Provider exits, mergers, and compliance mandates are creating a perfect storm, which means only the fastest, more strategic networks will thrive. As health plans face mounting pressure to adapt, not just to survive regulatory and market shifts, but to meet evolving member expectations. For executives, that means either act decisively now or risk falling behind.
The team at Andros has been closely studying these challenges and shifts, exploring how data, design, and operational agility can help plans navigate uncertainty and delivery for members.
Based on our research and experience implementing networks across healthcare, here are 3 trends shaping the future of network development and what health plans can do to get ahead.
Trend 1: Provider data accuracy and orchestration
Data is the foundation of every network strategy, but it’s rarely reliable. Enforcement of the No Surprises Act and CMS’s plan for a national provider directory highlight the urgency, yet compliance alone isn’t enough.
The real challenge is orchestrating accurate, timely data across multiple sources and keeping provider information up-to-date. Plans that can do this build networks with confidence, reduce compliance risk, and improve member experience. Leveraging platforms that support multi-source validation, continuous roster reconciliation, and automated attestation allows plans to focus on strategic network growth rather than manual data cleanup.
Trend 2: Design networks around members, not checklists
Network adequacy is just the starting point here. The next generation of networks aligns closely with member needs around access, affordability, quality, and equity.
This requires using claims, demographic, and social data to identify the right mix of providers, not just more providers. Behavioral health, telehealth, urgent care, retail clinics, and centers of excellence all play a role in meeting member expectations. Competitive benchmarking, including analyzing competitor networks, is also critical for plans seeking to move beyond adequacy and build truly high-performing, member-centric networks.
Trend 3: Flexible, segmented networks are a new competitive advantage
The debate is no longer “big or narrow”. The focus is on flexibility and segmentation. Plans are experimenting with approaches like gold carding, selective value-based contracts, and tiered payments to differentiate provider relationships rather than treating them as all-or-nothing.
Health system partnerships remain central, but many plans supplement them with wrap networks or targeted contracting to preserve access and choice. Automation is essential to making these segmented strategies operational. Without it, complexity can stall progress and frustrate providers. Flexible, data-driven approaches are key to designing networks that serve members effectively and efficiently.
Barriers that hold plans back
Even as these trends take hold, familiar obstacles slow progress:
- Siloed data and disconnected systems
- Manual contracting and credentialing processes that stretch capacity and frustrate providers
- Limited recruiting resources, especially as independent providers become scarcer
Overcoming these barriers requires infrastructure that unifies data, automates workflows, and supports targeted network growth. We’ve seen firsthand that plans that invest in these capabilities can move faster, scale smarter, and adapt more nimbly to market change.
Health plans that embrace these approaches will be positioned to respond to change, but more importantly, stay ahead of it. By leveraging the right tools, workflows, insights, and partners, plans can turn complexity into opportunity and build the high-performing networks their members deserve.
Your provider network is an engine of growth, satisfaction, and better outcomes. At Andros, we help health plans design networks that adapt, innovate, and put members first. Connect with Andros today to get started.
