Health insurers exceeded financial expectations in the first half of 2026. That’s the good news. The downside is that stubbornly high medical costs, sicker risk pools, member abrasion, and policy changes will create significant challenges well into 2027.
As payer organizations seek to balance cost control and member satisfaction, most boardroom discussions will again focus on per-member-per-month (PMPM) benchmarks. Yet while benchmarks allow plans to compare administrative costs against their peers, they’re single data points that show where to look, not which next steps to take. Individual PMPM benchmarks can even be misleading.
Payers looking to get ahead of their peers should view benchmarks in their proper context, alongside crucial considerations such as plan strategy, market intelligence, and regulatory needs. We have found that deploying this unique strategy can help payers save an average of $20.9 million, which equates to a 14.6% reduction across in-scope spend.