Why PROACTIVE CARE Is the Only Path to Lower Total Cost of Care

There is no way to reverse the upward trend in total cost of care without a PROACTIVE CARE strategy. Financial tactics alone, such as negotiating rates or frequently switching administrators and vendors, do not address the root cause: the growing demand for costly medical and pharmaceutical services driven by rising chronic conditions. Nearly six in ten commercially insured Americans had at least one chronic condition in 2024, and many had multiple co-occurring conditions, significantly increasing downstream utilization and cost (FAIR Health et al., 2026). At the center of any high-performing health plan should be a proactive care core made up of the member, the primary care provider, and a care advocate. The goal is earlier, more consistent engagement in care. Healthcare is complex both clinically and administratively, making it difficult not only to diagnose and treat correctly, but also to follow care plans over time. When members cannot manage chronic conditions efficiently, they do not manage them effectively, leading to avoidable inpatient utilization. Build your health plan around a strong PROACTIVE CARE foundation, enable the care core to do today’s work today, and total cost of care can begin to decline.

FAIR Health, Inc. (2026, February 2). Chronic conditions in the United States: A study of commercial claims. https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Chronic%20Conditions%20in%20the%20United%20States.pdf