June 2026 | By Carrie Jobe
Key takeaways for health plans:
- Most reconciliation, billing, and reporting challenges originate upstream. Improving individual workflows is not enough if the broader operational ecosystem remains disconnected.
- Member movement across Medicaid, Marketplace, Medicare, and ICHRA is increasing, making multi-market member management and data visibility more important than ever.
- The plans best prepared for future growth will connect enrollment, billing, payments, reconciliation, and member data to create more seamless member experiences.
Recently, I was speaking with a health plan leader about reconciliation. At least, that’s where the conversation started.
Within a few minutes, we weren’t talking about reconciliation anymore. We were talking about enrollment files, billing accuracy, payment workflows, member communications, reporting, and the challenges of tracking members as they move across lines of business. This happens often.
A conversation that begins with one operational challenge almost always leads to a discussion about something upstream or downstream. The reality is that enrollment, billing, payments, reconciliation, reporting, and member experience are not separate processes. They are deeply connected parts of the same operational ecosystem.
Yet most health plans still manage them as separate functions. That approach made sense when lines of business were isolated and member movement was less common. Today, the environment looks very different.
Why Traditional Health Plan Operations Are Becoming More Difficult to Manage
Health plans are supporting members across Marketplace, Medicaid, Medicare, employer-sponsored coverage, and increasingly Individual Coverage Health Reimbursement Arrangements (ICHRA). They are managing more products, more distribution channels, more regulatory complexity, and more consumer expectations than ever before. At the same time, many organizations are still relying on operational models built around individual workflows rather than connected experiences.
As new coverage models emerge, the challenge becomes even more important. An estimated 500,000 to 1 million people are now covered through ICHRA and QSEHRA arrangements, and 83% of employers offering these models had not previously offered health coverage.
Operational challenges show up far away from where they begin. A billing issue may have started with enrollment data. A reconciliation exception may be tied to a payment process. A reporting discrepancy may trace back to a manual workaround that was implemented months earlier to solve an entirely different problem.
By the time the issue surfaces, multiple teams are involved and significant effort is spent identifying what happened and where. That is why I believe one of the biggest opportunities for health plans today is not simply improving individual workflows. It is understanding how those workflows work together.
Enrollment, Billing, Payments, and Reconciliation Are More Connected Than We Think
Take enrollment as an example.
Enrollment is often viewed as the starting point of the member journey. Once the enrollment file is accepted, attention shifts to the next operational priority. But enrollment data does not stop moving once a member is enrolled.
That information drives billing. It influences payment processing. It impacts reconciliation. It appears in reporting. It affects member communications. And it shapes the experience a member has with the plan.
When enrollment data is accurate, every downstream process benefits. When it isn’t, the negative impact rarely stays contained to a single team.
The same is true throughout the operational lifecycle. If billing and payment systems are disconnected, reconciliation becomes more manual. If reconciliation is disconnected from source data, finance and operations teams lose visibility. If reporting is delayed or incomplete, organizations lose the ability to proactively identify issues before they affect members.
Connected Health Plan Operations Matter More Than Ever
None of these challenges exist in isolation. What makes this important right now is the direction the industry is heading.
Health plans are increasingly looking beyond a single line of business as they evaluate long-term growth strategies. We are seeing plans expand into adjacent markets, evaluate ICHRA opportunities, strengthen Medicare offerings, improve retention strategies, and explore ways to better support members throughout their coverage.
At the same time, members are becoming more dynamic. And have a new set of expectations. A person may move from Medicaid to Marketplace coverage. They may later receive an ICHRA contribution from an employer. Eventually they may transition into Medicare when they turn 65.
To the health plan, those may be different products, systems, and operational workflows. To the member, it is simply healthcare coverage.
This is why conversations around multi-market member management have become so important. Organizations recognize that member relationships increasingly span multiple products and multiple stages of life. Supporting those transitions effectively requires visibility across the broader ecosystem and a strong foundation of member data.
Changing Member Expectations Are Reshaping Health Plan Operations
For the first time, health plans are simultaneously serving multiple generations of consumers, each with different preferences, communication styles, and coverage needs. A recent college graduate shopping for Marketplace coverage, a working parent evaluating an ICHRA-funded plan, and a Medicare beneficiary managing chronic conditions all expect very different experiences.
Consumers have become accustomed to digital experiences that are personalized, intuitive, and available on demand. They expect health plans to remember who they are, understand their needs, and make interactions easier.
Healthcare has not always been able to meet those expectations.
Too often, members are asked to repeat information, navigate disconnected systems, or start over each time they move between products or lines of business. What feels like separate operational processes inside a .
This is where connected operations become increasingly important. The ability to create a complete view of the member across enrollment, billing, payments, communications, and service interactions is a prerequisite for delivering the personalized experiences consumers expect.
Health plans are exploring how emerging technologies, including AI, can help make those experiences more proactive, responsive, and tailored to individual needs. But personalization cannot happen without connected data.
The Future of Health Plan Growth Depends on Connected Operations
Every health plan’s operational ecosystem is different. Some organizations are focused on improving enrollment accuracy. Others are modernizing billing and payment workflows, preparing for ICHRA growth, or creating a more connected view of members across Medicaid, Marketplace, Medicare, and employer-sponsored coverage.
If you’re evaluating how your enrollment, billing, payments, reconciliation, reporting, and member data strategies fit together, I’d love to compare notes. Schedule a meeting with our team to discuss your goals, challenges, and opportunities, or connect with me directly on LinkedIn. I always enjoy hearing how health plans are approaching these challenges and where they see the industry heading next.
