A Strategic Framework to Navigate the One Big Beautiful Bill Act

Sweeping policy changes are nothing new in U.S. healthcare, but the One Big Beautiful Bill Act (OBBBA), also known as H.R. 1, represents a particularly consequential inflection point for health plans. With provisions that alter funding, tighten eligibility, and enhance accountability for administrative efficiency, OBBBA challenges payers to rethink their operations.

The impact extends beyond compliance. It disrupts long-standing operating models, accelerates the need for modernization, and exposes the hidden inefficiencies that have accumulated across payer ecosystems. However, amid the turbulence lies opportunity: health plans that act decisively can strengthen operational resilience, improve member engagement, and reduce the cost of care.

In this executive framework, we explore three imperatives that can help payers turn disruption into a strategic advantage:

1. Consolidate vendors to reduce cost and complexity
2. Automate workflows to enhance agility and ensure compliance
3. Engage members to drive satisfaction and retention

Together, these focus areas form the foundation for a leaner, smarter, and more connected health plan, one positioned to thrive in the post-OBBBA era.

1. The Case for Digital Consolidation: Simplifying Vendor Sprawl

For years, payers built their digital ecosystems piece by piece, adding point solutions for care management, utilization management, member outreach, health education, and engagement. The result is vendor sprawl: a tangle of platforms, contracts, and integrations that can drive up costs and dilute the member experience.

A 2025 PwC Health Research Institute report found that 62% of payer executives cite “too many disconnected point solutions” as a top barrier to operational efficiency and cost containment. The financial implications are real: redundant vendor contracts, increased administrative oversight burden, and fragmented data flows add millions in avoidable administrative costs annually.

Under OBBBA, this fragmentation becomes untenable. Health plans must process eligibility changes in real time, comply with new data reporting mandates, and deliver consistent and cost-effective care management, all of which require unified systems.

Forward-thinking payers are now consolidating member-facing functions under a single digital engagement layer. These platforms combine care management, health education, secure communication, and outreach, creating a continuous experience for both members and care teams.

Digital engagement platforms such as HealthEdge Wellframe™ exemplify this consolidation trend. Health plans can leverage these solutions to strengthen both care coordination and member trust.

The result? Lower administrative burden, improved efficiency across functions, and a more consistent experience for members are all essential differentiators as OBBBA reshapes market dynamics.

2. Automate to Adapt: Building Resilience Through Workflow Intelligence

OBBBA introduces new administrative complexity, particularly for Medicaid and Affordable Care Act (ACA) exchange plans. More frequent redeterminations, evolving eligibility requirements, and expanded reporting obligations are driving unprecedented increases in administrative tasks. For health plan executives, this means scaling operations without sacrificing accuracy or compliance.

Manual processes can no longer meet these demands. Workflow automation has become a core operational necessity, enabling payers to process more work with fewer errors, enforce consistency, and redirect staff toward higher-value activities. According to the HealthEdge Annual Payer Market Planning Report, most health plan executives are prioritizing technology modernization and automation to reduce administrative costs and strengthen compliance. This shift signals that automation is no longer viewed as a technology project—it’s a business continuity strategy.

For health plans, intelligent automation can:

• Streamline operational workflows such as prior authorization processing, eligibility verification, and scalable member outreach.
• Orchestrate interdepartmental coordination, ensuring clinical teams, member services, and operations staff act on the same data in real time.
• Reduce administrative overhead by eliminating redundant touchpoints between legacy systems.
• Enhance audit readiness through standardized documentation and digital traceability.

Wellframe automates member engagement and care management functions, triggering clinical risk alerts, population outreach, and enabling care teams to engage members more efficiently. A successful strategy must consider the entire health plan landscape: under OBBBA, automation is about giving care teams the intelligence and structure they need to act faster, maintain compliance, and operate with agility in an environment defined by constant change.

3. Member Engagement: The Retention Imperative

Perhaps the most visible and risky impact of OBBBA lies in member churn. As eligibility becomes stricter and redetermination cycles intensify, millions of individuals may move in and out of coverage more frequently. For payers, every lost member represents not just lost revenue but also increased acquisition costs and disrupted continuity of care.

Member engagement, once viewed primarily as a satisfaction metric, has evolved into a financial and strategic necessity. Retaining members reduces the impact of volatile eligibility and stabilizes government program reimbursement.

Leading plans are adopting mobile-first engagement models that combine personalized education, push notifications, and two-way messaging to keep members informed and connected. These approaches not only build trust but also drive measurable improvements in retention.

A recent HealthEdge Wellframe case study demonstrated that when a regional Blue Cross Blue Shield plan implemented Wellframe’s digital engagement platform, its care teams achieved a 91% increase in successful member outreach calls and six times more member interactions than traditional methods. These outcomes highlight how digital engagement can expand reach, strengthen relationships, and sustain continuous communication with members.

In short, engagement is the connective tissue that links eligibility, satisfaction, and retention in a post-OBBBA environment.

A New Operating Blueprint for Payers in the OBBBA Era

The One Big Beautiful Bill Act is reshaping the payer landscape in ways that demand greater agility, integration, and accountability. Health plans that remain dependent on fragmented systems and manual processes will struggle to meet new operational and regulatory expectations. To stay ahead, payers must adopt a unified model, one that integrates data, teams, and member experiences across the entire enterprise.

Digital platforms like Wellframe demonstrate how that model can come to life in practice, helping health plans streamline operations, automate intelligently, and deliver more connected member experiences that improve satisfaction and retention.

By bringing engagement, education, and care management into a single digital platform, Wellframe enables payers to reduce administrative overhead, enhance staff productivity, and strengthen member relationships. The result is a more efficient and resilient organization, one equipped to meet the demands of OBBBA today while advancing long-term goals for growth, value, and member trust.

Learn more about how your health plan can meet evolving member expectations with member engagement and care management solutions. Watch the webinar on-demand: “Navigating Digital Care Management Transformation: Delivering on Consumer Expectations with Effective Change Management.”