Earlier this month, we gathered senior executives from health plans across the nation to discuss health plan strategy at a moment of innovation, integration, and disruption in the industry.

Read below to learn the top insights they gained from our research and the perspectives they shared along the way.

1. Purchasers are pushing plans to achieve greater affordability using diverging methods.

Health plans are no longer solely bearing the scrutiny for rising health care costs. But, as one executive noted, “No one would call a 5-7% price increase a victory lap in any other industry.”

Purchasers are getting restless and demanding more from plans. But their strategies are diverging due to shifting stakeholder capabilities:

• Individuals may choose from a range of low-cost, limited-coverage options due to shifting regulations
• Employers, losing faith in high-deductible solutions, are asking for increased consumer guidance
• Medicaid plans must help members verify eligibility under new experimental limits
• Medicare Advantage plans can expand supplemental social benefits

Plans’ future profitable growth will depend on strategic investments to meet these new capabilities, without bloating their administrative spending.

2. Growing vertical integration signals new competitive standards.

While most plans aren’t going to broker behemoth deals like CVS-Aetna or Cigna-Express Scripts, they will face the new expectations promised by industry integration:

• Lower drug spending through transparent low-cost options, formulary steerage, and targeted medication management
• Smart network routing from provider entry sites to appropriate providers and care pathways
• Point of care insights to guide tailored cost-effective treatment decisions in real time

These are each hallmarks of an industry oriented on outcomes, rather than procedures. “We’re seeing a focus shift from patient care to patient needs,” said one plan leader.

3. To improve outcomes, plans must selflessly put their partners’ needs first.

Most plans use increased member cost sharing or risk-based payment models to compel members and providers to action.

But this ignores the practical realities those partners face. Population health models require tedious work from already overburdened providers with thin margins. Greater consumer responsibility requires members to wade into overwhelming tasks like discerning appropriate choices from an array of unclear price and quality options.

Successful plans will step in to help providers understand how to achieve their own objectives in lowering medical spend, and help members understand their true care choices.

4. Providers can change their care approach, but need plans' help to lower operating expenses.

Physicians are spending roughly half of their time on documentation and data review. This time spent away from patients harms both provider and member satisfaction.

Plans’ IT infrastructure may offer a solution to the overwhelming data strain facing providers. For example, automating prior authorization approvals or applying artificial intelligence to support clinical decisions can reduce the information processing burdens placed on clinicians.

5. Members rely on plans to guide them to affordable, personal care.

U.S. health spending, by default, must absorb a great deal of social support. As a result, there’s no room in the future for a health plan that sees itself solely as a financial company.

That starts with more proactively addressing members’ biggest challenges with the basics of using their benefits. As one plan executive stated, “It’s already hard to identify the best quality care; getting the most affordable care is even harder.”

To avoid dissatisfaction—or even disintermediation—plans must focus on addressing core service delivery failures that prevent members from easily getting what they want most: care that is provider-directed, affordable, and convenient.