While Americans continue to delay non-urgent care due to COVID-19, health plans are financially benefitting, reporting tremendous profits in the second quarter of 2020. But these gains should come with a warning: they won’t last. Already this year, insurers could be held accountable for huge medical loss ratio rebate payouts – an estimated $2.7 billion for ACA plans alone, almost double the amount paid out in 2019. Not to mention, deferring care or routine screenings – especially for chronic diseases, like diabetes or cancer – will undoubtably build up over time and become increasingly aggressive and expensive to treat. For instance, weekly cancer diagnoses are down 46.4% compared to the pre-COVID-19 period. So while health plans today are not seeing COVID-related headwinds on their financials, major cost pressures loom large. AHIP estimates the cost of COVID-19 at $30 billion to $547 billion over the next two years, a net increase of up to $118 billion after estimated COVID-related savings are taken into account.


Health plans will need to brace for when – not if – they’ll face the ensuing financial pressures. For many, that pressure has already started. Here’s what we’re hearing from health plan sales leaders today: 

  • “We’re still trying to understand the current marketplace dynamics and how to sell into it. How can we adapt our sales model to what’s going on now? What comes next?”
  • “My sales reps are wondering if they’re going to get paid, while I’m trying to best manage financial pressures on the costs of sales. How do I keep my best people in the long term while saving money in the short term?”
  • “We’re dealing with unprecedented cost pressures. How can I save $1 million now, but still be ready to grow next year?” 

To solve these challenges, health plans must move beyond adapting pre-COVID sales models to markets shaped by COVID-19 dynamics. To reinvent your go-to-market (GTM) strategy for an uncertain “new normal” and simultaneously relieve cost pressures, your sales organization must preserve your current customer base, add new members and lower costs of sales, all while positioning itself to succeed in the long term.    

Here’s how to set up your sales organization to succeed:  

  1. Upgrade virtual engagement capabilities. Improvements here will pay dividends even when travel again becomes an option, and tend to be incremental and cost effective. For instance, small investments in hardware, such as lighting, can create a significantly better virtual experience. Purposeful scheduling, timing and application of behavioral insights will also generate quick returns.
  2. Design an agile sales structure that allows teams to easily pivot. A flexible structure provides a stable foundation to deploy new coverage models and tactics. When combined with an effective market monitoring program, sales leaders can rapidly roll out new tactics and test and perfect them – staying out in front as the current crisis unfolds and preparing for future market upheavals.
  3. Rethink targeting. COVID-19 has impacted industries and parts of the country in very different ways and will continue to do so. To stay ahead of the rapid changes in their customer bases, health plans need to rethink who and how they target. New coverage constraints and changes in objectives compared to pre-COVID days will require a more dynamic targeting approach.
  4. Offset reductions with more efficient sales organization sizing. Over the past few months, many sales leaders have already been directed to “do more with less.” Fortunately, the successes other industries have had with hybrid sales roles are transferable to health plans. Hybrid roles that seamlessly transition between virtual and in-person could significantly reduce costs and improve productivity.
  5. Reduce rigidity in territory design and management to better deal with uncertainty. Short term, the reduction or elimination of travel supports increasing territory size. Now is also a good time for more long-term thinking and for implementing a less disruptive, more dynamic process to reassign agencies and employers to handle market disruptions and turnover.

These guidelines will equip your sales organization to deal with the current near-term uncertainties and be best positioned for success in the long term.


Want to learn more about how to reinvent your go-to-market strategy? On September 22, join ZS’s Healthcare Dive webinar with Notable Health, “How Health Plans Can Prepare for the New Normal.”