A Care Management Guide for Health Plans: Navigating the One Big Beautiful Bill 

The One Big Beautiful Bill Act (OBBBA) is reshaping healthcare, especially for Medicaid and Medicare plans. With tighter budgets, closer oversight, and an emphasis on population health in rural communities, care management is entering a new era. For health plans, the message is clear: adapt quickly or risk falling behind.

The New Reality for Care Management

OBBBA is bringing big changes that demand smarter, more flexible strategies. Medicaid cuts mean plans must deliver more with fewer resources, making efficiency and measurable outcomes essential. Regulators are also raising the bar. The Centers for Medicare and Medicaid Services (CMS) and state audits are increasing, especially around risk adjustment and overpayments, so accurate documentation and strong data practices are more important than ever.

At the same time, $50 billion in new funding for rural health creates opportunities to expand digital care and engagement strategies that close long-standing gaps in access.

How Health Plans Can Prepare

To succeed under OBBBA, health plans will need to rethink how they connect with members, strengthen operations, and adapt to ongoing change. Health plans now must focus on reimagining member engagement, improving population health, leveraging AI, and remaining agile to comply with new regulations.

Reimagine Member Engagement Through Digital Tools

Members increasingly expect to connect digitally with their health plan. A recent HealthEdge survey found that 78% of all health plan members and 81% of Medicaid members are open to, or already using, their plan’s mobile app. User-friendly channels improve accessibility and health literacy, giving members the support they need anytime and anywhere.

When healthcare experiences are personalized and intuitive, members are more likely to feel satisfied, stay engaged, and remain loyal over time. For underserved groups in particular, digital-first outreach can be the difference between receiving the care they need and going without it. Digital-first solutions are more than convenient, they extend care team capacity, reduce administrative burden, and make it easier to engage and retain hard-to-reach populations, particularly in rural areas.

Focus on Population Health Outcomes

The focus on “health equity” may have shifted back to “population health” but the goal is the same: address nonmedical drivers of health while meeting regulatory expectations. Doing so not only helps members, but it also controls costs and improves quality scores.

Health plans should look to advanced risk assessment tools and care gap analytics to help identify rising-risk members earlier, so they can intervene before problems escalate. Flexibility is also key, as integrating both built-in and external tools allows plans to tailor strategies to their populations. Done well, these approaches support better outcomes across measures like Medical Loss Ratio, Star Ratings, HEDIS, and quality improvement programs.

Leverage AI Tools and Optimize IT Resources

AI-driven tools have become essential for modern care management. These AI tools streamline workflows, surface actionable insights, and help care teams make faster, better decisions. Beyond efficiency, AI provides intelligence that makes it easier for care managers to quickly understand a member’s history, coordinate care, and take timely action. This can result in lower costs and a more personalized, connected experience for members.

There is also an IT efficiency opportunity for health plans. Many health plans juggle disparate tools that do not work well together, creating internal data silos and inefficiencies. Consolidating these into an integrated digital ecosystem reduces complexity, improves data sharing, and makes scaling easier. When care teams have seamless systems, they spend less time troubleshooting and more time supporting members. This kind of IT optimization not only strengthens operations but also ensures digital transformation delivers real results.

Stay Agile with Regulatory Changes

OBBBA is set to adjust regulations on a rolling basis and differ by state, so health plans need to be nimble. Running “what-if” scenarios and adjusting benefits or eligibility structures on the fly is now table stakes.

Plans that can adapt quickly will avoid compliance headaches while staying ahead of the curve as regulations continue to evolve. Agility is a competitive advantage now more than ever.

Using the OBBA as a Catalyst for Change

The One Big Beautiful Bill is not just another piece of legislation—it is a catalyst for health plan transformation. Health plans that embrace digital-first engagement, focus on outcomes, harness AI, optimize IT ecosystems, and remain nimble with regulations will be best positioned to succeed. It goes beyond compliance to delivering better outcomes for members while controlling costs.

Solutions like HealthEdge GuidingCare®, HealthEdge Wellframe™, and the broader HealthEdge solution suite tackle these care management challenges head on to give health plans a competitive advantage. By consolidating technology, streamlining care management, and enabling smarter engagement, these platforms provide the foundation for meeting today’s challenges while preparing for what comes next.

Want to learn more about how HealthEdge solutions can help payers consolidate and enhance care management? Read the case study, “How a Regional Health Plan Unified Care Management with HealthEdge.”