Amid rising pharmacy and medical cost pressures, Bloomington, Minn.-based HealthPartners is accelerating efforts to simplify access to care and address affordability, while making near-term financial decisions to sustain care delivery for the long run.
“At HealthPartners, one of our promises is to make things simple and affordable,” Andrea Walsh, president and CEO of HealthPartners, told Becker’s. “Internally, we talk about operating as a system, but for patients and members, it shows up as ‘no wrong door,’ helping with navigation and support in ways that meet people where they are, are sensitive to their values and preferences, and help them figure out how to use their healthcare coverage to get the most out of it.”
Those efforts come as HealthPartners — which serves more than 1.4 million patients and 1.4 million health plan members — navigates ongoing financial pressures, including rising medical and pharmacy costs that have strained margins and forced decisions around coverage and enrollment.
In 2025, the organization reported an operating loss of about 1% on $9.3 billion in revenue, while maintaining adequate cash reserves due in part to investment income and cost management efforts. Medical trend rose 11%, driven partly by higher utilization, and pharmacy costs continued to climb, including an 8.7% increase in the average cost of a 30‑day generic prescription and a 10.4% increase in the average cost of a 30‑day specialty prescription. Claims payments totaled more than $4.1 billion.
Amid this backdrop, Ms. Walsh said HealthPartners has made targeted trade-offs to manage affordability — particularly around pharmacy benefits and Medicaid participation.
One example is GLP-1 medications. HealthPartners does not cover GLP-1s for weight loss across Medicare and most commercial plans, citing cost concerns. While these drugs are widely used for diabetes and show promise for obesity treatment, their current pricing — which can reach tens of thousands of dollars annually per patient — is not sustainable at scale, Ms. Walsh said.
Most of HealthPartners’ commercial plans exclude coverage of weight loss medications. However, Minnesota’s Medical Assistance program covers these drugs on its Preferred Drug List, and health plans that administer Medicaid are required to follow that coverage.
The organization also made a difficult call around Medicaid enrollment. Facing a roughly $200 million operating loss in 2024, HealthPartners exited Minnesota’s Special Needs Basic Care Medicaid program and paused enrollment in other Medicaid plans, according to an April 30, 2025, report from The Minnesota Star Tribune. About 6,200 members were affected by the program exit; they needed to transition to new managed care plans.
“We told the state we could not take more enrollees for 2025 due to financial losses in 2024 and insufficient rates for 2025,” Ms. Walsh said. “As a nonprofit regional system, we want to serve everyone, but we must make short-term financial decisions to ensure we can serve patients long term.”
The pause is no longer in effect. HealthPartners has resumed Medicaid enrollment in 2026, with membership reaching 146,371 as of April, reflecting improving financial stability and ongoing discussions around rate adequacy.
“From my vantage point, we have been in an era of financial improvement and addressing medical trends,” Ms. Walsh said. “We are not out of the woods, but we have initiatives underway to improve how we work and find efficiencies.”
HealthPartners is also undergoing leadership changes as it navigates today’s industry environment. In April, the organization named Blake Berquist executive vice president and CFO. He previously served as CFO for UnitedHealthcare’s national commercial business and succeeded Penny Cermak, who retired.
The organization continues to work toward a 2.5% operating margin long term.
Efficiency — not just cost-cutting — is also a theme running through HealthPartners’ use of AI. Ms. Walsh pointed to ambient documentation tools in clinical visits as an example.
“This enables patients and clinicians to engage in conversation without clinicians being tied to their computers documenting the visit,” she said. “It has been a game changer for clinicians and for patients. We are better able to connect, build trust, and improve quality and affordability long term through the assimilation of information that the tool provides.”
Another avenue of efficiency HealthPartners is pursuing involves using AI to match cancer patients with clinical trials nationwide — a process that was previously done manually.
The organization has established governance processes to ensure AI tools are used appropriately, and that they protect patient privacy and maintain quality and reliability, Ms. Walsh said.
“Our perspective is that AI is at the worst it will ever be, but we need to carefully shepherd it forward so it delivers on our promises to patients and members,” she said.
The post HealthPartners’ trade-offs: ‘Short-term financial decisions to serve patients long term’ appeared first on Becker's Hospital Review | Healthcare News & Analysis.
