CEO Gail K. Boudreaux explains how Elevance Health is connecting medical, pharmacy, behavioral, and home-based care to make health care simpler and more affordable at scale.
For all the advances in modern medicine, the health care experience can still feel stuck in another era: fragmented, reactive, and difficult to navigate. At the same time, health care costs continue to rise, placing more pressure on families, employers, and care providers alike. That’s why Elevance Health has focused its strategy on two clear priorities: lowering the cost of health care and simplifying the experience.
The idea is straightforward, but delivering it requires a fundamental rethinking of how health care works. For Elevance Health, the answer lies in a whole-health model that connects medical, pharmacy, behavioral, and home-based care with human, digital, and AI-enabled capabilities to make health care simpler, faster, and more personalized.
“The premise is clear,” says Elevance Health president and CEO Gail K. Boudreaux. “When care is better coordinated, needs are identified earlier. When people are guided to the right care at the right time, outcomes improve and costs come down.”
That approach is already producing measurable results, from fewer avoidable emergency room visits and high-cost admissions to more efficient care delivery. In this conversation with Fortune Brand Studio, Boudreaux shares how Elevance Health is translating its strategy into performance and what it will take to build a more connected, predictable, and human-centered health care experience at scale.
How did lowering health care costs and simplifying care become the company’s north stars?
We hear the same two frustrations from members, employers, and care providers: Health care costs too much, and it is too complicated.
Consumers want clarity and support in the moments when they are making decisions. Employers want affordability and predictability. Care providers want less administrative burden and better information at the point of care.
The challenge is that the health care system is still too fragmented and too reactive. Too often, it is built to respond after people are sick, rather than helping them stay healthy or get support earlier.
That is why we are focused on the areas where we can make a direct difference: making the experience clearer and more connected while addressing the drivers of cost. When care is coordinated, when people get help earlier, and when they are guided to the right care in the right setting, outcomes improve and costs can come down.
More affordable and easier to navigate is a straightforward concept, but it is not simple in practice. Where do you begin?
We start with the moments that matter most in a person’s health journey and ask a simple question: What is the next right action, and how do we make it easier to take?
Too much care happens too late, when a preventable issue has become an emergency. We are using data and predictive analytics to identify risk earlier, including members who may be at risk for substance use disorder or complex chronic conditions, and connect them to the right support before the problem gets worse.
That may mean primary care, behavioral health, pharmacy support, home-based care, or help navigating benefits. It is not a one-size-fits-all approach. It is about building the system around the person, not asking the person to figure out the system.
How do you stay focused without getting stuck in the weeds?
Focus requires discipline. Everything we invest in must show a path to improving outcomes, simplifying the experience, or reducing unnecessary cost. Ideally, it does all three.
We do not invest in technology for technology’s sake. We invest where we can make a process simpler, help a member get care earlier, give a care provider better information, or remove cost that does not add value.
We also hold ourselves accountable to measurable results. Across our integrated care models and cost-of-care initiatives, we are seeing examples of progress, including fewer emergency room visits, stronger medication adherence, reduced high-cost admissions, and more efficient care delivery.
What have been the most difficult challenges, and how is Elevance Health addressing them?
Lowering the cost of care is one of the defining challenges in health care because the drivers are broad and interconnected. Prescription drug prices, hospital costs, higher utilization, administrative friction, and delays in care all add pressure.
We cannot solve every driver alone, but we can remove avoidable cost and complexity where we have influence. That means identifying risk earlier, guiding members to the right care setting, reducing unnecessary administrative steps, and supporting care providers with better information.
We are seeing progress. HealthOS, our patient management system, has reduced documentation requests by more than 60% and accelerated prior authorization turnaround times. Our value-based oncology model has reduced chemotherapy-related admissions by 50% in our commercial risk-based business. These are examples of the structural improvement we are focused on: better care, less friction, and lower avoidable cost.
But this is not a quick fix. It requires changing how care is delivered, how care providers are supported, and how the system works around the people it serves.
Elevance Health is investing more than $1 billion in digital and AI-enabled capabilities in 2026. How is this changing your work?
AI is not a standalone strategy for us. It is one way we make Elevance Health’s clinical, benefit, pharmacy, provider, and operational knowledge more useful in the moments when decisions are made.
The most effective applications are where technology and human expertise work together. We use predictive analytics to identify emerging risks earlier, automation to reduce administrative burden, and data integration to give care providers more complete and timely information.
Our AI-enabled virtual assistant is available to 22 million commercial members, helping people get answers faster and with less friction. More than 60,000 associates are using productivity tools, and automation has reduced administrative burden in areas such as chart requests by up to 43%.
The goal is not to replace clinical judgment. It is to help our teams see patterns sooner, simplify routine work, and create better insights so members can get the right support earlier and care providers can spend less time on administrative friction.
What about the effect of AI and digital investment on external stakeholders?
One example is prior authorization, which has been a source of frustration for members and care providers for years. Prior authorization plays an important role in supporting safe, evidence-based, and cost-effective care, but we also must make the process materially simpler and faster.
Since January 2024, we have removed prior authorization requirements for more than 400 medical codes for in-network providers. For electronic prior authorization requests, about two-thirds are already processed in real time, and we remain on track to reach 80% by 2027.
Technology, including AI-enabled tools, helps by improving provider connectivity, reducing missing information and enabling more real-time decisioning. At the same time, clinical oversight remains essential. A clinical professional is always involved in adverse prior authorization decisions.
What will prove that Elevance Health has achieved its mission?
Success is when health care starts to feel fundamentally different: more intuitive, more connected, and less burdensome.
People should not have to piece the system together themselves. They should know where to go, get care earlier and more easily, and have support along the way.
We will see that in the data: fewer avoidable hospitalizations, better chronic disease management, and more consistent outcomes. But we will also hear it in how people talk about their experiences.
If we do this right, health care becomes more predictable, more connected, and more sustainable over time. People will have confidence that coverage and care will be there when they need them, without unnecessary complexity or surprise.