Take 5: Affordability VP Ben Pepin shares how Blue Cross is taking on high healthcare costs

1. Can you tell us about your background and your role at Blue Cross?

I joined in January. Before that, I spent two years at Blue Cross and Blue Shield of Kansas City, prioritizing and leading enterprise projects. Earlier in my career, I was with Accenture, focused on the health payer space and working with health plans across the country.

A lot of my experience has been in operational transformation, claims, and identifying opportunities to manage both medical and administrative costs. That’s what led me into this role, where my focus is on affordability and how we manage the cost of care for our members.

2. What does affordability mean to you?

Affordability is about helping ensure our members can access high-quality care when they need it, now and in the future. That means working to keep the healthcare system stable by managing costs in a way that supports healthcare providers and helps our members access the most appropriate and effective care at the right time and place.

My priorities reflect that. First, it’s making sure we’re focused on the initiatives that will have the biggest impact on cost of care, like pharmacy and medical expenses. 

Second, it’s thinking more broadly about how the healthcare system is evolving. I see more opportunities to further evolve relationships with providers. Take MRIs and other imaging services, for example. Costs can vary significantly depending on where a member receives care, even when the test and quality are the same. Finding ways to standardize pricing for routine services will go a long way in controlling costs and improving affordability. We need to always consider where else we can impact cost without negatively impacting care. 

I also see opportunities to better incentivize health. That means ensuring providers and health plans share accountability for driving even better outcomes. While healthcare costs continue to increase at a rapid pace, we are focused on ways to improve the long-term sustainability of our healthcare ecosystem – because unaffordable care is inaccessible care.

3. What’s driving healthcare costs?

Simply put, people are using more healthcare services and at greater volumes. On top of that, costs charged by providers continue to increase. National spending on hospital care reached $1.8 trillion in 2025, up 8.2% from the previous year, according to AHIP, a national health insurance trade association. 

Prescription drugs are another major driver. The increased use of high-cost medications and specialty drugs pushed prescription drug spending to more than $518 billion in 2025. That’s up more than 11% from the previous year.

We're also seeing increased use of AI-assisted billing tools that make it easier for providers to document and submit a greater number of patient conditions and risk factors in order to receive higher payments. In many cases, this increases costs without a direct correlation to improved member health and outcomes. 

 When you put all of that together, it can become very challenging to keep costs in check.

4. What is Blue Cross doing to help improve affordability? What are the challenges?

A big part of our work is helping members get the right care at the right place and time.

That might mean reaching out after a hospital stay so members understand the next steps in their care. It also includes helping people choose the right type of setting for their healthcare. For example, going to the emergency room for a non-emergency condition is going to cost literally thousands of dollars more than a trip to a clinic or urgent care.    

At the same time, some cost factors are outside of an individual’s control. Hospitals and drug companies set their own prices. Providers determine which treatments to prescribe and how care is delivered. Our role at Blue Cross is to help navigate those realities while keeping coverage as affordable as possible for members. We’re also focused on tackling fraud, waste and abuse so healthcare dollars stay directed to appropriate and effective care. It’s important for our members to know that Blue Cross has a dedicated team focused solely on detecting and deterring fraud across all types of care.

In all of this work, collaboration across the healthcare ecosystem is so important. Providers, health plans, and pharmacy partners all need to work together to make progress.

5. What do you want members to know, and what gives you optimism about the future?

I want them to know that our goal is to make sure every member receives safe and high quality care at a fair price, every time. 

When there are processes or guidelines in place, including prior authorization, it's because we believe they're necessary to help manage costs and keep coverage sustainable for everyone. At the same time, we regularly review requirements to ensure they are applied only where they are necessary and provide clear value. Our goal is to make healthcare as accessible as possible so our members can get the care they need and stay healthy.

What gives me optimism is that the topic of healthcare affordability is getting more attention now than ever before. People are more aware of the challenges and the various factors that impact the cost of care. That awareness creates an opportunity to do things differently.

Ultimately, success means we’re managing costs responsibly today while building a system that works better in the future, so that we’re here to support our members for many years to come.