Health plan leaders agree: sustainable growth in today’s payer market demands more than simply adding lives. It requires a fundamental rethinking of how value is created. Across the industry, executives point to deeper provider alignment, scaled value-based care, smarter use of AI and data, and more meaningful member engagement as the clearest paths forward. Together, these strategies form a blueprint for durable, long-term growth.
Member Engagement and Care Navigation
Empowering Members and Caregivers
Todd DeYoung, Associate Vice President of Clinical Vendor Management at Humana, sees member engagement as the foundation of sustainable growth. He argues that payers must unlock the “often-untapped power of the caregiver.” By elevating care navigation and strengthening coordination across the healthcare ecosystem, organizations can simplify the experience at every touchpoint. Furthermore, aligning referral patterns with clinical vendors, providers, and health systems creates a more seamless, personalized journey. As a result, both members and caregivers gain access to the right support at the right time.
Value-Based Care at Scale
Moving From Contracting to Operating in Value
Felix Aguilar, MD, Quality Medical Director at L.A. Care Health Plan, identifies value-based care enablement at scale as the strongest long-term growth engine. He notes that cost-trend pressure is structural. Therefore, payers that move from “contracting for value” to actually operating in value build a lasting competitive advantage. This approach allows payers to improve outcomes, reduce total cost of care, deepen provider alignment, and expand margin outside MLR constraints — all while differentiating in an otherwise commoditizing market.
Raul Daza, MD, Vice President of Payor and Provider Collaboration at GuideWell, similarly emphasizes provider-led, total cost-of-care initiatives. He argues that empowering providers to “own the problem” and collaborate with payers drives meaningful improvements in health outcomes. Moreover, it reduces unnecessary utilization while improving patient engagement. Working together, payers and providers can identify opportunities to optimize care pathways and deliver better outcomes at a lower cost.
AI and Data-Driven Growth
Building a Virtuous Cycle with Technology
Todd Carlson, Senior Vice President of Engineering at CareSource, believes the biggest growth opportunity belongs to organizations that apply AI early to structurally reduce costs. Payers that use AI to drive administrative efficiency, optimize clinical operations, and lower medical cost trends can reinvest savings into member value. In addition, AI enables hyper-personalized member experiences — from tailored outreach and care navigation to proactive interventions. This increases engagement, retention, and membership growth. When combined with data-driven clinical insights, the result is a virtuous cycle: lower costs, better experiences, healthier members, and durable growth.
Nishant Anand, MD, President and CEO of Altais, adds that sustainable growth will come from integrating whole-person care with disease management in a data-driven way. Rather than reactive utilization management, he envisions proactive health optimization powered by predictive analytics and AI. When technology pairs with strong clinical oversight, it enables earlier intervention and lower total cost of care. Consequently, the organizations that succeed will be those that move upstream and make health — not just healthcare — their core strategy.
Employer Market and Mid-Market Opportunity
Serving the Underserved Mid-Market Employer
Christina Rassi, Chief Growth Officer at Evry Health, highlights the mid-market employer as the most underserved and underappreciated growth opportunity in the payer market. With employer healthcare costs projected to see their largest increase in 15 years, CFOs and HR leaders are done passively renewing fully insured arrangements. They want transparency, predictability, and proof of performance. Self-funded plan design delivers all three — but only when surrounded by the right accountability infrastructure: clinical engagement, care coordination, and actionable outcomes data.
Chris Gay, CEO of Evry Health, takes a broader view, noting that intense scrutiny on premium escalation will drive more investment in data, technology, and tools vendors. He describes this as “selling metaphorical shovels” — building long-term advantages for affordability, population health, and underwriting through improved payer technologies.
Provider Alignment and Collaboration
Rowing in the Same Direction
Julia Bruner, MD, Chief Medical Officer at Aetna OhioRISE, emphasizes that industry-wide collaboration is essential. As value-based arrangements grow and the way populations receive care evolves, the runway with each member becomes variable. People switch plans both within and outside their control. Because of this, payers inherit the successes and failures of their colleagues’ prior engagements. Therefore, for sustainable growth and cost control, payers must focus on improving long-term health outcomes and reducing total cost of care — together.
Erin Weber, Chief Policy and Research Officer at CAHQ, agrees. She stresses that growth cannot simply be about adding lives given the uncertainty around Medicare Advantage rates. Instead, payers must invest in better data, smarter automation, and stronger provider alignment. Plans that reduce administrative friction and improve both provider and member experience will be best positioned to grow in a tight margin environment.
Integrated Care Models and ICHRA
Provider-Sponsored Plans and Innovative Benefit Design
Ashley Fisher, Vice President of Strategy at Health Alliance Plan, points to the convergence of value-based care and group population management as the most sustainable growth opportunity. Payers must do more than administer benefits; they must partner with providers to deliver high-value care, focus on prevention, and manage the total health of their populations. This approach not only drives sustainable growth but also lowers costs and improves health outcomes.
Cristal Gary, President and CEO of Meridian Health Plan of Illinois, identifies ICHRA (Individual Coverage Health Reimbursement Arrangements) as a significant growth avenue. As ICHRA adoption grows, payers that leverage technology and data to simplify plan selection, navigation, and ongoing engagement will be best positioned for long-term success. Pairing innovative benefit design with a seamless, tech-enabled member experience will serve as a key differentiator.
Jennifer St. Thomas, Senior Vice President of Commercial and Medicare Markets at Mass General Brigham Health Plan, highlights integrated models that align care delivery and coverage as the path to long-term value. As a provider-sponsored health plan, she notes the importance of tailoring strategies to local communities to meet the distinct needs of the populations served.
Outcome-Oriented Payment Models
Tying Reimbursement to Real Performance
Ty Wang, Co-Founder and CEO of Angle Health, sees a major opportunity in outcome-oriented payment models. These models drive overall costs down and create consistency in how ROI and clinical impact are measured. By tying reimbursement to risk-adjusted total cost of care and measurable outcomes, they separate programs that genuinely bend costs from those driven by engagement metrics alone. As real performance becomes transparent, effective solutions move from point solutions to embedded components of clinical care pathways.
Employer Ownership of Healthcare Data
Shifting Power Back to Plan Sponsors
Claire Brockbank, Director of Policy and Strategy at Building Service 32BJ Benefit Funds, argues that hospital prices are increasing at twice the rate of most other healthcare services. Therefore, the most sustainable growth opportunity lies in reestablishing a direct role in the healthcare value chain for employers and union health funds. By demanding full ownership of their data and a complete understanding of contract details, plan sponsors become informed negotiators. Consequently, every dollar spent contributes to real clinical value for employees and union members.
Conclusion
Across the payer landscape, one theme emerges clearly: sustainable growth demands a shift from volume to value. Whether through AI, value-based care, provider collaboration, or employer market innovation, health plan leaders agree that the organizations willing to invest deeply — in data, technology, and partnerships — will be best positioned for long-term success. The future of payer market growth is not about adding lives. It is about improving them.
