Key takeaways
- A strong health plan commercial executive is a lynchpin to position the organization for long-term growth, resilience and performance in the face of affordability challenges and shifting market demands.
- Digital transformation in health plans enables innovative product development and improved experiences for employers and members.
- Multichannel, digital marketing is critical to meet consumers where they are and to drive health and commercial outcomes.
Today’s commercial market health plan leaders face real headwinds. The affordability crisis continues to expand, with utilization and consumer demand for high-priced treatments for weight management and oncology hitting a tipping point. Many plans saw their worst financial year in decades in 2024, and early 2025 forecasts predict little relief.
Meanwhile, competition is accelerating. New entrants are gaining traction by delivering what employers and consumers increasingly expect: Affordability, convenience and a seamless digital experience with full transparency into their journey. National carriers are differentiating themselves with integrated clinical solution companies, while regional health plans are experiencing declining market share due to limited innovation investment capacity.
In this climate, commercial executives aren’t just functional leaders. They’re strategic linchpins for future viability. From product development to sales, marketing and customer engagement, the commercial function’s ability to steer the ship through uncertainty will define which plans survive—and which plans thrive.
New entrants are gaining traction by delivering what employers and consumers increasingly expect: Affordability, convenience and a seamless digital experience.
In our last article, we laid out four shifts health plans must lead to reposition their organizations for success. Today, we go deeper—exploring practical, real-world examples to make those shifts stick.
1. Health plan commercial strategy centered on key stakeholders
A winning strategy starts with delivering value to key stakeholders—employers, brokers and members. That means retaining key accounts and growing amid rising expectations. Digital infrastructure is no longer optional. It’s the cost of doing business. Health plans without a strong digital infrastructure risk higher admin costs and lagging customer satisfaction.
Modern employer-facing platforms that combine data management, access and security with flexible technology are now table stakes. These portals should allow self-service functionality, streamline account management and free up time for teams to focus on higher-value interactions. More importantly, they should enable proactive communication and targeting so plans can continually reinforce their value and stay top-of-mind in competitive situations.
As health plans advance deep understanding and engagement with the consumer, it’s important these insights connect back to impactful engagement with employers and brokers centered around consumer health access, coverage and empowerment.
2. Data-driven healthcare marketing and health plan member engagement
Health plans have long struggled to engage consumers in meaningful ways—especially compared to the expectations set by industries such as retail or financial services. But in today’s climate of economic uncertainty and low public trust, failing to connect with members isn’t just a missed opportunity—it’s a risk to the bottom line.
That’s why health plans need smarter, more intentional marketing strategies to catch consumers’ attention and share targeted and helpful information about health and health plan products. It’s not just about casting a wider net. It’s about connecting the right message to the right person, at the right time.
Multichannel, data-driven marketing programs designed to drive both health and commercial outcomes are the future of member acquisition and retention. These campaigns start by defining a clear objective—whether it’s supporting sales, driving enrollment or encouraging preventive care.
It’s no longer enough to segment audiences by geography, demographics and product type. Imagine a marketing campaign that adapts content based on members’ preferred language, recent preventive care activity and their employer’s benefit priorities—driving higher engagement while meeting business goals. Dividing major market segments into more precise microsegments allows us to understand the propensity toward an outcome at a much deeper level. Tailored, compelling messages focused on addressing those finer micro characteristics replace the “spray and pray” approach marketers have used in the past. We can learn about the human being behind the member, subscriber or employer label.
3. Digital transformation in health plans drives future-proof product design
Product teams sit at the intersection of market demands and operational delivery. Yet health plan products are too often developed in silos, with disconnected decisions and inefficient execution. To succeed, health plans must redefine what they mean by “product.” It’s not just benefit design anymore. It’s the full customer experience: Clinical programs, digital tools, networks, affordability solutions and everything in between.
We believe the shift to a product management mindset is overdue. That means:
- Grounding innovation in customer and market data, not internal preferences
- Using consistent cross-functional processes to prioritize and fund innovation—not siloed pet projects
- Building common capabilities that can be reused and scaled across products, instead of bespoke efforts that slow time to market
- Implementing a repeatable commercialization process that ensures new offerings make it to market quickly—and stick
- Engaging cross-functional teams early to avoid surprises, clarify requirements and deliver stronger outcomes
By evolving their approach to product, health plans can move faster, reduce complexity and deliver more value, while driving down administrative costs.
4. Health plan customer experience: Building an elevated ecosystem
Sales and account teams are the face of the health plan. They hold the relationships that drive retention and growth. But they’re too often burdened by outdated systems and manual workarounds that slow them down and prevent them from delivering the kind of high-touch experience clients expect. With the right tools and support, sales teams can spend less time on paperwork and more time acting as trusted advisers. Modern, AI-enabled platforms can streamline everything from client insights to follow-ups and enable higher impact engagement.
Teams also need the right training, incentives and user-friendly tools to ensure these systems are relevant and productive over time. That means designing tools with the sales rep in mind, coaching teams to use insights effectively and aligning performance goals with long-term customer value. When sales teams are empowered by data—and supported by innovative product design—health plans can deliver a more responsive, differentiated experience that drives real loyalty.
Health plan commercial strategy for long-term growth and resilience
With the level of financial pressure and uncertainty in the health insurance industry today, it’s tempting to hunker down and wait out the turbulence. You’re not navigating these challenges alone. By partnering together and focusing on shared goals, you can lead your organization through uncertainty and deliver real value to your members and clients. Strengthening the foundation of modernized technology platforms and improving effectiveness and efficiency across core functions and processes are critical to help commercial functions do more with less and drive growth within challenging market dynamics.
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