Not everyone could make it to HLTH this year, but the conversations happening across the Venetian Expo Center from October 19–22 were too important not to share. With over 12,000 healthcare leaders gathered in Las Vegas (including 2,750+ CEOs and executives from the nation's largest payer and provider organizations), the HLTH conference served as a pivotal moment for the industry.
Pega was proud to be a sponsor at HLTH 2025. Our team of healthcare leaders spent three days on-site in back-to-back sessions and meetings, connecting with senior executives from top U.S. healthcare payers, providers, and life sciences companies.
What they heard wasn't just conference chatter; it was a clear signal of where the industry is headed and felt like a collective turning point. The energy wasn’t just about what’s new in healthcare, but how to make innovation actually work. AI was everywhere, but what stood out most was the shift in tone. The industry is no longer debating whether to adopt AI, but how to adopt it responsibly.
If you couldn't attend, here's what you need to know.
Affordability isn’t optional: The operational imperative for payers
Affordability has shifted from a strategic goal to a survival requirement. A session at HLTH 2025 titled “Affordability Isn’t an Option—It’s the Key to Survival!” highlighted the mounting pressures on healthcare payers to lower administrative costs while improving medical cost management. As non-standard and value-based payment models proliferate, payers face billions in financial risk because traditional systems are not equipped to audit, forecast, or predict costs beyond standard claims. Many programs are still managed outside core payer infrastructure, limiting scalability and operational efficiency.
Speakers including Lori Logan, President and CEO of NASCO, and Lori Aronson, VP of Care Delivery Solutions at Blue Cross Blue Shield of Michigan, discussed strategies to address these challenges. Their recommendations emphasized streamlining operations, embedding risk management into everyday workflows, and leveraging technology to deliver on the promise of affordability while maintaining quality care.
“Affordability isn’t just a metric, it’s the lifeline for healthcare organizations. Payers that can integrate cost management into their operational fabric will not only survive but thrive in a value-based world.”
Healthcare affordability is no longer optional. Without systems that can scale, predict, and manage costs across evolving payment models, payers risk both financial stability and patient access. Operational modernization is essential to enable proactive management of costs, risk, and care delivery.
From AI hype to responsible application
A session with CVS Health, “The Knowns and Unknowns of an AI-driven Health Care Future,” reframed how the industry is thinking about AI. The focus wasn’t on potential but on responsible AI: how to govern, scale, and sustain AI in a way that protects patients, empowers clinicians, and earns trust.
Responsible AI adoption:
- Adopt new technology with clarity
- Awareness that different taxonomies require their own governance
- Collaborations across the ecosystem to ensure that AI frameworks promote fairness, privacy, safety, and efficacy.
“AI was everywhere at the conference, but the real takeaway was the need to pair it with empathy. Technology alone won’t fix healthcare. It’s how we use it to strengthen relationships that matters most.”
AI’s next battleground: From claims combat to collaboration
Healthcare leaders are no longer asking whether AI belongs in care delivery, but how to apply AI responsibly and sustainably. The success of AI in healthcare will depend on governance that protects trust and integration that enhances, not complicates, clinical and operational workflows.
One of the most talked-about sessions at HLTH 2025 came from a session with Cigna, the “Bot Fight Club” panel, which described an escalating digital arms race between payers and providers.
Competing workflows in health systems has resulted in a system where algorithms are negotiating with algorithms over every healthcare dollar, leaving patients caught in the middle as authorizations lag and clinical decisions slow.
On one side, payers are deploying AI to detect fraud, identify coding anomalies, and streamline claim reviews.
On the other, providers are training their own algorithms to predict denial patterns, optimize submissions, and appeal rejections with tireless precision. One speaker noted, “We’re using artificial intelligence to solve problems that artificial intelligence helped create.” It was a sobering reminder that automation without alignment can deepen the very inefficiencies it’s meant to solve.
“To truly unlock efficiency in healthcare, payers and providers need to connect systems, automate decisioning, and collaborate in real time. This kind of transparency reduces administrative friction and transforms competing workflows into coordinated, patient-centered experiences.”
The real opportunity lies in shifting from adversarial automation to collaborative intelligent workflows. Payers and providers share more common goals than ever: improving accuracy, reducing administrative friction, and focusing resources where they matter most on patient outcomes.
What this means for healthcare leaders
If there's one overarching takeaway from HLTH 2025, it's this: The healthcare industry is ready to move from talk to action. Leaders are demanding measurable outcomes, seamless data integration, and operational efficiency that makes a real difference in members' lives.
"What struck me most was how closely these discussions mirrored the conversations I'm having with our clients every day, especially around connecting front-end experiences with back-end efficiency. The executives at HLTH weren't just thinking about their next technology purchase; they were thinking about how to fundamentally transform their organizations to deliver better care at lower cost. That's exactly the conversation we should all be having."
Looking ahead
HLTH 2025 reinforced that healthcare transformation isn't something that happens at conferences. It happens in the day-to-day work of connecting systems, streamlining processes, and putting members at the center of every decision. If the themes we've outlined resonate with challenges you're facing in your organization, we'd welcome the conversation.
Want to see how other healthcare organizations are making an impact, join us at PegaWorld 2026 from June 7–9, 2026.