Thoughts from the Road

A Mid-Sized Dilemma

Mid-sized, regional health plans are stuck in the middle. Every health plan faces the same issues: consolidating providers and medical trends that premiums can’t cover. But mid-sized payers have a specific challenge of being neither fish nor fowl. On one hand, national plans and dominant local plans have scale and contracting advantages that are difficult to match. On the other hand, there is an increasing number of “piranha” plans that bite off small, niche chunks of sub-sub segments. So, what is a mid-sized plan to do? How can they create market distinction?