Alignment Healthcare has California roots, but its CEO, John Cao, is confident about planting seeds for growth elsewhere.
Mr. Cao weighed in on Alignment’s strategy Jan. 14 during the J.P. Morgan 2026 Healthcare Conference in San Francisco. Just days before, the Medicare Advantage insurer highlighted 31% year-over-year growth, ringing in 2026 with 275,300 members.
Still, faster enrollment growth from contracts — particularly in California where independent practice associations can sometimes serve as “middlemen” in contracting, Mr. Cao said — can invite risk. Mr. Cao said these associations often operate around global capitation, where physician groups get a fixed payment per patient per month, which can serve as a friction point.
“We could have grown a lot more,” Mr. Cao said. “We chose not to grow even more and take bad contracts. We let somebody else take that. It’s OK. No free lunch.”
He emphasized thinking about longer-term contracts, focusing on “durability.”
“It doesn’t do any good if we grow by X number, and you got a one-year deal,” he said. “It’s short-term gratification.”
While Mr. Cao said he thinks California will remain the company’s “engine,” proportions will change as Alignment expands outward — and he is just fine with that.
“I don’t think it’s ‘either/or.’ I think it’s gonna be ‘both/and,'” he said of geographic shifts.
