Three things keeping health plan leaders up at night — and smart strategies to address them

Health plan leaders are facing what some would call a perfect storm: the 2026 Final Rule, tightening federal budgets and rising member expectations. These forces are affecting every line of business, especially for small and mid-sized payers. The impact is particularly visible in Medicare Advantage, which is entering a new era of heightened CMS oversight and growing emphasis on member satisfaction directly shaping revenue and ratings.

Though these pressures are real, they also present opportunities to work smarter. For plans looking to advance their operations, embracing adaptable solutions can turn today’s challenges into tomorrow’s advantages. 

Below are three of the biggest concerns weighing on health plan leaders — and strategic guidance on each.

1. Regulatory complexity is outpacing manual processes

   From agent compensation transparency to CMS audits and grievance tracking, sweeping new CMS requirements are raising the bar for oversight. Yet many payers still rely on legacy systems and manual workflows that simply weren’t designed for today’s pace of change. Falling behind doesn’t just risk compliance penalties — it can also erode member trust and strain relationships with both members and providers.

   To keep up, health plans need platforms that do more than check the box on HIPAA and CMS standards. The most effective systems have the flexibility to incorporate regulatory updates without system disruptions. They also have configurable automation to ensure plans consistently meet CMS turnaround times and communication requirements — flagging only work that requires manual review and easing the burden on internal teams. This way, compliance becomes a built-in feature of operations rather than an after-the-fact scramble.

   Conduent’s re-engineered HSP Payer Suite integrates compliance capabilities into all inbound and outbound enrollment transactions and related member communications to ensure they comply with CMS regulations. This built-in compliance monitoring helps payers swiftly adapt to new requirements and avoid costly missteps.

2. Lack of flexible scalability is a risk

   Growth is essential — but without operational agility, it can quickly become a liability. Expanding into new counties, onboarding members, or managing seasonal surges can stretch plans’ in-house infrastructure to the breaking point. It’s what makes attempting to scale in-house very often slow and expensive.

   Health plans are wise to evaluate whether their current infrastructure can support growth and shifting demands without compromising speed, quality or cost-efficiency. Modular systems and flexible delivery models make a big difference. They make it possible to scale up or down as needed without overhauling the entire operation often complementing existing infrastructure to ensure growth is sustainable rather than disruptive.

   With modular architecture and versatile deployment options including SaaS, BPaaS, and on-prem, the HSP Payer Suite offers this kind of flexibility. It supports scalability across Medicaid, Medicare Advantage, ACA, Vision, and Dental — helping payers strategically expand with confidence while sustaining cost-efficient operations.

3. Members expect a more seamless and hassle-free experience

   Whether part of a Medicare Advantage program, an employer-sponsored plan, marketplace or specialty program, today’s health plan members expect seamless, personalized service. With CMS placing greater emphasis on health equity, behavioral health and satisfaction metrics, experience is no longer just a differentiator — it’s directly tied to compliance and revenue. That makes the stakes for getting it right higher than ever.

   Payers need systems that unify member data, streamline communication and support proactive, multilingual engagement. These capabilities not only improve member satisfaction but also contribute to better Star Ratings and regulatory outcomes that drive long-term retention.

   Integrated platforms like the HSP Payer Suite help bridge the gap between member experience and operational performance. By centralizing data and enabling targeted outreach, they empower plans to deliver service that’s both compliant and compassionate.

Turning pressures into performance

The challenges keeping health plan leaders up at night are significant — but they’re certainly not insurmountable. In rethinking how their plan operates — and who they partner with — payers can turn today’s pressures into tomorrow’s exceptional performance. 

The future favors agility. Aligning with a capable partner and adopting a versatile platform designed for both compliance and flexibility will help plans excel.

Learn more on our website how Conduent’s flexible HSP platform and operational support are helping payers prepare for the 2026 rule changes.