David Jones, Chief Medical Officer, Anthem Blue Cross Blue Shield of Georgia

In an interview with Focus:, David Jones, chief medical officer at Anthem Blue Cross Blue Shield of Georgia, discussed affordability, digital innovation, value-based care, and health equity as the company’s top strategic drivers. “Meaningful progress will only come through strong partnerships and collective action,” Jones said.

What shifts have most impacted the organization’s strategy across Georgia?

Several key shifts have shaped our strategy. At the macro level, the economic climate has affected everyone, including health care. That has made it even more important to stay closely connected with providers, system partners, and members to understand the impact of rising costs and help people maintain coverage.

Healthcare costs, long a concern, have accelerated, contributing to what many now describe as a health care affordability crisis. This is particularly evident in Atlanta, where it affects the entire system.

Expanded coverage through the Affordable Care Act and other plans has increased access, which is a positive development. However, greater coverage typically leads to higher utilization, which can drive costs. Even so, it means more people are receiving necessary care. At the same time, we are seeing higher acuity across the population, with more complex conditions requiring frequent or intensive care, a trend reflected across the industry.

Behavioral health needs are also increasing, representing another major shift influencing our strategy. Finally, changes at the federal level affecting Medicaid and Medicare eligibility, along with potential adjustments to ACA subsidies, require us to remain agile and responsive. Our goal is to help people maintain or gain coverage despite this uncertainty.

What is Anthem doing to improve affordability, access, and quality of care across Georgia?

Our approach is grounded in a whole-health strategy that supports members’ physical health, both acute and chronic, as well as behavioral health and social drivers of health. All three are essential to improving affordability, access, and quality.

Behavioral health is now recognized as equally important as physical health, as each can significantly influence the other. A serious physical illness can lead to anxiety or depression, and untreated behavioral health conditions can worsen physical outcomes.

Social factors also play a major role. Approximately 80% of health outcomes are influenced by factors outside the clinical setting. Where people live, their access to food, transportation, and support systems all matter. Addressing those realities is critical to helping people stay healthy.

What trends are shaping how care is delivered in Georgia?

Care delivery is increasingly focused on providing the right care, at the right time, in the right setting. That includes shifting services from inpatient settings to outpatient care or even into the home through hospital-at-home models. These changes improve both quality and cost efficiency.

From the employer perspective, since many people receive coverage through work, there is growing interest in alternative health plans that complement traditional offerings and give employers and employees more control over cost and access. Even in major metro areas like Atlanta, same-day or next-day access to primary care can be challenging, and these models help fill that gap.

Employers are also seeking clearer data on which programs deliver measurable results. We continue to refine our analytics to provide sharper insights into what is working and to what degree. Predictability is another major need. As cost trends rise, employers want more frequent and accurate forecasts, not just annually, but quarterly, so they can respond proactively.

What are the most promising opportunities to expand value-based care in Georgia?

Value-based care is central to the future of health care. Unlike fee-for-service models that reward volume, value-based care aligns payment with outcomes, including quality, cost, and patient experience.

Nearly 70% of our providers participate in some form of value-based arrangement, making ours the largest value-based network in the state. The opportunity now is to expand these models further and refine incentives to support better outcomes and greater cost efficiency.

While most value-based care has focused on primary care, there is strong potential to extend these models into specialty care. Doing so would reduce unnecessary services, improve coordination, and enhance outcomes. We also see opportunities to design benefits that encourage members to choose providers participating in value-based care, as these providers consistently deliver stronger preventive care, better chronic disease management, and fewer hospitalizations.

How is Anthem using technology and AI to improve health care delivery and the member experience?

Our Sydney app is a cornerstone of our digital strategy. It is user-friendly, highly functional, and widely recognized across the industry. Sydney allows members to access care easily through their mobile devices.

Beyond viewing benefits, members can schedule virtual visits, locate nearby urgent care centers, and search for primary care providers based on language or demographic preferences. The app also sends reminders for preventive screenings, and we continue to expand its functionality.

Artificial intelligence also plays a growing role in our operations. We use AI thoughtfully to enhance accuracy, service, and personalization while maintaining privacy and safety. AI helps streamline customer service, improve claims accuracy, and personalize care, allowing us to deliver more targeted outreach and resources based on individual needs rather than broad population data.

We also leverage HealthOS, our data-sharing platform, which aggregates information from multiple sources and integrates it into providers’ electronic medical records. This gives clinicians a more complete view of a patient’s history, including care received outside their system, improving coordination and outcomes.

What strategies is Anthem using to address health disparities and promote equity in rural and urban communities?

Equity is embedded in how we operate. Rather than treating it as a standalone initiative, we apply an equity lens across all decision-making. One key avenue is our foundation, which funds programs aimed at reducing disparities in care.

Maternal and child health is a major focus. Georgia has some of the highest maternal morbidity rates in the country, and we support care access before, during, and after pregnancy, along with pediatric services. These efforts have helped reduce preterm births and other complications.

In rural communities, we supported a doula training program through a medical school, preparing 25 to 30 local advocates to provide care in underserved areas. Doula support has been shown to reduce hypertension, improve birth outcomes, and support postpartum recovery.

We also emphasize food as medicine. Nutrition plays a critical role in preventing and managing chronic conditions, and we support programs that expand access to healthy food and address food insecurity in both rural and urban communities, including metro Atlanta.

What are Anthem’s top priorities over the next three to five years?

Our priorities remain focused on affordability, outcomes, and simplicity.

Affordability is one of the most pressing challenges in health care. Even if cost growth slows, the impact on individuals remains significant, and managing affordability will continue to be a top priority.

Improving outcomes is equally critical and begins with access. Whether care is virtual or in person, barriers remain, even in urban areas where transportation or logistics can limit access. Removing those barriers is essential.

We are also focused on simplifying the health care system. Its complexity creates frustration for members, providers, and administrators. Through responsible use of AI and improved data-sharing platforms, we aim to make the system more connected, transparent, and easier to navigate.

How is Anthem collaborating with providers and other stakeholders to improve care and address long-term challenges?

Strong collaboration is essential. We view payers and providers as part of a single, interdependent ecosystem. The closer we work together, the better the outcomes.

Our collaboration extends beyond contracts. We engage regularly with providers to understand the challenges their patients face. Since those patients are also our members, these insights help shape more effective solutions. When an issue appears in one setting, we often see it elsewhere, allowing us to identify scalable interventions and outreach strategies.

Addressing long-term challenges such as rising costs and persistent disparities requires shared responsibility among payers, providers, employers, members, and communities. Meaningful progress will only come through strong partnerships and collective action.