Health plan leaders say sustainable growth in today’s market will not come from adding lives alone — it will come from fundamentally rethinking 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.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: Where do you see the most sustainable growth opportunity in today’s payer market?
Todd DeYoung. Associate Vice President of Clinical Vendor Management, Humana (Louisville): The most sustainable growth opportunity in today’s payer market lies in truly engaging with our members and unlocking the often‑untapped power of the caregiver. By elevating care navigation and strengthening coordination across the healthcare ecosystem, we can simplify the experience at every touchpoint. Aligning referral patterns with clinical vendors, providers and health systems will create a more seamless, personalized journey. Ultimately, this approach empowers both the member and the caregiver to access the right support at the right time.
Julia Bruner, MD. Chief Medical Officer, Aetna OhioRISE (New Albany): Collaboration within the industry is key. As we move into value-based arrangements and how the population receives care changes, the runway with each member is variable. People (members) switch plans within their control and outside of their control. In these instances, we reap the success and failure of our colleagues’ prior engagements and service. So, for sustainable growth and cost control, payers need to be rowing in the same direction, focusing on the same areas that improve long-term health, outcomes and ultimately reduce total cost of care.
Todd Carlson. Senior Vice President of Engineering, CareSource (Dayton, Ohio): The most sustainable growth opportunity in today’s payer market sits with organizations that lead early in applying AI to structurally reduce costs and reinvest those savings into member value. Payers that use AI to drive administrative efficiency, optimize clinical operations and lower medical cost trends can pass those savings along to states and members, strengthening trust and competitive positioning. At the same time, AI enables hyper-personalized member experiences, from tailored outreach and care navigation to proactive interventions, which increases engagement, retention and ultimately membership growth. When combined with data-driven clinical insights that improve health outcomes, this creates a virtuous cycle: lower costs, better experiences, healthier members, and durable growth that is difficult for laggards to replicate.
Felix Aguilar, MD. Quality Medical Director, L.A. Care Health Plan (Los Angeles): I see the most sustainable growth opportunity in today’s payer market in value-based care enablement at scale. Payers that move from “contracting for value” to operating in value are building a long-term advantage. This is the strongest growth engine because cost-trend pressure is structural. Value-based care enablement is the most sustainable long-term opportunity. It’s the only area where payers can improve outcomes, reduce the total cost of care, deepen provider alignment, build defensible capabilities and expand margin outside MLR constraints. It’s also the area where payers can differentiate most meaningfully in a market that’s otherwise commoditizing.
Erin Weber. Chief Policy and Research Officer, Council for Affordable Quality Healthcare (Washington, D.C.): I see the most sustainable growth opportunity in helping payers perform better with the members they already have. With federal experimentation around new payment models and real uncertainty ahead for Medicare Advantage rates, growth cannot just be about adding lives. It must be about managing total cost of care more effectively. That means investing in better data, smarter automation and stronger provider alignment. Plans that reduce administrative friction and use technology to improve both provider and member experience will be best positioned to grow in what will likely be a very tight margin environment.
Raul Daza, MD. Vice President of Payor and Provider Collaboration, GuideWell (Jacksonville, Fla.): I believe the most sustainable growth opportunity in today’s payer market lies in total cost-of-care initiatives that are provider-led and focused on value-based care arrangements. By empowering providers to “own” the problem and work collaboratively with payers, we can drive meaningful improvements in health outcomes while reducing the cost of care. By working together, payers and providers can identify opportunities to optimize care pathways, reduce unnecessary utilization and improve patient engagement, ultimately leading to better health outcomes at a lower cost.
Ashley Fisher. Vice President of Strategy, Health Alliance Plan (Detroit): From my vantage point, straddling a health system with a wholly owned insurance subsidiary, the most sustainable growth opportunity in today’s payer market is the convergence of value-based care and group population management. Employers and families are buckling under the weight of rising healthcare costs, and success requires addressing this challenge head-on. Payers must do more than administer benefits; we must partner with providers to deliver high-value care, sharpen our focus on prevention, and more effectively manage the total health of our populations. This approach not only drives sustainable growth but also lowers costs and improves health outcomes.
Nishant Anand, MD. President and CEO, Altais (Oakland, Calif.): Sustainable growth in the payer market will come from integrating wellness/whole person care with disease management in a meaningful, data-driven way. The future is not reactive utilization management — its proactive health optimization powered by predictive analytics and AI. This is the only way to make healthcare accessible, deliver optimal long-term health outcomes, and affordable. When technology is paired with strong clinical oversight, it enables earlier intervention, better outcomes and lower total cost of care. The organizations that succeed will be those that move upstream and make health, not just healthcare, the core strategy.
Christina Rassi. Chief Growth Officer, Evry Health (Dallas): The most sustainable growth opportunity is the mid-market employer — and it has been underserved for too long.
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 the accountability infrastructure surrounds it: clinical engagement, care coordination, and outcomes data that employers can act on.
The payers and advisors who win the next decade will be the ones who absorb complexity on behalf of their clients and prove value through measurable results — every single year. That is not a product play. That is a partnership model. And right now, the market is hungry for it.
Chris Gay. CEO, Evry Health (Dallas): Selling metaphorical shovels. The intense scrutiny on premium escalation and underwriting economics will lead to more investment in metaphorical shovels: data, technology and tools vendors will benefit. Long-term advantages for affordability, population health and underwriting are possible with improved payer technologies.
Meredith Duncan. President and CEO, Texicare (Austin): The most sustainable growth opportunity lies in breaking the cycle that has defined the small business health insurance market for decades — costs rise, coverage shrinks, small businesses can’t afford to offer benefits and employees lose access to care. I’ve spent 20 years working with small business owners across the country, and I’ve watched this pattern repeat. But I’ve also seen what happens when you fundamentally change the approach. When you design plans that encourage preventative care, employees stay healthier. Healthier employees mean healthier businesses, which build stronger economies.
Jennifer St. Thomas. Senior Vice President of Commercial and Medicare Markets, Mass General Brigham Health Plan (Boston): The most sustainable growth opportunity in today’s payer market lies in integrated models that align care delivery and coverage to provide long-term value. As a provider-sponsored health plan, we’re uniquely positioned to bring product innovation and population health strategies together to improve health outcomes and drive affordability. Combined with being a regional plan, our focus is on our unique understanding of our local community and how to tailor our approaches to meet the needs of the people we serve.
Cristal Gary. President and CEO, Meridian Health Plan of Illinois (Burr Ridge): One of the most sustainable growth opportunities in today’s payer market is ICHRA, particularly as employers look for more flexibility and choice. As ICHRA adoption grows, payers that can 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 be a key differentiator over time.
Ty Wang. Co-Founder and CEO, Angle Health (San Francisco): We see a huge opportunity for outcome-oriented payment models that drive overall costs down, leading to sustainable growth. These create much-needed consistency in how ROI and clinical impact are measured, cutting through the noise of a crowded digital health market. By tying reimbursement to risk-adjusted total cost of care and measurable outcomes, they separate programs that bend costs from those driven primarily by engagement metrics or marketing. As real performance becomes transparent, effective solutions will move from “point solutions” to embedded components of clinical care pathways.
Claire Brockbank. Director of Policy and Strategy, Building Service 32BJ Benefit Funds (New York City): With hospital prices increasing at twice the rate of most other healthcare services, the most sustainable growth opportunity lies in reestablishing a direct role in the healthcare value chain for the true payers of healthcare costs – employers and union health funds. The current system is built to be intentionally opaque, but employers can shift the power dynamic by demanding full ownership of their data and demanding a full understanding of the details in their contracts. By removing the mystery, plan sponsors become informed negotiators with hospitals, thereby ensuring every dollar spent is contributing to clinical value for their employees and union members. Northwell Direct is a prime example of a partner that has recognized this shifting tide, creating a partnership model between purchasers and providers.
