Beyond the numbers: What Q2 earnings really reveal about the future of health plans

By David Shapiro, GM and SVP, Member Experience, Press Ganey

Every earnings season follows a familiar script. Analysts focus on medical costs. Investors ask about margins. Executives discuss Medicare Advantage performance, Medicaid trends, pharmacy costs, provider reimbursement, and productivity initiatives. By the time the calls conclude, Wall Street has a clearer picture of how each organization performed over the last quarter.

While that matters, if you only listen for the numbers, you’ll miss the bigger story.

Earnings calls are more than financial updates. They’re one of the few moments each quarter when healthcare’s largest organizations step back from day-to-day operations and articulate what they believe will define success over the next several years. This quarter, what stood out wasn’t any single company’s performance. It was how remarkably similar the conversations had become.

Whether discussing commercial, Medicare Advantage, or Medicaid, nearly every call described some version of the same challenge: rising medical costs, greater clinical complexity, increasing provider pressure, changing regulations, operational transformation through AI, and a renewed focus on efficiency.

On the surface, these sound like separate issues competing for executive attention. They’re not. They’re connected. And together, they point to a much larger transformation taking place across healthcare.

For decades, competitive advantage was built around managing healthcare transactions more effectively than everyone else. Success meant processing claims efficiently, negotiating provider contracts, managing utilization, and reporting quality. Those capabilities remain essential, but they’re no longer where the next generation of value will be created.

Increasingly, the organizations that outperform won’t simply manage healthcare more efficiently. They’ll become better at influencing health outcomes before they become financial outcomes.

That’s the real story behind this earnings season.

Consider the issue that dominated nearly every earnings discussion: medical costs. The industry continues to face pressure from higher utilization, specialty pharmacy, provider reimbursement, and complex member populations. The instinctive response is to become better at managing those costs through stronger utilization management, more sophisticated analytics, or greater operational efficiency.

Those investments are necessary. But they’re also reactive.

Medical costs rarely begin as medical costs. They begin much earlier with a member who delays care because they don’t understand their benefits, a patient who misses preventive care because navigating the healthcare system feels overwhelming, or a provider whose administrative burden makes coordinated care more difficult. By the time those events appear in a financial report, the opportunity to prevent them has often passed.

The highest-performing health plans understand this.

They’re shifting their focus upstream. Instead of asking, “How do we manage expensive events more efficiently?” they’re asking, “How do we prevent those events from occurring in the first place?”

That shift changes everything. It changes how organizations think about data. It changes how they invest in technology. It changes how they partner with providers. And it changes the role experience plays in driving performance.

AI provides a perfect example. Just two years ago, AI conversations centered on possibility. This earnings season, executives spoke about AI as an operational capability driving productivity across the enterprise.

But AI, by itself, isn’t the story. The organizations creating the greatest value aren’t simply deploying AI. They’re feeding it better information. Claims data tells one story. Clinical data tells another. Operational metrics reveal something different. Experience data often provides the earliest signal that a member, provider, or care team is beginning to struggle.

When those signals are connected, AI becomes more than an automation tool. It becomes an early warning system capable of identifying members whose outcomes are still influenceable and helping organizations intervene before today’s experience problem becomes tomorrow’s financial problem.

The same transformation is happening in provider relationships. Historically, providers were viewed primarily through the lens of contracting and reimbursement. Today, they’re increasingly recognized as one of the most important drivers of member experience, quality performance, and financial sustainability.

Leading health plans are moving beyond measuring provider satisfaction. They’re working to understand where providers experience friction, reduce administrative burden, strengthen collaboration around value-based care, and create shared accountability for outcomes. They recognize that member experience and provider experience are inseparable. When providers struggle, members inevitably feel the consequences.

This represents a broader shift in how leading organizations think about performance. They’re no longer treating CAHPS, HEDIS, HOS, Stars, pharmacy, provider experience, and clinical quality as separate programs competing for resources. Instead, they’re connecting them into a single improvement strategy built around one question:

How do we improve outcomes?

At Press Ganey, we’ve long believed that experience is more than something to measure. It is one of the earliest indicators of future behaviors. The organizations leading the next chapter of healthcare won’t win because they have better dashboards or more sophisticated reports. They’ll win because they’ve built an operating model that continuously listens, learns, predicts, and improves. They’ll identify members before avoidable costs escalate. They’ll strengthen provider partnerships before administrative burden affects care delivery. They’ll connect quality, experience, and operations instead of managing them independently.

Most importantly, they’ll recognize that experience is no longer simply an outcome to report. It becomes the intelligence layer that helps organizations understand what’s happening today, predict what will happen tomorrow, and simulate the decisions that create better outcomes.

That is where AI becomes transformational — not by replacing people, but by helping health plans anticipate member needs, strengthen provider partnerships, and intervene while outcomes are still influenceable.