Skip to main content

I had the opportunity to attend the Health Plan Alliance (HPA) Value Visit which brought together sales and marketing leaders from community-based health plans across the country. The event was a deep dive into the shifting dynamics within commercial and individual market segments and explored successful methods for reaching consumers to achieve growth goals and gain competitive advantages. Here’s a closer look at insights and discussions from the event.

Medicare Advantage Continues to Boom

The hero for many health plans over the past year is the Medicare Advantage (MA) market. Even plans experiencing losses in all other lines of business still experienced growth in the MA market. In 2023, MA claimed more than 50% of the total Medicare membership for the first time, a trend that’s expected to continue as more boomers’ transition from employer-sponsored, Medicaid, and markets.

I expect that this market boom will last for years to come as the eligible population continues to grow and both national and regional plans look towards long-term MA investments. The challenge many of the community-focused plans face is balancing the Final Rule impact, which in theory should help level the playing field but will also significantly cut into profitability.

ACA Marketplace Sees Steady Growth and Stability

Most regional plans reported success and growth on the ACA Marketplace. Those who did not see substantial growth at least reported market stability and profitability. Increased affordability and enrollment gains from 2024 Medicaid disenrollments contributed to record-high Open Enrollment numbers.

Commercial and Individual Market

ACA Enrollment Trends and Growth created using data from ASPE’s “Health Coverage Under the Affordable Care Act: Current Enrollment Trends and State Estimates” report and KFF’s “Marketplace Enrollment Tracker”

Volatility in the Small Group Market

Many health plans reported losses in the small group market, though a few noted significant growth. This segment’s performance varies greatly by geographical area and is heavily influenced by regional market presence and state regulations. The regional variation presents a complex challenge for health plans looking to improve small group margins, which must come from very calculated, data-driven approaches. With growing challenges in the small group market, I predict that the Individual Coverage Health Reimbursement Arrangement (ICHRA) will continue to increase in popularity as a group-coverage alternative.

Achieving Success in Different Types of Health Plans

Exploring growth strategies reveals a significant diversity in approaches, particularly among regional health plans, which are often provider-sponsored or owned. Here are a few strategies that I found particularly impressive and unique:

A Partnered Approach to Market Penetration and Expansion

Several leaders shared their successful penetration into new geographic markets and/or lines of business. One provider-owned health plan shared successful expansion of Administrative Services Only (ASO) offerings in new regions in addition to their successful launch of Medicare Advantage in a new state. The Market President of shared how calculated their approaches were – at the heart of it all were close ties to their key partners in both network and brokers/agents.

Product Pricing for Growth

Another smaller, regional provider-sponsored plan shared their strategy adjustment to increase membership: going low!

They deployed rate reductions that earned their plans the first, second, and third position on the first page of plan selection. Their ACA membership skyrocketed from 400 to 8,000 in just a year. This example highlights the importance of a strategic and sustainable approach to scaling, emphasizing phased entries to assess market fit and tailoring offerings to member needs.

Market Differentiators Beyond Local Ties

The SVP and Chief Growth Officer for a regional payer noted that merely being a local health plan is no longer a sufficient differentiator. With shrinking market share and the continued threat from industry giants, regional plans must leverage more than just community ties. He identified the following as the top market differentiators for any health plan:

  1. Affordability
  2. Access to coverage
  3. Easier navigation of care

I agree with him that being local is no longer enough to set health plans apart. Community efforts coupled with a robust data repository enables health plans to enhance affordability, access to coverage, and easier navigation of care. Providing access to alternative and unconventional payment methods that meet community needs has allowed regional plans to break into traditionally hard-to-reach populations. An example of this in action: Softheon offers community lockbox drop offs where members can pay their premium payments in cash.

I have seen regional plans with partnered health systems achieve great market penetration by supporting provider-sponsored payments. The ability to process premium payments from multiple parties grants access to coverage when prior government-sponsored options were unaffordable or inaccessible.

The HPA Value Visit was filled with great back-and-forth discussion and insights into how health plans can strengthen their competitive advantage and meet their growth objectives. If you’d like to discuss any of the topics covered in my recap or explore how your health plan can adapt these insights, feel free to reach out to me at tcohen@softheon.com or connect on LinkedIn.