With changes in the healthcare environment come new opportunities – and new competition. Previously clear lines between insurers and providers have blurred, with acquisitions happening in both directions. Large employers have signed up directly with integrated delivery networks and centers of excellence, choosing to define their own provider networks. Other players have developed business models intended to obviate the need for insurance companies.

As transparency increases and the market shifts to focus more on value and consumers, segmentation and differentiation will be critical. Payers will need to clearly understand how different stakeholders define value, especially as insurance takes on more of a retail distribution model. While price has always been a key factor, the nature of the network, service, and quality of care will only become more important. Reducing churn will also support growth efforts, and plans that can improve retention will reap the benefits of wellness programs and care management.

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