Mission Alone Won’t Save You: A Call to Action for Community Health Plans

The Storm We’re All Facing 

Hardly a week passes without news of another community-based plan struggling financially having to merge, or worse, winddown. As Sachin Jain recently highlighted in his Forbes piece, nonprofit regional health plans are experiencing a “slow bleed”—caught between capital constraints, subscale operating costs, and increasingly aggressive competition from well-funded national players. 

 But here’s what the narrative we’ve seen in the news misses: community health plans possess unique strengths and relationships that can’t be bought or scaled overnight. 

 What Makes Our Boats Different 

 Community health plans are the organizations that show up when others don’t. When national carriers pull out of challenging markets or reduce benefits, community plans stay committed to their members and communities. We answer to our members in ways that simply don’t happen at large for-profit nationals—try getting the CEO of a national health plan to pick up the phone when a mother of an autistic member calls – a call I have taken in my previous life as CEO of a regional health plan. 

 Our boards often include community members or their representatives, creating true accountability that goes beyond bottom-line results. We understand local provider networks, community resources, and the social determinants that affect our members’ health in ways that distant corporate headquarters never could. 

 The question isn’t whether these advantages matter, we know they do. It’s how we leverage them strategically while addressing our structural challenges. 

 Charting a Different Course 

 In my previous article on the intelligence imperative, I outlined how health plans navigate change through three core strategies: 

• Get a deep understanding of EACH of your members 

• Know your capacity inside and out 

• Match members to what they actually need 

These principles are crucial, but health plans need to go further. We need to speed up innovation, not take a wait-and-see approach. 

 This means making smart buy-versus-build decisions, embracing strategic partnerships that preserve mission while expanding capability, and leveraging technology to level the competitive playing field. Regional nonprofit health plans can be perfect partners for AI and technology firms precisely because we’re nimble enough to implement and iterate quickly. 

 The Path Forward: From Planning to Implementation 

That’s why we’re hosting our second think tank: “Strategic Paths for Community Health  

Plans: Preserving Mission Amid Federal Funding Reductions.” Building on our first session’s foundation, this interactive forum moves from planning to implementation.  

 We’ll explore practical solutions to the challenges we all face—subscale operating costs, staff recruitment difficulties, capital constraints—while discussing how to leverage our unique local advantages. Most importantly, we’ll examine methodologies for evaluating partnerships and implementing change management processes that position us to get ahead rather than fall behind. 

 I’ll be joined by Casey Hossa (CIO, Health New England) and Rob Robinson (CEO, Alliance Health), bringing complementary perspectives from across the nonprofit health plan ecosystem. Despite our different backgrounds, we agree on one thing: community health plans can’t afford to wait. 

 Different Boats, Shared Navigation 

 The ocean is rough, and the currents are strong. But community health plans have something national carriers can’t replicate: authentic relationships with the communities we serve and the agility to adapt our approach based on local needs. 

 To emerge from this storm stronger, more innovative, and better positioned to serve our members, we must acknowledge that we’re in different boats while learning from each other’s navigation strategies. 

 The future belongs to community health plans that are bold and decisive enough to embrace structural transformation while staying true to their mission.