5 keys for health plan success in a complex, competitive landscape
Health plans are facing some of the most formidable — and transformative — moments in recent history. Regulatory shifts, rising costs, changing member expectations, and the move to value-based care are all creating new demands on plans. The pressure is real. But with the right strategy, these challenges also open the door to meaningful innovation and impact.
In this blog, we explore five essential strategies high-performing plans are using to stay competitive, improve outcomes, and deliver real value to their members and their organization.
1. Drive smarter member engagement and retention
In today’s market, acquiring new members is only half the battle. Retaining and engaging the ones you already have is equally ( if not more) critical. To do that, plans need to deliver experiences that feel personal, relevant, and trustworthy.
This starts with education. When members have access to credible, easy-to-understand health information in the formats they prefer — like videos, interactive tools, and structured programs — they’re more likely to take action. Layer in digital assistants and more engaging health risk assessments, and you’re giving members the tools to stay informed, proactive, and healthier over time.
The goal? Make every interaction feel less like a transaction and more like a relationship.
2. Close care gaps through better care management
Plans need to reach members at the right moment, with the right message — without creating more work for care teams. That’s where centralized care management platforms come in. With the ability to deliver education, coordinate care, and triage needs in one place, these tools streamline workflows and boost efficiency.
Timely communication matters, too. SMS texting, for instance, often outperforms traditional outreach thanks to its immediacy — 99% of texts are opened and 90% are read within minutes. That makes it a powerful way to close gaps and prompt members to act now. Outreach with relevant, evidence-based education gives care teams the ability to influence behavior in a meaningful, measurable way.
3. Improve quality metrics and ensure compliance
Metrics like HEDIS® and Star Ratings are more than performance indicators — they’re invariably tied directly to funding, member trust, and a plan’s ability to grow. And with evolving CMS requirements, quality has never been more important.
Plans that succeed here take a member-first approach: use demographic and behavioral insights to tailor communications, simplify care delivery with integrated tools, and empower members with self-management resources. Whether it’s scheduling preventive screenings or improving medication adherence, it all adds up to stronger outcomes and better ratings.
And don’t forget: When care feels more personalized, members feel seen — and satisfaction can increase dramatically.
4. Turn data into actionable strategy
Data is your friend. That’s because it can become the foundation of proactive care. The most effective plans aren’t just collecting data — they’re embedding it directly into the clinical workflow. That means insights show up where they’re needed most. Think EMRs, care management tools, and digital platforms. This enables real-time action. Providers and care managers can reinforce education, recommend next steps, and guide members toward healthier choices — all while keeping teams aligned around common goals. Over time, this integration leads to a virtuous cycle of more informed care, more engaged members, and better overall performance.
5. Demonstrate ROI across the board
In a value-based world, success needs to be visible — and measurable. Health plans are expected to show clear outcomes tied to their strategies, whether that’s improved adherence, reduced hospitalizations, or stronger Star Ratings.
And no, it’s not just about making a point. Proving ROI helps organizations optimize investment, secure leadership buy-in, and achieve continuous improvement. Analytics play a critical role here. By measuring engagement, tracking progress, and surfacing trends, plans can fine-tune their programs and ensure they’re making the greatest impact — for both members and the bottom line.
Final thoughts (for now)
Succeeding in today’s complex healthcare environment isn’t about doing more. It's about knowing what matters, and executing it with precision and efficiency. These five strategies help health plans meet rising expectations, navigate regulatory pressures, and deliver high-quality care that members trust.
For a more in-depth roadmap, download our ebook: Winning strategies for modern health plans: How to thrive in an increasingly complex environment.
