Shaping the Commercial & ACA Products of the Future

Update

04/23/2025

Community-based health plans are under increasing pressure to compete with national carriers while maintaining their unique market identities and care delivery strengths. In response, Health Plan Alliance members came together for the Commercial & ACA Products Fly-In—an intensive, solutions-oriented summit focused on what’s working, what’s next, and how regional plans can win in the commercial market.

Defining the Market Landscape
The meeting opened with a data-driven analysis of the 2025 enrollment cycle, highlighting key market shifts and challenges. McKinsey & Company extended this lens with projections for the next five years, offering a robust framework for 3–5-year strategic planning. These sessions equipped members with a clear understanding of current positioning—and a strategic roadmap for navigating the future.

Innovating Network and Premium Strategies
Members explored practical approaches to product competitiveness through evolving network models and pricing strategies. OpenNetworks shared how their Blue Card-like arrangement supports geographic expansion while preserving local identity. Milliman offered valuable guidance on premium strategy, balancing competitive pricing with sustainability and risk management.

Exploring New Product Models
Defined contribution models and innovative self-funded designs emerged as key areas of opportunity. Remodel Health, The HRA Council, and Presbyterian Health Plan addressed ICHRA adoption and positioning. Oxbridge Health introduced Episode Benefit Plans that mirror national innovations like United’s Surest Plan while prioritizing member experience and provider alignment.

Refining Exchange Strategy
As ACA Exchange markets evolve, members learned from Evensun and CHRISTUS Health Plan how targeted pricing and segmentation strategies can enhance risk selection and product design—critical insights for plans aiming to protect and grow their footprint in this space.

What's Next: Keeping the Momentum Going
HPA members are continuing their learning journey through our specialized workgroups, which provide focused environments for problem-solving and peer exchange:

ASO Workgroup: A strategic forum exploring growth strategies for self-funded products, stop-loss structures, and captives.
Commercial & ACA Product Workgroup: Tackles evolving cost pressures, MLR performance, member experience, and regulatory changes.

All meeting materials are available in the Documents section of the event page. We encourage members to share them with their teams and continue the conversations sparked during the fly-in.