Alliance of Community Health Plans
Report on Affordability in Health Care, 2026
June 2026
Introduction
Whether people get their news from television, radio, print or even Instagram, affordability – or, rather, unaffordability – dominates headlines. The average age of first-time homebuyers is at an all-time high, the costs of everyday goods and services continue to strain budgets and for too many Americans, affordable and accessible health care feels out of reach. With an especially consequential midterm election season approaching, affordability issues will play an outsized role in the national conversation.
Health care affordability is increasingly central to that conversation. Policymakers, employers and consumers are scrutinizing the causes of rising costs across the system, including consolidation, drug pricing and the growing influence of for-profit conglomerates.
With health care spending rising and regulatory pressures increasing, large national insurers are pulling out of markets they deem no longer profitable. ACHP’s nonprofit, provider-aligned member health plans, however, take a different approach. They are locally governed, rooted in their communities and committed to long-term patient outcomes and to lowering the total cost of care. These plans, for example, kept 2026 Part D deductible increases to $42, on average, compared to national carriers whose deductibles increased by nearly $80.1
1Source: ACHP analysis of Annual Part D Deductibles, CMS MA Landscape file (2025 to 2026)
Between 2025 and 2026, ACHP member plans absorbed a disproportionate number of new MA enrollees. In some counties, these plans are now the last remaining MA option, preserving access to coverage for seniors who may not have other affordable options.2
For the past six years, ACHP’s annual Report on Affordability in Health Care has offered insights, data and concrete examples that demonstrate specific ways local, nonprofit plans provide better, coordinated care for patients and communities. This year’s report takes a holistic view of the power of payer-provider integration by examining the programs and systems that improve health outcomes, lower costs, expand access and enhance affordability.
2Source: HealthScape MA Plan Disruption | ACHP Market Analysis 2026
Increased Value, Improved Outcomes
Contrary to public opinion, the insurer is not simply the financing side of health care.
It is a core structural force that shapes the incentives driving the care delivery side of the equation.
Historically, insurers and providers have been adversaries: negotiating prices, disputing claims and managing care approvals and denials. A fee-for-service hospital that reduces unnecessary admissions loses revenue, creating a barrier to linking cost reductions with improved quality and outcomes. The payer-provider partnership model, however, removes those barriers and reduces friction between patients and the system.
Whole House Math
Think of this as ACHP member HealthPartners does: “Whole House Math.”
When insurers and providers work together, financial incentives align: every prevented hospitalization and ER visit, as well as every prevented chronic disease complication, saves money for the entire enterprise.
The formula is good for patients, for care delivery and for health plans. It can also be good for doctors and hospitals. During the COVID pandemic, while most clinical enterprises suffered painful drops in patient volume and revenue, those in capitated or value-based models saw dollars continue to flow in from their health plan partners.
Without aligned incentives that get the right care to the right patients, the economics of quality improvement are often perverse. After all, a doctor in a fee-for-service environment is a revenue loser with every prevented appointment.
ACHP member plans are the critical drivers that make payer-provider integration work, consistently outperforming fragmented fee-for-service alternatives on quality and improving their local communities’ health outcomes.
Prior Authorization: Ever Closer to Zero
Few conversations about prior authorization in health care end with a desire to maintain the status quo. After all, it is often derided as a driver of administrative burden and delayed patient care. ACHP members have long taken a different approach. There are situations where it can – and should – be reduced, demonstrate better coordination, integration and interoperability and reflect a commitment to value-based care with provider partners, resulting in less reliance on prior authorization as a tool. Instead, it is used to ensure safety, reduce friction, improve outcomes and deliver better value.
In February, 2026, NEJM Catalyst published three case studies by ACHP’s Ceci Connolly and Dr. Charles Bloom, Chief Medical Officer at Health Alliance Plan by Henry Ford Health detailing how nonprofit, provider-aligned plans adhere to clinical best practices and deliver high-quality care. Bottom line, by their very nature, provider-aligned plans rely on prior authorization less and focus its use on situations where it has the greatest impact on clinically appropriate care.
As the case studies show, ACHP plans frequently use technology to “get to yes” on clinical requests in real time. Often, a prior authorization can trigger a conversation with a doctor that saves the patient thousands of dollars in copays. Strategies outlined in the article also highlight how provider-aligned plans, often sharing digital records, can streamline or eliminate prior authorizations.
“This model more efficiently marries sophisticated technology with collaboration to reduce friction, improve outcomes and equip the health sector to deliver better value. Although prior authorization is unlikely to go away entirely, we have the tools to effectively move us closer to zero.”
Strategies in Action
Aligning Care and Community to Improve Children's Health
As part of an integrated health system, Pennsylvania’s Geisinger Health Plan aligns care delivery with complementary, community-based programs to improve health outcomes. By leveraging its payer-provider partnership, Geisinger delivers coordinated, prevention-focused programs that measurably improve children’s behaviors and health knowledge.
Seeds of Nutrition
For example, the plan launched the Seeds of Nutrition program in Luzerne County, Pa., where nearly half of sixth graders fall into the obese BMI range. The interactive and research-based program is designed to prevent childhood obesity and promote healthy habits among elementary and middle school-aged students. Participating students learn about the importance of essential nutrients, hydration, sleep and physical activity.
Movement Madness Challenge
Separately, Geisinger Health Plan launched a four-week, team-based competition, the Movement Madness Challenge, to encourage physical activity. The results:
Geisinger builds on existing community programs, rather than launching siloed efforts. The plan uses data to refine impact and partners with local community organizations to ensure interventions, such as Seeds of Nutrition and the Movement Madness Challenge, meet local needs. This drives better outcomes through prevention, chronic disease management and local accountability.
Across targeted counties, pediatric obesity rates show modest but meaningful improvements, particularly among CHIP populations in counties such as Lackawanna:
With a focus on tackling childhood obesity as part of its involvement in ACHP’s Chronic Disease Pledge, Geisinger Health Plan continues demonstrating how provider-aligned integration is bending the curve on childhood obesity prevalence.
The Chronic Disease Pledge
ACHP member plans have pledged to lower the incidence of chronic disease by setting measurable, community-specific goals that address the social, political and environmental drivers of disease.
Meeting Complex Behavioral Health Needs
Group Health Cooperative of South Central Wisconsin relied on its integrated model to launch its Intensive Outpatient Program in 2021. Since its founding, the program has improved access, affordability and outcomes for members seeking care for conditions including ADHD, depressive and bipolar disorders, trauma-related disorders and other DSM-5 Behavioral Health diagnoses.
By increasing the number of mental health specialists, expanding services and addressing gaps in unmet community need, the plan reduced the waiting list for patients seeking care with a specialist from more than 200 to zero. The results? Patients shifted away from a more extreme partial hospitalization program — in which patients spend several hours a day in a hospital setting but sleep at home — alongside stronger performance metrics:
Aside from improving access and outcomes, the effort has demonstrated significant financial impact, as GHC-SCW recognized greater than 33 percent year-over-year savings (2024-2025) in per member per month costs among program participants and $4 million in total cost reduction since 2021.
Coordinated Diabetes Management
The Diabetes Care Connection program at Health Alliance Plan by Henry Ford Health in Detroit, Michigan, highlights an advanced form of integration, in which a health plan, delivery system and population health arm work in concert to deliver personalized diabetes management at scale. The results are striking:
Traditional diabetes medications typically lower A1C by 0.7%-1.0% on their own, indicating the coordinated program can be twice as effective as standard treatments alone. With 20% of participants utilizing GLP-1 medications, the positive outcomes were largely driven by diet, exercise and lifestyle support – all of which are core components of the Diabetes Care Connection.
By embedding educators, dietitians and care managers into a unified model and extending it beyond the core system, Health Alliance Plan reached members earlier in their disease progression, improved outcomes across risk levels and saved nearly $600,000 in health care costs. This approach shows how aligned infrastructure drives better control, lower costs and more proactive chronic disease management.
…A severe foot infection and an A1C over 9 changed everything. I had two choices: lose my foot or change my lifestyle. I chose change and began my journey with Diabetes Care Connection… I listened to the DCC team. My foot is healing, I’m working out, I’ve lost 70 pounds, lowered my A1C to 6.2 and reduced my medications.”
Integration in Action: Streamlining GLP-1 Access
When GLP-1 medications are combined with appropriate nutrition counseling, patients maximize weight loss, preserve muscle mass and are better able to manage side effects. As demand for the medications skyrocketed, Minneapolis, MN-based HealthPartners relied on its integration to bring the health plan and physician group together for members covered by Medical Assistance (Minnesota’s Medicaid program). By proactively connecting patients to the health plan’s Lifestyle Coaching program and embedding tools and documentation within its electronic health record, the team created clearer guidelines for clinicians and stronger member and patient support.
Utilization and cost trends for GLP-1 weight loss medications were high, driven largely by demand from our own health system patients. Rather than simply tightening criteria, we stepped back and asked: How do we support members more effectively while also addressing affordability?”
Members reported feeling supported in their weight-loss journey and being better prepared to manage potential side effects of medication.
Reducing Low Birth Weight
When population health programs became a significant focus several years ago at Michigan’s Priority Health, the team decided to investigate ways to reduce the incidence of low birth weight, specifically amongst its Medicaid population in Detroit. Infants born with a low birth rate have a noted increased risk of poor health outcomes and increased risks of developmental delays and mortality. Infants born at normal weights, on the other hand, are more successful in school, healthier and achieve higher educations and incomes.
Priority Health developed a maternal health community health worker program to quickly identify high-risk pregnancies. Data showed that Detroit and Highland Park were especially impacted, with low birth weight affecting nearly 20% of births. By refocusing existing staffing resources and optimizing person-to-person outreach, Priority Health ensured each family had everything it needed during and as long as three years after the child's birth.
Wraparound Services Leads to Reduced Readmissions
Philadelphia’s Jefferson Health Plans (JHP) partnered with Jefferson Health’s Population Health team and other clinical experts to drive down avoidable hospital readmissions amongst its members participating in a coordinated transition-of-care program:
Considering the average national cost of a 30-day readmission exceeds $16,000, every prevented occurrence means fewer dollars spent throughout the health care system.
JHP places a care coordinator within the hospital to proactively identify Medicare members at high risk for hospital readmission, including those admitted with conditions such as sepsis, heart failure and respiratory disease. This coordinator ensures a smooth discharge by arranging durable medical equipment, coordinating prescription delivery and securing transportation.
Jefferson Health hospitals work with patients so they have follow-up appointments, referrals for in-home support and virtual follow-up care. After patients are discharged, a transition-of-care manager conducts in-home visits to assess members’ needs and to reinforce care plans. MyLaurel, a contracted mobile medical group, then provides additional in-home clinical support while a traditional care manager coordinates transportation and schedules follow-up appointments with primary care providers or specialists within one week of discharge.
Working in close coordination with its provider partner, JHP’s wraparound services strengthen care transitions from hospital to home, reduce gaps in care and prevent avoidable readmissions. JHP’s ties to its health system provides further evidence of the impact these relationships have on improving outcomes and reducing spending.
Conclusion
With a national focus on the growing unaffordability of everyday items, the high cost of health care routinely makes headlines. Major structural reforms will be needed to tackle underlying cost drivers and the perverse financial incentives of fee-for-service medicine. In the meantime, ACHP and its members are using the levers of health promotion to ensure Americans have high-value choices today.
At the heart of health care value is the unique payer-provider partnership model.
ACHP’s nonprofit health plan members work in concert with their clinical partners to prevent hospitalizations, promote appropriate medications and deliver well-coordinated care. Every unspent dollar can be reinvested in prevention and innovative programs that improve population health, keeping resources in the communities where members live and receive care.
Better managing chronic conditions, reducing low birth rates and crafting holistic weight loss programs are some of the ways ACHP member companies keep health care affordable. Combining coverage and care to seamlessly serve the health needs of a local community is a proven model of success.
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