Howard Weiss, Vice President of Government Affairs at EmblemHealth

Summary

---

Becker’s Healthcare Podcast: Howard Weiss, VP of Government Affairs at EmblemHealth

Date: January 18, 2026
Host: Scott King
Guest: Howard Weiss, Vice President, Government Affairs, EmblemHealth

---

Episode Overview

This episode explores current trends, pressures, and innovations facing health insurers, with a focus on payer-provider relationships, community health initiatives, the impact of consumer demands, the potential of artificial intelligence (AI), and regulatory strategies for improving healthcare affordability and access. Howard Weiss shares candid insights from his leadership at EmblemHealth, one of New York’s largest nonprofit health insurers.

---

Key Discussion Points & Insights

Howard Weiss’s Career Background

• [01:00] Howard traces his path from national policy—15 years at AHIP focusing on Medicare/Medicaid—to leadership at EmblemHealth and earlier roles with pharmacy associations.
  • “EmblemHealth is a nonprofit health insurer headquartered in New York City... I've been working in government relations here for about nine years.” (Howard, 01:01)

---

Payer-Provider Relationships Under Pressure

• [01:36—04:30]
  • Increased cost pressures and workforce shortages challenge both sides.
  • EmblemHealth’s value-based arrangements with Advantage Care Physicians (ACPNY) demonstrate better outcomes and affordability but are difficult to replicate with large hospital systems.
  • Real system-wide change requires "meeting halfway," both payers and providers addressing internal inefficiencies.
  • Utilization management must be streamlined; providers need to recognize the impact of high pricing on overall system affordability.
  • Notable Quote:
    • “From a health plan perspective, that means fixing our systems that take clinicians away from treating patients... From a provider perspective, there needs to be a recognition that high prices... affect everyone.” (Howard, 02:58)

---

Consumer Demands Driving Industry Change

• [04:30—05:45]
  • Growing consumer dissatisfaction, especially regarding high costs and utilization management perceived as barriers to care.
  • Payers and regulators are feeling unprecedented pressure reflecting the voice of the consumer, shaping future priorities.
  • Notable Quote:
    • “We've heard loud and clear and I think in more intense ways than we have in the 25 years that I've been doing this, that there's dissatisfaction with the high cost of health care.” (Howard, 04:53)

---

Bridging the Gap Between Strategy and Execution

• [05:54—09:13]
  • EmblemHealth’s investments in addressing food insecurity and operating “Neighborhood Care” centers offering free services to all underscore the importance of community engagement.
  • Real-world barriers, such as mismatched perceptions of care access, can create distrust unless tackled with culturally sensitive, convenient, and accessible programs.
  • The Bronx Community Diabetes Wellness pilot showed that localization—multiple languages, flexible scheduling, community venues—leads to measurable improvements.
  • Memorable Moment:
    • “One key takeaway... was that sustained participation required an engagement strategy that was designed around trust, culture and convenience... in non traditional spaces like places of worship or community centers or local block parties.” (Howard, 07:28)
  • After a year, the program saw over 100 events and ~1,500 participants, demonstrating the power of neighborhood-based models.
  • Notable Quote:
    • “Closing the gaps between strategy and successful execution depends on meeting communities on their terms, in their languages and in their neighborhoods.” (Howard, 08:44)

---

Scaling Community Health Initiatives

• [09:13—10:08]
  • Pilots start small and scale thoughtfully; EmblemHealth is actively considering expanding such programs citywide, allowing time for iterative learning.
  • “We approach in a very smart way, understanding that... we want to learn from what we were doing before we more broadly offered this type of program.” (Howard, 09:44)

---

The Transformational Impact of Artificial Intelligence

• [10:27—11:48]
  • AI referenced as a surprise but critical answer for reshaping health plans in the next few years.
  • Real-world applications: targeting enrollees affected by climate events, personalized vaccine reminders, and process improvements.
  • Hopeful that AI can harmonize utilization management, streamline administrative processes, and address consumer pain points.
  • Notable Quote:
    • “My hope is that responsible use of AI will improve health plan relationships with providers... AI has the potential to eliminate many consumer concerns about the healthcare system.” (Howard, 11:26)

---

Regulatory and Industry Reforms to Improve Affordability & Access

• [11:48—13:49]
  • Solutions to excessive administrative burden:
    • Centralized provider directories and credentialing to avoid redundant paperwork.
    • Possible adoption of a "single database" for provider information, currently being considered by CMS.
    • Support for scope of practice reforms to empower care teams.
  • Notable Quote:
    • “Provider offices spend hours and hours responding to the same questions from different health plans... CMS is working on solutions that will allow providers to send or made updated information once to a database that health plans would consult.” (Howard, 12:19)
  • Calls these “achievable reforms” that directly address systemic inefficiencies.

---

Pressures on Health Plan Margins & 2026 Priorities

• [13:49—15:26]
  • Margin pressures: rising hospital and drug costs, regulatory changes (e.g., HR1), public scrutiny over healthcare costs.
  • Prior authorization reform is highlighted—EmblemHealth and industry groups are voluntarily streamlining these processes.
  • Collaboration with providers and pharma is critical to avoid even greater government intervention.
  • Notable Quote:
    • “We need significant cooperation from healthcare facilities and drug companies to make health insurance more affordable... Otherwise, all of us are at risk for creating an even larger role for government in the healthcare system.” (Howard, 15:11)

---

Memorable Quotes & Timestamps

• “Despite all the good collaboration between plans and providers... there remains strong levels of dissatisfaction about the quality and cost of care.” (Howard, 01:58)
• “We really hope the pressures that we are all under... will lead to more constructive collaborations on solutions that best serve our customers.” (Howard, 03:53)
• “When the programs we operate don't reflect how members and communities access care, it can create a sense of disconnect or distrust.” (Howard, 06:52)
• “My hope is that responsible use of AI will improve health plan relationships with providers.” (Howard, 11:27)
• “These reforms will improve plan provider relationships and support more collaboration on solutions to improve affordable access to healthcare services for everyone.” (Howard, 13:38)

---

Timeline of Key Segments

| Timestamp | Topic | |:--------------|:-----------------------------------------------| | 01:00 | Howard’s career & EmblemHealth intro | | 01:36 | Payer-provider relationships & value models | | 04:30 | Consumer pressure and dissatisfaction | | 05:54 | Strategy vs. execution in community initiatives| | 09:13 | Scaling pilot programs | | 10:27 | AI's impact on health plans | | 11:48 | Regulatory reforms for efficiency | | 13:49 | Margin pressures and 2026 outlook |

---

Summary

This episode offers a frank, insightful discussion of the intricacies facing payers and providers in today’s healthcare landscape. Howard Weiss argues that meaningful progress requires building trust at the most local levels, leveraging technology responsibly, and enacting achievable administrative reforms. Above all, collaborative action—not siloed effort—is essential if the industry is to regain consumer trust, keep costs down, and avoid more sweeping government intervention.

Transcript

[A]

This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago.

[B]

Hello everyone and welcome to the Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Howard Weiss, Vice President, Government affairs with Emblem Health. Howard, how are you doing today?

[C]

Just fine. Thanks for having me.

[B]

Thanks so much for joining us. I really appreciate it. I know we're going to get into a lot of kind of the big trends and topics facing healthcare today, but before we get started, could you please just tell me a little bit about your background, Howard, and how you started your career journey?

[C]

Sure. So I work at Emblem Health. We are a nonprofit health insurer headquartered in New York City and mostly serving downstate New York. I've been working in government relations here for about nine years. Before that I worked at the National Trade association representing health insurers, AHIP, for 15 years in Washington, D.C. mostly focusing on Medicare and Medicaid issues and before that worked at another trade association in D.C. representing chain pharmacies.

[B]

Thanks so much for sharing that background info there, Howard. The first topic I wanted to get to, first question I have for you is how are your relationships with providers changing as both sides face cost pressure and workforce shortages?

[C]

Yeah, it's a very interesting question. I think speaking at the system level, the American healthcare system is being challenged by consumers and government in unprecedented ways. Despite all the good collaboration between plans and providers to develop arrangements rewarding value over volume, there remains strong levels of dissatisfaction about the quality and cost of care. At Emblem Health, we have a unique relationship with a physician practice called Advantage Care Physicians of New York, or acpny, that provides primary and specialty care to about half a million people in New York City and Long Island. We have seen from our arrangements with ACPNY and others how developing value based arrangements holding both the plan and provider accountable leads to better outcomes and more affordable care. However, in many cases, especially with some of the large hospital systems, we have had difficulty developing similar types of arrangements. We at Emblem Health firmly believe that the best solutions to the growing dissatisfaction with the health care system will come from collaborations between plans and Providers, however, we will need to meet each other halfway to create real changes for the people we serve. Now, from a health plan perspective, that means fixing our systems that take clinicians away from treating patients and reduce the availability of services people really need. That includes taking a serious look at our utilization management processes, limiting them to services where there is significant evidence of misuse, and making it as easy as possible for providers to work with us. From a provider perspective, there needs to be a recognition that high, that the high prices they sometimes charge affect everyone. Health insurance usually protects consumers from the high list prices for expensive services like hospital stays and some prescription drugs. And that's really important because that's the way people access care. However, these high price increases, these high prices increase the cost of health insurance, which means fewer people can afford the coverage that they need. We really hope that the pressures that we are all under from consumers and from policymakers will lead to more constructive collaborations on solutions that best serve our customers.

[B]

Howard, I want to follow up on something you said there. It's really interesting. Obviously we've heard about this administration, how it's affecting healthcare, the regulations. But you mentioned consumers and I thought that was interesting. How are you seeing consumer, and maybe consumer demands kind of challenge the system and the work health plans are doing?

[C]

Yeah, I mean, I think what we're hearing from policymakers in large part reflects the real concerns of consumers. And we've heard loud and clear and I think in more intense ways than we have in the 25 years that I've been doing this, that there's dissatisfaction with the high cost of health care. And yes, from some of the utilization management techniques that plans use, which people see as denying them access to the care they need. So not only from a micro sort of market level perspective, from a broader perspective, these are the real pressures that, you know, ICR industry is under. And how we navigate those pressures can really dictate the industry's future.

[B]

Absolutely. And moving along to the next topic, where do you see the biggest gap today between payer strategy and operational execution?

[C]

Yeah. Well, I want to preface my response because you might think I won't be getting to the answer, but I promise you I will. I am really fortunate to work for a company that understands how active participation in communities is not only good practice, it's good business strategy. For example, Emblem Health really made recently made significant investments in addressing food insecurity in the areas we serve. My colleague Heather Tamborino, our chief financial officer, recorded a Becker's podcast on this initiative not too long ago. That I would really encourage others to listen to to better understand the business case for doing good. And in addition, Emblem Health operates 15 neighborhood care centers throughout New York City where we offer free services to all members in the community, so not just our members. And these services include wellness classes, help with social service, navigation and nutritious food giveaways. However, as we have pursued this approach, we have often found that there is a gap between strategy and successful execution at the community level, where these well intentioned strategies meet real world barriers. When the programs we operate don't reflect how members and communities access care, it can create a sense of disconnect or distrust in many of the entities that are responsible for their career. We saw this recently play out in our Community Diabetes Wellness program, a free community based initiative focused on prevention, education and ongoing support which we piloted in the Bronx, a part of our city that is home of diverse communities with high levels of chronic disease. One key takeaway from this project was that sustained participation required an engagement strategy that was designed around trust, culture and convenience. That meant understanding that offering classes in multiple languages, flexibility and class design, whether it be in person, virtual or hybrid options, and timing to fit our neighbor schedules, early morning, evening and weekend classes, and bringing care directly to the community we serve in non traditional spaces like places of worship or community centers or local block parties. We learned these lessons and after one year, the program demonstrated that a neighborhood based model could measurably improve access, engagement and clinical outcomes. We held more than 100 diabetes related events across the Bronx with almost 1500 community participants who were able to get screened or get advice on lifestyle changes that they could make to be healthier. So to me, the success of this program reinforces that closing the gaps between strategy and successful execution depends on meeting communities on their terms, in their languages and in their neighborhoods to build the kind of trust that improves healthcare outcomes.

[B]

Yeah, I think that that sounds like tremendous work done in the community there, Howard. You know, great job to everyone. When you're able to plan and execute that way and you see the impact it has in a community, do you think about what it takes to scale something like that or do you kind of work on another initiative?

[C]

Yeah, I mean, we specifically chose the Bronx to do a pilot program. I think that those of my colleagues are now thinking about ways to more broadly offer these types of programs throughout the rest of the city. So for us, right, I mean, I think we not to toot our own horn, but we approach in a very smart way, understanding that we are trying something new and we want to learn from what we were doing before we more broadly offered this type of, this type of program.

[B]

Well, yeah, I think that's incredible. I think programs like that obviously make a huge difference. And Howard, if I can get you to put on your health plan fortune telling hat and look into your health plan crystal ball, what's one investment or initiative you believe will most reshape how health plans operate over the next two to three years?

[C]

Well, Scott, I'm going to surprise you with this answer, but I'm going to mention AI or artificial intelligence. I'm sure you haven't heard that answer from anyone else, but we do think it has a great potential in several different ways. Again, I'm going to recommend a recent Becker's podcast with Emblem House Executive Chair Karen Ignani and our Chief Medical Officer Dr. Dan Net, in which they explain how our company is establishing AI based initiatives that identify our enrollees who are most affected by climate events like heat waves or snowstorms and help them connect with the resources they need. We also have used AI to encourage our enrollees to get their flu vaccines and are considering other ways to help them get the services they need. From my perspective, and hitting on some of the issues that we discussed earlier, my hope is that responsible use of AI will improve health plan relationships with providers. Whether that means creating more uniform clinically based utilization management standards across the industry or improvements to administrative processes. AI has the potential to eliminate many consumer concerns about the healthcare system.

[B]

And if you could change one regulatory or industry practice tomorrow to improve affordability and access, what would it be and why?

[C]

Yeah, Scott, as you can imagine, I'm sort of a pie in the sky type of person. But I consulted with colleagues and they recommended that we talk about things that were actually doable. And as we look at the existing environment, there are several achievable reforms that will reduce costs for health plans and providers and allow clinicians to focus on patients rather than paperwork. The one that always comes to our mind is the issue about provider directories, right? And the accuracy of provider directories, which we all agree that health plan enrollees need accurate information about the providers in our networks. However, that means that provider offices spend hours and hours responding to the same questions from different health plans looking to update their directories. We know now that the federal Centers for Medicare and Medicaid Services is working on solutions that will allow providers to send or may updated information once to a database that health plans would consult without having to contact their offices. These solutions could also be a source of Credentialing information, limiting the need for providers to submit different forms to multiple health plans. So that's just one. If I can be granted one and a half. You know, we would also mention scope of practice reforms, which we think also has a way of alleviating pressures on advanced clinicians so that they can focus on what they do best and increase satisfaction amongst other providers. We're very hopeful that these changes will improve plan provider relationships and support more collaboration on solutions to improve affordable access to healthcare services for everyone.

[B]

The last question I have for you, Howard, what issue is putting the most pressure on health plan margins right now and how are you responding? Responding differently or are going to respond differently in 2026?

[C]

Yeah, I mean, I think we know that each insurer is developing strategies for what promises to be another challenging year. You know, I think that includes dealing with high hospital and drug costs, plus the changes to Medicaid and other public health programs that were put into the into place by HR1. As I, you know, the issue that I tend to focus on and dwell on, I think my colleagues would probably say is the increased scrutiny of federal, state governments that are all focused on reducing healthcare costs. You know, as I mentioned before, I don't think that this is an issue that we can address alone. And I'm very satisfied that the level of dissatisfaction, pardon me, that we are seeing industry efforts to reestablish trust, such as the national effort to voluntarily reform prior authorization practices led by AHIP and the Blue Cross Blue Shield Association. We think that that's a really significant step. However, in order to address the real issues affecting our healthcare system, we need significant cooperation from healthcare facilities and drug companies to make health insurance more affordable and increase accountability for outcomes. Otherwise, all of us are at risk for creating an even larger role for government in the healthcare system.

[B]

Well, I think a lot of us can certainly agree on that, Howard, and thanks so much for joining us on the podcast and for a great conversation. I look forward to working with you again in the future.

[C]

Thank you very much.