Episode Details

For years, regional health plans benefited from powerful tailwinds: Medicare Advantage growth, Medicaid expansion, and a prospering ACA marketplace. But many of those growth engines have stalled, just as new pressures emerged: rising utilization, runaway spend, pricing uncertainty and more scrutiny from patients and policy makers. The result is a dramatically different financial reality for health plans. In 2024, only eight of 33 Blues plans reported positive operating margins.

In this episode, host Rae Woods sits down with Jared Landis, Vice President of Advisory Board's Health Plan Research practice, to unpack how regional plans got here and the three-year turnaround strategy regional and Blues plans are now pursuing.

Together, they explore the market forces that upended the payer playbook, the operational and pricing changes plans are making to stabilize performance, and how AI-enabled transformation could reshape the future of the insurance business.

Stay tuned to the end of the episode for an update on the Rural Health Transformation Program, including a key deadline this fall.

We’re here to help:

• Episode | Ep. 257: Paul Markovich on new builds, breakups, and bold healthcare bets
• Episode | 305: “The work isn’t easy, but it’s clear”: How healthcare leaders are responding to the market
• Episode | 302: CMS announced the 2027 MA final rate. What do payers and providers need to know?
• Playlist | Radio Advisory Provider Strategy and Financial Outlook playlist
• Expert Insight | Can health plans turn their MA business around this year?
• Research | Health plan strategy
• Report | Rural health transformation funds: Where they're really going
• Ready-to-Use Slides | Health Plan Market Explorer
• Webinar | Understanding health plan decision-makers

Sponsor link:

Listen Now