Priority Health, the insurance division of Grand Rapids, Michigan-based Corewell Health, is strategically positioning itself for long-term Medicare Advantage sustainability as the healthcare industry grapples with escalating costs and increased utilization rates. With 1.3 million members under its coverage, including 240,000 Medicare Advantage enrollees, the organization is taking a comprehensive approach to balance member benefits with financial viability.
Interim President Nick Gates recently shared insights into how the insurer continues to integrate its health plans with care delivery services, emphasizing the critical importance of sustainable growth in an increasingly challenging marketplace.
Medicare Advantage Strategy for 2026
The healthcare landscape in 2025 has presented unique challenges for Medicare Advantage plans nationwide. Priority Health’s response centers on what Gates describes as a focus on long-term sustainability rather than short-term gains.
Balancing Benefits and Sustainability
“Recent financial pressures have us really focused on sustainability,” Gates explained. “We’ve worked closely with our teams and agents, gathering feedback from our community to balance strong medical benefits and supplemental benefits that our members value. Our focus is on long-term sustainability.”
This approach represents a shift from the aggressive growth strategies that characterized the Medicare Advantage market in previous years. Instead, Priority Health is prioritizing member retention and quality outcomes over rapid expansion that might compromise financial stability.
Understanding Utilization Pressures
The Medicare Advantage industry faces unprecedented cost pressures from multiple sources, and Priority Health is no exception to these market forces.
Rising Drug Costs Drive Utilization
According to Gates, the primary cost drivers include:
- Rising drug costs across all therapeutic categories
- High-cost injectables, particularly in oncology treatment
- Increased inpatient care utilization
- GLP-1 medications for diabetes and weight management
- Gene therapies representing cutting-edge but expensive treatments
“The biggest impact is from drug spend – GLP-1s, oncology medications, high-cost injectables, and gene therapies are all part of the long-term trend,” Gates noted.
Industry-Wide Challenges
These cost pressures aren’t unique to Priority Health. The entire Medicare Advantage sector is experiencing similar challenges, with many national insurers reconsidering their market participation strategies. However, Priority Health’s integrated model provides certain advantages in managing these costs through coordinated care delivery.
Growth and Market Expansion Perspective
Despite industry challenges, Priority Health maintains a measured approach to growth that emphasizes quality over quantity.
Integrated System Advantages
“Our focus has been on product design and sustainability and really providing an exceptional experience to our members and focusing on our core membership,” Gates emphasized.
The organization’s integrated model offers several key benefits:
- Simplified member experience through coordinated care
- Ability to wrap comprehensive programs around members
- Focus on both member experience and quality outcomes
- Enhanced care coordination across the healthcare continuum
Market Commitment Strategy
Priority Health has taken a different approach compared to some national competitors who have withdrawn from less profitable markets.
“We’re committed to the markets we serve. We’re here for our agents, our members, and our communities,” Gates stated. “We saw last year that some of the large national insurers were pulling out of counties or areas that they felt weren’t profitable for them. We’ve committed to the state of Michigan, we’ve committed to the communities, and we’re here to stay.”
Innovation and Member Benefits
Priority Health continues to differentiate itself through innovative member benefits and strategic expansion.
Geographic Expansion
The organization has successfully expanded its footprint beyond Michigan, now operating in Indiana, Ohio, and Wisconsin. While Medicare Advantage products aren’t yet available in these new markets, Gates indicated this could be a future consideration.
Cutting-Edge Benefits
Priority Health has distinguished itself as an innovator in value-added services:
- First Medicare Advantage plan in Michigan to embed GRAIL Galleri technology
- Early cancer detection capabilities for members
- Continued focus on high-quality products that address member needs
Future Outlook
Looking ahead, Priority Health’s strategy centers on sustainable growth while maintaining its commitment to member value and community service. The organization’s integrated model positions it well to navigate ongoing industry challenges while continuing to innovate in member benefits and care delivery.
The focus remains on product design that balances member needs with long-term financial sustainability, ensuring Priority Health can continue serving its communities for years to come.
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