As the healthcare industry braces for the potential ripple effects of the One Big Beautiful Bill Act (OBBBA), payers are evaluating how to respond in ways that balance compliance, sustainability, and member needs. They may adopt existing practices or explore new approaches that support both regulatory requirements and member expectations.
Drawing on his work advising eight of the top ten U.S. health insurers, Sanjay Subramanian, SVP & Healthcare, Payer Business Unit Leader at Cognizant, contends that moments of regulatory change are best met with a focus on a long-term plan that lays the groundwork for greater adaptability and stability in the years ahead.
OBBBA: Compliance is only Part of the Picture
While compliance is a key concern for many payers, Subramanian encourages a broader perspective. “The most misunderstood aspect of OBBBA is assuming it’s simply a compliance exercise rather than an opportunity for a market reset,” he says.
The Act introduces several financial adjustments, including scaling back supplemental programs, shortening open enrollment, reducing ACA subsidies, and tightening eligibility requirements. While these changes could impact member retention and financial performance for payers, particularly in the managed care sector, Subramanian suggests there may be greater opportunity for process improvement.
“Change on this scale will always be disruptive in some way, but it’s also a catalyst for reinvention,” Subramanian explains. “OBBBA creates a new system and a chance to move away from reactive measures to instead invest in strategies across five notable priorities
Those priorities include human-centered experience design for greater member retention, leveraging advanced technology for agility and operational efficiency, embracing real-time data sharing to support value-based care, reimagining wellness through prevention programs, health risk assessments, and addressing chronic health issues, and harnessing AI-driven insights to anticipate and manage high-cost risks.
“Compliance is essential, but it’s just a starting point. Organizations that can effectively leverage tools that combine foresight with efficiency will be best prepared—not just for OBBBA—but for whatever comes next,” Subramanian adds.
Embracing a Proactive Mindset
In navigating OBBBA, payers may find themselves falling into familiar patterns. According to Subramanian, one of the most common challenges is miscalculating the time and resources it takes to verify member eligibility.
“Payers often underestimate the operational complexity of eligibility redeterminations and overestimate their readiness for real-time member engagement,” he says. “The real challenge isn’t technology, it’s mindset.”
Rather than viewing each regulation as an isolated requirement, Subramanian encourages payers to consider how these new rules interact across financial, operational, and member experience domains. “I’ve often heard from payers that too many responses are still patchwork fixes,” he notes. “The shift must be proactive: redesigning workflows, investing in modern, agile platforms, and embedding predictive analytics to anticipate churn before it happens.”
How Technology Enhances Understandings of Risks
“In Medicaid especially, the most powerful innovations are happening where technology meets community,” Subramanian says. “We’re seeing disruptive models emerge like real-time risk assessments of factors that affect patient health embedded in digital enrollment, AI-driven triage tools that match members with local food or housing resources, and partnerships with nontraditional players like ride-share companies or fintech firms offering micro-grants for rent and utilities.”
He points to initiatives like the “Housing First” program for chronically homeless Medicaid populations, which saw a 33% drop in emergency department visits compared to matched controls (Commonwealth Fund, 2022).
“One promising approach is embedding care coordinators in trusted community hubs like schools, churches, and food banks while equipping them with interoperable data platforms to coordinate care and track outcomes in partnership with connected health plans,” he explains. “It allows payers to act on holistic, real-time information about a member’s needs and not just their medical history.”
Looking ahead, Subramanian sees potential in further integration, such as medically tailored meals delivered on demand through grocery partners or transportation arranged as easily as an Amazon order. “By combining technology with creative partnerships, payers can transform health risk assessments from a cost center into a lever for member engagement, improved outcomes, and a key driver for success in value-based care arrangements,” he says.
Platform Modernization: Agility as a Competitive Advantage
As regulatory requirements shift, proactive payers are prioritizing platform modernization to keep pace. According to Subramanian, the most agile organizations are investing in flexible operating models that allow for rapid response.
“The most forward-thinking payers pursue modular, cloud-based architectures that enable agility for new policy or reimbursement models and embed analytics into every workflow,” he explains. “Investments in scalable platforms, hybrid cloud strategies, and API-first ecosystems enable health plans to respond rapidly to market change and ‘productize’ administrative services for efficiency and innovation.”
Ultimately, these digital transformations aren’t just about tech. They are directly tied to improving member outcomes. “Tech modernization aligns directly to payer business priorities and elevates member experience, shaping the ‘moments that matter’—those crucial points in the care continuum that influence outcomes,” Subramanian notes.
Redefining Resilience in 2025 and Beyond
So, what does long-term resilience look like in the post-OBBBA era?
“Today, resilience is less about weathering storms and more about anticipating them,” Subramanian says. “It means having adaptable, digital-first platforms, agile talent and operations, a strategy for product-line diversification, flexible funding models, and strategically chosen partners that bring speed, scale, and specialized expertise. Just as important is fostering a culture that embraces change.”
He observes that resilient payers are those who are able to pivot smoothly from fee-for-service to value-based care, from legacy systems to AI-driven operations— all without disrupting the member experience. “The resilient payer of tomorrow is adaptive, data-rich, and member-oriented,” he adds.
From Vendors to Value-Creating Partners
Achieving this vision requires a fresh approach to traditional partnerships. Subramanian suggests that payer-vendor relationships can evolve beyond transactions and tactical outsourcing toward more collaborative models.
“The most effective partnerships are those where payers and vendors work together to address shared goals—whether that’s integrating data systems, improving care coordination or streamlining administrative processes,” he explains. “When both sides bring complementary expertise and a willingness to adapt, it’s easier to innovate and respond quickly to industry changes. Payers should look for vendor partners who are willing to co-invest, co-innovate, and co-own outcomes.”
Subramanian points out that these broader collaborations can have a direct impact on both member experience and operational efficiency.
“For instance, when payers and their partners share real-time data, it becomes much easier to identify gaps in care and coordinate timely support for members,” he says. “We’re seeing organizations unlock new insights and develop more connected, responsive services by working together in this way.”
A Moment of Reinvention
Overall, Subramanian sees this moment as a chance for payers to thoughtfully reimagine how they serve members and adapt to new expectations.
“We’re at a point where changes in regulation and technology are coming together in ways that can feel complex, but also open doors to meaningful progress in shaping Healthcare’s future,” he says.
For organizations that lead with purpose and invest in long-term capabilities, particularly in digital empathy and data-driven operations, Subramanian believes the rewards can be significant.
“Lasting transformation works best when it’s holistic, with every initiative anchored in improving member outcomes,” Subramanian notes. “Payers that embrace complexity, prioritize digital empathy, and lead with intent won’t just adapt to change—they’ll define it.”
For more information, visit cognizant.com/Digital Healthcare Solutions|Cognizant.
Daniel Casciato is a seasoned healthcare writer, publisher, and product reviewer with two decades of experience. He founded Healthcare Business Today to deliver timely insights on healthcare trends, technology, and innovation. His bylines have appeared in outlets such as Cleveland Clinic’s Health Essentials, MedEsthetics Magazine, EMS World, Pittsburgh Business Times, Post-Gazette, Providence Journal, Western PA Healthcare News, and he has written for clients like the American Heart Association, Google Earth, and Southwest Airlines. Through Healthcare Business Today, Daniel continues to inform and inspire professionals across the healthcare landscape.
