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Each year, we delve into the complex landscape in which health plans operate, identifying and distilling the most pressing themes and actions to prioritize.

This year, many health plans are taking an especially critical lens to the consumer experience and how well consumers believe their coverage and services are addressing their healthcare needs.

Health plans enter 2025 against the backdrop of vocal consumer scrutiny, policy changes stemming from the elections, and the constant forces of innovation and disruption.

This report examines five key areas in which health plans can upgrade strategies to drive long-term success:

  1. Employer-sponsored business is no longer running on autopilot.
  2. Headwinds in the Medicare Advantage market have intensified into a “perfect storm.”
  3. Evolution of the duals landscape necessitates integration across Medicare and Medicaid operating models.
  4. Strategic approaches to value-based care empower providers and elevate outcomes.
  5. Old school payment integrity operational levers need to modernize.

In considering the health plan outlook for the new year, we remain focused on helping health plans provide the access, services, affordability, quality of care, and experiences their members are seeking.

Read the report