue Cross Blue Shield plans, as insurers unite to compete with larger entities. Jakob sheds light on the rising AI arms race between payers and providers which intensifies coding and denials. He also reveals insights on upcoming CMS rules for prior authorization and critiques the inefficiencies of automated administrative battles, calling for a redesign in the system.
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Blues Consolidate To Gain Scale
- Blue Cross Blue Shield plans are consolidating into affiliations to pool technology and claims capabilities.
- Smaller independent Blues need scale to compete with national payers, so more deals are likely.
Highmark And Kansas City Affiliation Example
- Jakob described Highmark affiliating with Blue Cross of Kansas City as effectively a merger despite staying separate legally.
- He noted similar moves by Cambia and prior Vermont-Michigan arrangements as examples of the trend.
AI Fuels Payer-Provider Friction
- Hospitals and insurers are deploying AI tools to maximize coding and revenue, which increases friction.
- This 'bots battling the bots' dynamic intensifies adversarial payer-provider relationships and administrative denials.