Rethinking Health Plans for the Affordability Era

Lori Logan, NASCO President and CEO

The numbers are hard to ignore.  

The average American family now spends more than 10% of their household income on health insurance premiums and deductibles alone. Employers are absorbing cost increases of 7 to 9%  per year. Total U.S. healthcare spending reached $5.3 trillion in 2024. Meanwhile, the traditional playbook of narrow networks, utilization management, and consumer cost-shifting has done little to slow the trend.  

That’s why NASCO created a four-part series that confronts this reality head-on with practical thinking on the healthcare affordability crisis. If you’re responsible for leading, supporting, or advising a health plan, this series is well worth your time.

Healthcare Affordability Part 1: The Case for Transformation, Now

In From Healthcare Affordability Crisis to Transformation, Now, I trace the arc of cost-containment from the managed care era of the 1980s and 1990s to the consumer-directed era of the 2000s and the value-based care movement of the 2010s and detail why each fell short.  

The takeaway is not that those approaches were wrong; they were incomplete. None addressed medical costs, administrative costs, provider incentives, and member experience simultaneously. The piece introduces the concept of a new “structural affordability era” and argues that the moment to act is now. 

Healthcare Affordability Part 2: Why Traditional Approaches Are Failing

The second piece, Healthcare Affordability: Traditional Approaches Are Failing, gets specific about the cycle that keeps health plans stuck.  

When product design is misaligned with outcomes, member experience deteriorates. When members struggle to navigate care, utilization rises. When utilization rises, plans shift more costs to members. When costs shift to members, access erodes further, and the cycle starts again.  

The central argument is that the only way to break this cycle is to pull structural levers simultaneously: aligning product design, provider incentives, member engagement, and operational models so the entire ecosystem moves together. 

Healthcare Affordability Part 3: The Health Plan as Affordability Orchestrator

Published in Fierce Healthcare, Orchestrating Affordability: The Critical New Role of the Health Plan reframes what health plans must become. The traditional aggregator model of building networks, packaging benefits, negotiating discounts, and processing claims was designed for a world of scale and volume.  

That world is gone.  

In its place there is a far more complex ecosystem of alternative payment models, specialty therapies, virtual care, and value-based arrangements that demand active orchestration. The piece breaks down what orchestration looks like in practice across network strategy, product packaging, and member experience.

Healthcare Affordability Part 4: Three Steps to Start

The series closes with Insight to Action: Orchestrating Healthcare Affordability, the most tactical of the four pieces. I outline three concrete steps health plans can take to begin the transition: 

1. Set an insight-driven strategy grounded in a clear-eyed view of where medical costs. 

2. Assess capability gaps in core systems and network infrastructure. 

3. Prioritize investments that address both administrative efficiency and medical cost performance simultaneously.  

This piece is refreshingly honest. This path to affordability is neither simple nor linear, but health plans that follow it will do more than manage costs. They will redefine their competitive position. 

Taken together, the series makes a cohesive argument: the healthcare affordability crisis is not a moment to wait out. It is a mandate to transform. Read the series and come away with a sharper sense of what health plan leadership looks like in this new era. 

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To get started reading my healthcare affordability series, click here.