Operating margins for health plans since 2000 has been averaging ~2%, dipping below 1% in 2024. With the Centers for Medicare & Medicaid Services (CMS) proposing a 0.09% rate increase for 2027 Medicare Advantage payments, the financial outlook for health plans remains challenging and will require more than traditional cost-cutting tactics. It will need a new delivery paradigm to address the increasing medical costs and member expectations. 

Services-as-Software™ (SaS) is that new delivery paradigm that converts the potential of AI into significant real-world operational improvements such as lowering costs to deliver the entire flow from prior authorization and referrals (278) to explanation of benefits processing (835), and enabling more proactive member management across risk, referrals, and experience at faster speed, while remaining compliant to regulations.


This HFS roundtable will tackle this central question through a series of focused breakout rooms covering:

  • What are the challenges to adapting SaS?
  • What SaS outcomes can be committed to that are measurable at the transaction level and material to the P&L
  • What governance and change model will make SaS safe, scalable, and fast in a regulated environment?
HFS participants


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