Health plans are taking a harder look at every partner, every program, and every dollar. In today’s Medicare Advantage environment, demonstrating improvement in a single metric is no longer enough. Partners increasingly need to show that their programs create meaningful clinical, experiential, and financial value.
The question is becoming much bigger:
Can you improve outcomes, strengthen the member experience and reduce Total Cost of Care at the same time?
At PlanPlus by Curant Health, we have the evidence to prove that the answer is yes. And the greatest opportunity may be among the members who are often the most challenging and expensive to manage.
Health Plans Are Under Pressure to Prove Value
Medicare Advantage remains a critical part of the healthcare landscape, with 55% of eligible Medicare beneficiaries enrolled in Medicare Advantage in 2026.[1] Yet plans are simultaneously navigating significant cost and performance pressures.
Due to these pressures, the Medicare Advantage landscape continues to change. In 2026 alone, 2.6 million people enrolled in Medicare Advantage plans were displaced when their plan terminated contracts and/or shifted geographical coverage. KFF, an independent health policy research, polling and news organization, points to rising healthcare utilization, federal payment changes, strategic shifts and efforts to improve profitability as factors influencing insurers’ decisions to reduce plan offerings or exit certain markets.[2]
At the same time, Centers for Medicare & Medicaid Services (CMS) continues to emphasize outcomes and experience. Changes finalized for the 2027 Star Ratings refocus the program on clinical care, outcomes and patient experience where meaningful differences exist among plans.[3]
In this environment, health plans need more than vendors. They need partners capable of proving their value.
Cutting Costs Is Not the Same as Reducing Total Cost of Care
You cannot meaningfully impact Total Cost of Care without effectively investing in the members who are among the most complex to care for.
A plan can reduce spending by eliminating a program, narrowing a benefit, or choosing a lower-cost solution. But reducing one expense does not necessarily reduce Total Cost of Care.
True TCoC management requires a different question:
What can we do today to prevent a much more expensive event tomorrow?
For members living with chronic conditions such as congestive heart failure (CHF), diabetes, and hypertension, this question is especially important. These members are often managing multiple medications, providers, and appointments, which can become a barrier to proper care. When those complexities are not effectively managed, the consequences can include poor medication adherence, disease exacerbation, emergency room utilization, and hospitalization.
Better Medication Care Can Change the Economics
PlanPlus combines predictive analytics with proactive, longitudinal clinical engagement to identify emerging risks and medication-related barriers before they become more serious and potentially more expensive.
Our Medication Care Management® model goes beyond transactional adherence outreach. We work to understand what is actually standing between a member and better health, whether that is medication cost, side effects, transportation, regimen complexity, confusion about a diagnosis or another clinical or non-clinical barrier.
The goal is not simply to impact an adherence metric. The goal is to invest in member and plan outcomes.
Consider the results of PlanPlus’ recent work with Security Health Plan.
PlanPlus supported a cohort of 574 rural members diagnosed with heart failure. After one year, medication adherence improved from 80.2% to 90.6%. Hospital admissions declined 39.5%, while emergency room visits decreased 15.6%.[4]
The financial results tell an even more compelling Total Cost of Care story.
Medical spend decreased by approximately $694.79 PMPM while pharmacy spend increased approximately $108.81 PMPM, reflecting improved adherence and optimized therapy. The result was $585.98 in average PMPM Total Cost of Care savings and an estimated 5:1 ROI.[4]
That distinction matters. The pharmacy line item increased. Total Cost of Care decreased.
This is what true value creation can look like: investing upstream in better medication care to help prevent costly downstream medical events.
Better Experience and Lower TCoC Can Happen Together
Behind every per member per month (PMPM) calculation is a person trying to manage their health.
A member with CHF taking multiple medications does not experience healthcare as a cost category or quality metric. They experience questions: Why was my medication changed? What am I supposed to take? How do I manage these side effects? How will I afford this prescription?
When a trusted clinical team can help answer those questions, identify risks and remove barriers, the impact can extend across the healthcare journey.
The member receives more personalized support. The plan has an opportunity to improve outcomes and satisfaction. And avoidable utilization can decline.
That is especially meaningful as CMS continues to focus Star Ratings on areas including outcomes, intermediate outcomes, patient experience and access.[3]
Health Plans Need Partners That Can Prove Their Value
The future of Total Cost of Care management is not simply about doing less for high-risk members. It is about doing more with high-impact interventions.
For members managing CHF, diabetes, hypertension, and other complex chronic conditions, medication is one of the most frequent touchpoints in their healthcare journey. PlanPlus transforms that touchpoint into an opportunity to identify risk, remove barriers, improve the member experience, and help prevent avoidable utilization.
Because the real measure of a health plan partner isn’t simply what the program costs. It’s the value the program creates.
Learn How PlanPlus Turns Better Care Into Better Results
References
- KFF. Medicare Advantage in 2026: Enrollment Update and Key Trends. June 5, 2026, updated July 1, 2026. https://www.kff.org/medicare/medicare-advantage-in-2026-enrollment-update-and-key-trends/
- KFF. Medicare Advantage 2026 Spotlight: A First Look at Plan Offerings. 2025. https://www.kff.org/medicare/medicare-advantage-2026-spotlight-a-first-look-at-plan-offerings/
- Centers for Medicare & Medicaid Services. Contract Year 2027 Medicare Advantage and Part D Final Rule. April 2, 2026. https://www.cms.gov/newsroom/fact-sheets/contract-year-2027-medicare-advantage-part-d-final-rule
- PlanPlus by Curant Health. How Medication Care Management Transforms Heart Failure Care and Cuts Costs in Rural Wisconsin Community. https://theplanplus.com/project/case-study-how-medication-care-management-transforms-heart-failure-care-and-cuts-costs-in-rural-wisconsin-community/
- Centers for Medicare & Medicaid Services. 2027 Medicare Advantage and Part D Rate Announcement. April 6, 2026. https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-rate-announcement
- Centers for Medicare & Medicaid Services. Chronic Care Management for Complex Conditions. https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/chronic-care-management-complex-conditions
