Top 4 Pain Points for Most Health Plans in 2024 

From regulatory compliance to member satisfaction, health plan administrators are constantly juggling multiple priorities while striving to provide quality care and remain financially sustainable. In this blog post, we’ll explore the top four pain points faced by health plans across the United States today and how you can revolutionize your sales distribution and performance through digital innovation. 

Data Security and Privacy: Health plans handle vast amounts of sensitive personal and medical information, making them prime targets for cyber threats and data breaches. Ensuring the security and privacy of this data is crucial for maintaining trust with members and complying with regulatory requirements. Implementing robust cybersecurity measures and staying vigilant against evolving threats is a constant challenge. One of the strongest ways to reduce security threats is to limit the vendors you choose to engage with for your book of business management. Comprehensive solutions that integrate password protection and dual authentication can help to keep your sensitive data consolidated and protected. EvolveNXT offers an end-to-end solution with high security protections to ensure your sensitive data is always protected. 

Complex Regulatory Compliance: Health plans operate within a heavily regulated environment, with requirements at federal, state, and local levels. Compliance with regulations such as the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), and Medicare guidelines can be intricate and time-consuming. Keeping up with regulatory changes and ensuring adherence poses a significant challenge. From license management to CMS compliance, it is vital that health plans invest in partners who prioritize efficient and accurate regulation compliance. With tools like EvolveIBC (Integrated Background Check) and EvolveDOI (Appointment Management) you can trust that your downline is constantly in compliance, allowing you to focus on other sales channel needs with peace of mind.  

Member Engagement and Retention: Engaging members in their plan, promoting preventative services, and fostering ongoing relationships can be challenging. Many health plans face difficulties in effectively communicating with members, providing personalized support, and encouraging healthy behaviors. Retaining members in a competitive market is also a concern. Targeted member outreach is a great solution to member retention and increasing a plan’s STAR rating. With EvolveTMO, plans can identify at-risk members, assign engagement tasks to their brokers, and incentivize that broker to connect all within one module.  

Technology Integration and Interoperability: Health plans rely on a multitude of technology systems for functions such as claims processing, care management, member enrollment, and data analytics. Integrating these systems and ensuring interoperability between different platforms can be complex and costly. Health plans may face interoperability challenges when exchanging data with providers, pharmacies, government agencies, and other stakeholders, hindering care coordination and efficiency. 

As opposed to individual point solutions, EvolveNXT offers an “all-in-one” platform to solve for any of a health plan’s concerns in one cohesive integration. EvolveNXT’s cutting-edge software solutions not only simplify commission calculations but also provide comprehensive business management tools tailored to the unique needs of their clients. The team of skilled developers and industry experts work tirelessly to ensure that their software and support remains at the forefront of technological advancement, delivering unparalleled accuracy, efficiency, and reliability. 

Explore the comprehensive portfolio tailored for health plans, designed to enhance sales channel efficiency and ensure compliance seamlessly on our website or contact us for additional information at

Discover more from Health Insurance Sales Commission Management Software, Medicare Broker Commissions Software - EvolveNXT USA

Subscribe now to keep reading and get access to the full archive.

Continue reading