Leadership Health Care (LHC), a Nashville Health Care Council program for emerging leaders, Cohorts provide the participants an opportunity to engage in a peer mentoring program facilitated by an experienced healthcare executive. Throughout six cohort sessions, participants discuss substantive topics around a common focus area to enhance their knowledge and leadership skills.
At a recent LHC Managed Care Cohort session, Caleb Gallifant, Vice President of Integrated Health at Humana, challenged participants to rethink what managed care truly means in today’s healthcare environment. No longer confined to traditional insurance, managed care is evolving into a broader, more strategic approach to integration, one that connects financing, care delivery, and patient outcomes. As healthcare organizations face increasing complexity and pressure, reimagining managed care is no longer optional—it’s essential.
Core Tenets of Managed Care
Mentor Caleb Gallifant emphasized that at its core, managed care is about achieving best possible outcomes for patients, promoting preventive care that improves quality, and controlling costs to create value for patients and other stakeholders in our healthcare system. As the sector evolves and more payers also own facets of the care delivery ecosystem, they have more direct accountability to improve patient outcomes and integrate a fragmented healthcare system.
Managed care, according to Gallifant, is most effective in systems where primary care serves as the central organizing force. “The whole health system could be improved by expanding and better reimbursing primary care,” he said. The cohort discussed emerging models—like capitated payment systems in Medicare Advantage—that shift incentives. In these models, providers are paid a set fee per patient, encouraging longer, more meaningful patient interactions. Gallifant contrasted this with fee-for-service systems, where primary care doctors often see 25–30 patients a day, potentially compromising quality for production volume.
In a capitated environment, he explained, “we have an incentive to spend 40 minutes or more with each patient,” enabling deeper relationships, better medication management, and more effective care for patients with complex needs. These models reduce unnecessary escalation to specialty care, improving outcomes, while potentially lowering costs for patients and the overall healthcare system.
At its heart, managed care isn’t just about a reimbursement model—it’s a structural commitment to quality care and to primary care as the most scalable lever for driving that change.
Understanding Integration and Its Implications
Traditionally, systems like Kaiser Permanente delivered and financed healthcare under one roof. But today, there are a wider range of models, including "payviders:” organizations where providers own health plans, or vice versa.
As Gallifant notes, this evolution creates opportunities for payers and providers to serve patients through better care quality and lower costs while also raising important questions about market dynamics and competitive fairness. The boundaries are shifting, and with them come new considerations for regulation, equity, and innovation.
The Rise of the Payvider Model
The cohort discussed the advantages and challenges of integrated care models. These models align insurance and care delivery under one entity, creating more cohesive financial incentives and allowing for a stronger focus on preventive care and outcomes, rather than volume-based reimbursement.
The emergence of the payvider model marks a major departure from traditional silos in healthcare. By combining payer and provider roles, organizations can create integrated care pathways that are more responsive to patient needs.
He explained that integrated models tend to outperform traditional, fragmented systems in key areas like hospital admissions and chronic disease management. This is especially true in senior-focused primary care, where more frequent patient visits have translated into better access and engagement, particularly among underserved populations.
However, while this model shows promise, it's difficult to execute. Organizations that try to evolve across both insurance and care delivery must invest heavily in infrastructure, data integration, and care management capabilities. Caleb pointed out that while many are attempting to operate across three pillars—insurance, care delivery, and services—few are truly strong in all areas.
Importantly, he highlighted that moving from care delivery into insurance is especially challenging due to scale, capital requirements, and regulatory complexity. Some organizations that initially expanded into insurance are now reevaluating that decision, realizing that vertical integration is not always sustainable or aligned with their long-term strategy.
Embracing Change for a Better Tomorrow
As the managed care landscape transforms, success will depend on the ability of healthcare leaders to thoughtfully balance innovation with equity, efficiency with transparency, and growth with responsibility. The path forward isn’t about reverting to old models or jumping headfirst into unproven ones. It’s about designing systems that are flexible, patient-centered, and prepared for the challenges ahead. The future of managed care will belong to those who can navigate its complexity while staying anchored in the fundamental goal: delivering better care at a sustainable cost.
Leadership Health Care’s mission is to cultivate talented healthcare professionals into the industry leaders of tomorrow. LHC aims to provide young professionals with ongoing opportunities to develop their knowledge of the healthcare industry through educational events and networking opportunities. Fill out this form to learn more about LHC.