Research & Insights

Health plans

Health plans must meet growing purchaser and consumer expectations along with the accompanying challenges. Our research team works with plans of all sizes and types to provide the strategic insight and market intelligence that equips health plan executives to make smart decisions and position their organizations for future success.  


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Tackle these challenges

Health plans vary immensely in their size, scope, and strategic priorities. A baseline understanding of the health plan market requires a grasp on the following dynamics:

  • How plans make money: Premiums, quality bonuses, diversified assets.
  • Common “types” of health plans: National, regional, provider-sponsored, community/local.
  • Key lines of business: Medicare Advantage, Medicaid Managed Care, employer market, individual market.
  • Executive priorities: Strategy and growth, utilization and costs.

Increasingly health plan executives think of growth as a health plan via two primary avenues: line of business growth and asset diversification. Health plans must excel against strong existing competitors and established, yet evolving, market dynamics.

  • Plans are rapidly chasing member growth in their insurance lines of business with Medicare Advantage receiving outsized attention given profitability and growth trajectory.
  • Many health plans are expanding their offerings to include diversified health care service divisions.
  • Understand the demographics in your geography to understand opportunity for greater membership growth.
  • Provider relations is an imprecise term used to describe the relationship between health plans and providers — most notably physicians.
  • Collaborative providers are essential to advancing health plan strategic goals such as value-based care, behavioral health integration, and efficient specialty referrals.
  • The path forward seems clear: successful plans will relentlessly focus on physician-led, data-driven provider enablement.

Member engagement is the process of building, nurturing, and managing relationships with members to drive behavior change.


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