From Strategy to Execution: How Community Health Plans Turn Local Strengths into Competitive Advantage

The Reality: Different Boats, Same Storm

The conversation opened with a critical insight that reframes how community health plans should view their position in today’s market. “People seem to think that all health plans right now are in the same boat, and when, in fact, we’re in different boats, but dealing with the weather conditions or the choppiness of these waters, and they’re affecting us very differently,” explained Trey Sutten. This perspective became the foundation for understanding why community plans need distinct strategies rather than trying to mirror national carriers.

Rob Robinson illustrated this reality with stark numbers from North Carolina, where federal cuts could impact 255,000 people losing coverage. Yet rather than viewing this as purely a threat, the panel explored how community plans can leverage their unique positioning during uncertain times. The key is recognizing that proximity creates opportunity—when others pull back, community plans remain present.

The Strategic Framework for Technology Decisions

One of the most practical discussions centered on build versus buy decisions—a daily reality for resource-constrained community plans. Robinson outlined Alliance Health’s evolved thinking: “When we buy now, it’s when partnerships offer proprietary insights and speed… When we build, it’s when local customization is critical.”

The framework that emerged provides clear guidance for community plans evaluating technology investments:

 When to Buy:

• Regulatory and compliance functions – These offer no competitive advantage and change frequently based on federal requirements
• Commodity workflow solutions – Standard platforms like Salesforce where customization happens at the edges
• Quick-to-market capabilities – Member portals and standard tools where speed to deployment matters more than differentiation
• Specialized expertise with limited internal skills – AI and advanced analytics where partnerships provide capabilities you can’t quickly build (what Siftwell is for Alliance)

When to Build:

• Member experience differentiators – Tools that use your unique member data and local insights to create experiences national plans can’t replicate
• Highly integrated systems with proprietary data – Claims processing and care management where you need complete control over logic and data flow
• Local customization requirements – Solutions that must adapt quickly to state-specific requirements or community needs
• Innovation at the edge – Capabilities that create competitive advantage through your specific market position

For example: Alliance Health chose to build their own claims system and care management tools because state requirements change frequently and they wanted complete control over their data. Meanwhile, they partnered with organizations like Siftwell for analytics expertise they couldn’t quickly develop internally.

Hossa reinforced this approach from a technology perspective, noting that community plans should “differentiate with the information, the data that you have right… things that are custom and unique to your members, to your member experience.” The goal isn’t to replicate what national plans do, but to do what only a community plan can do.

Data-Driven Local Impact

The conversation showcased how community plans can use data to amplify their existing strengths rather than chase national benchmarks. Alliance Health’s work with Siftwell identified 2,000 emerging risk members—people who weren’t yet in crisis but would become high-cost without intervention. This proactive approach projects $200 per member per month in savings by acting before members reach crisis status.

Perhaps more importantly, the analytics revealed insights that local knowledge alone missed. When examining housing instability among their community living program participants, the data showed that unmanaged diabetes, not mental health conditions, was the primary driver of housing separation. This discovery led to redesigning care teams to include nurses focused on housing stability—an intervention that only makes sense with deep local understanding combined with sophisticated analytics.

Robinson emphasized how this represents a fundamental shift: “We knew who the highest cost, highest risk folks are… what we were looking for [was] who are those that are emerging that if we don’t act now, they’re going to become the highest of the highest risk. And so we can act now and not always be in crisis mode.”

Protecting Mission Under Pressure

As federal funding pressures mount, the panel addressed what community plans should protect above all else. The consensus centered on capabilities that amplify mission rather than just reduce costs.

Core Protection Priorities:

• Crisis services and home-based community services – These safety net functions define your mission and create community value that justifies local investment
• Technology staff and automation capabilities – Essential for doing more with the same resources while maintaining quality and compliance
• Care management teams for direct member intervention – The human connection that differentiates community plans from automated national carriers
• Low-cost, high-impact interventions – Programs like Medicaid-assisted substance use treatment that demonstrate clear ROI and population health improvement

Robinson was clear about his priorities: “We would definitely want to bolster, or at least maintain crisis services, home and community-based services… keeping some low cost services that have had an impact.”

From a technology perspective, the protection strategy focuses on capabilities that enable the organization to amplify its mission. Hossa noted the importance of “data analytics that drive margin and compliance” because “no profit, no mission.” The goal is maintaining financial sustainability while preserving the community focus that creates long-term value.

The discussion revealed that community plans facing budget pressures shouldn’t abandon their local investments but rather become more strategic about demonstrating their value. Robinson’s experience with county partnerships shows that local stakeholders will invest in proven approaches, but the plans need to clearly communicate outcomes and maintain the relationships that make such partnerships possible.

Turning Accessibility into Competitive Advantage

The discussion revealed that what many view as a limitation—smaller scale and local focus—actually creates sustainable competitive advantages. Rob shared a telling example from his interactions with county leadership: “One of my county managers said, ‘Well, they had a good show, but the one thing that I know is going to be different, is Rob, when I call you as the CEO, you will call me back, right?’ And they don’t think that they will get the response from the leadership that they would from a large commercial health plan.”

This accessibility translates into tangible partnerships and community investment. Community plans can leverage this advantage through specific strategies.

Building Local Partnership Capital:

• Embed staff directly in communities – Physical presence in each service area builds relationships that can’t be replicated remotely
• Maintain CEO and leadership visibility – Regular engagement with county commissioners, mayors, and community leaders creates trust that survives leadership changes
• Create formal funding partnerships – Structure agreements where counties invest directly in programs, sharing both risk and governance
• Develop crisis response capabilities – Demonstrate community value during emergencies when relationships matter most

Alliance Health has successfully secured tens of millions in county investments for crisis services, with all seven counties they serve now contributing funding. These aren’t just contracts—they’re partnerships built on trust and demonstrated local impact. The counties invest because they know the leadership, understand the outcomes, and can directly influence program design.

Casey Hossa expanded on this theme, describing how Health New England approaches their market differently: “We feel like we’re MacGyver… we’re creative, right? Because the speed of decision making and governance allows us to move quickly.” This agility allows community plans to respond with one or two people rather than committees, launching innovation pilots that prove value quickly while national plans are still forming task forces.

The Path Forward

The session concluded with a recognition that community health plans can compete with national carriers effectively. They need to become better at being community health plans—leveraging local knowledge, building authentic relationships, and using technology to amplify rather than replace their human connections. In a market where scale often dominates, these leaders demonstrated that proximity and purpose create their own form of competitive advantage.

 Watch the full recording below.