In early January, Tamar Goldblatt was named vice president of payer revenue strategy and contracting at St. Louis-based Ascension.
Since then, Ms. Goldblatt has worked closely with system and ministry leaders to understand the distinct needs of each market and align them with Ascension’s broader payer strategy. Her work comes at a time where Medicare Advantage instability, rising denial rates and growing administrative burden have turned once-routine payer discussions into high-stakes negotiations.
Becker’s connected with Ms. Goldblatt to discuss her top priorities nearly one year into the role, the trends that are reshaping payer partnerships and how she approaches payer collaboration.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are your top priorities in your new role at Ascension? How do you plan to achieve these goals?
Tamar Goldblatt: My top priority is advancing a payer strategy that enables Ascension’s long-term sustainability and ensures our ability to provide compassionate, high-quality care to the communities we serve. To do that successfully requires disciplined use of data, strong relationships and close alignment across the organization, along with clear accountability for execution and results.
One of the unique challenges of my role at a system of Ascension’s size and scope is the imperative to balance national strategy and system-wide processes with the unique needs and attributes of each ministry. I am working closely with our system and ministry leadership to understand the distinct needs of each market and find pathways to dovetail those needs with Ascension’s broader strategies. Throughout that work, our Mission remains my guide, helping me ensure that the decisions I make strengthen Ascension’s ability to serve all.
Q: What healthcare trends are you keeping a close eye on right now? Why?
TG: I am closely watching four major areas that are redefining how we approach payer partnerships.
First, our industry has seen a level of instability in Medicare Advantage that Ascension is not immune to. Every week I see news of a new payer or provider opting-out of MA. While I believe firmly in the importance of coverage options, the high denial rates and growing administrative burdens in MA have changed the approach in these negotiations from being “routine” to quite high-stakes. Ascension’s mission is to serve all persons with special attention to those who are poor and vulnerable and for us, it’s a question of sustainability. We have to ensure that our participation in MA actually facilitates care rather than creating roadblocks for our patients and our clinicians.
Next, we’re seeing an increase in the impact of payers leveraging data and technology in ways that ultimately complicate patient care and drive up administrative burden. Rather than using data integration to streamline the delivery of care, we are frequently seeing complex algorithms and automated systems deployed to increase denials and intensify utilization reviews. This creates an unsustainable dynamic where providers are forced to build out massive technical infrastructures to refute payer second-guessing and keep up with the appeals. My focus is on shifting this paradigm. Data should be a bridge, not a barrier. We need payer partnerships where technology is used to collaboratively remove friction rather than simply speeding up the cycle of disagreement and pulling our resources away from patient care.
Third, I’m closely watching shifts in the ACA market including enrollment in and the potential growth of [individual coverage health reimbursement arrangements], recently renamed “[custom health option and individual care expense] arrangements”. I firmly believe in any model that makes coverage more affordable. But, as individuals make decisions among plans, and whether to stay covered at all, and as employers shift away from traditional employer group plans, the market is fragmenting. My concern is less about the insurance math and more about patient continuity and understanding of benefits. When individuals navigate the marketplace on their own, we often see them landing in underinsured or narrow network plans with high out-of-pocket costs that act as barriers to care. We need to ensure that this shift doesn’t inadvertently disconnect patients from their established doctors or create new hurdles when they need complex care.
Finally, I am highly focused on the continued shift in the site of care. Patients want more accessible, affordable options, and the market is moving quickly to meet them. At Ascension, we are actively leading this transition with our ongoing, significant investments in ambulatory sites of care. This isn’t just about shifting where we perform procedures; it’s our direct response to rising affordability pressures and the need to make healthcare easier to navigate. By expanding our ambulatory footprint, we are ensuring we use our resources responsibly while allowing patients to easily access high-quality care right in their own communities.
Q: How do you approach building relationships with payer partners? What do you think is key to successful collaboration?
TG: At Ascension, everything we do is rooted in our mission. My approach in all payer relationships begins by identifying where our missions overlap. And ultimately we all want healthier communities. When we anchor on that common ground, the dynamic shifts from a question of if we should work together to a collaborative conversation about how we get there together.
Beyond that foundational alignment, the era of the “us versus them” transactional negotiation is in my rearview mirror. Successful collaboration today requires us to move past the negotiating table and spend real time deeply understanding each other’s businesses. We have to drive toward areas of synergy that create long-term sustainability for both parties. It’s no longer just about negotiating a rate; it’s about building a framework where Ascension can continue to provide quality care, and the payer can offer a stable, affordable product to the community. If the model isn’t sustainable for both parties, it eventually fails the patient.
Finally, I believe in being radically transparent about where the friction lies in our daily work. When we face administrative hurdles, like complex prior authorizations or high denial rates, that is a “tax” on the healthcare system that helps no one. It delays care for the patient and adds unnecessary cost for both the payer and the provider. In the spirit of shared goals, I urge our payer partners to look at the data with us. If we can collaboratively identify and remove that friction, we aren’t just improving our working relationship; we’re lowering the total cost of care and allowing our clinicians to focus on what they do best: healing patients.
Q: Can you share the best piece of leadership advice you’ve received? How do you plan to use that in your new role?
TG: The best advice I’ve received is a combination of two ideas: listen deeply, but never be afraid to challenge the status quo.
Early in my career, someone told me, “Just because it was done this way before, doesn’t mean it should be done that way again.” That single sentence really shaped how I operate. But over the years, I’ve also learned that before you can change things effectively, you first have to respect and understand why they were built that way in the first place.
In my new role at Ascension, I am applying this advice in two distinct ways. First, I am heavily focused on listening and building relationships. Because each of our ministries is incredibly unique, I am spending time with our local, clinical, and operational leaders to understand their specific operational and strategic realities. A systemwide payer strategy is only as strong as our ability to execute it locally, which means we have to build it with a deep respect for the distinct dynamics of every market we serve.
Second, I am using those insights to actively inform our strategy. The healthcare landscape today looks nothing like it did even three years ago. If we want better, more sustainable results for our patients and our ministries, we have to be willing to fundamentally rethink our legacy processes and be architects of the new.
