Turn Midyear Pressure Into Second-Half Growth

Here Is What Leading Health Insurers Are Doing Differently

Payers entered 2026 optimistic. Six months in, the picture is more complicated. Rising medical costs are driving medical loss ratio (MLR) up and compressing margins. As a result, employers are rebidding for business that previously renewed quietly and sellers are being asked to do more, with more tools, against more sophisticated buyers.

All while every commercial leader we talk to is wrestling with the same uncomfortable question: Are our midyear investments translating into behavior change or just adding complexity?

According to the Alexander Group’s June 2026 Health Insurance report, growth has officially moved from a strategy problem to an execution problem. The headlines are revealing:

• 100% of health insurers are making changes to their compensation plans this year, a level we haven’t seen before
• 75% are increasing sales headcount, the highest of any of Alexander Group’s sectors (except for MedTech)
• 94+% expect AI to impact their go-to-market jobs.

Although the pressure is real, health insurers need to make sure their response is disciplined.

Four Insights Shaping Midyear Execution

1. Channel expansion is the number one growth priority, and the legacy broker model is where most leaders are stuck

Channel expansion, or broadening the routes to market beyond a legacy broker-centric model, topped the 2026 Alexander Group Sales Pulse Survey as the leading growth priority for health insurers. Despite employers demanding proof of value and brokers shopping for the carrier that maximizes their economics, most broker programs are still relationship-based, with static commissions and limited enablement. Legacy broker programs are usually heavily entrenched, which is exactly why there is a meaningful first-mover advantage for payers willing to redesign them as strategic performance management systems instead of payout models.

2. More coverage, more complexity—and no lift in seller productivity

Payers are continuing to invest heavily in additional sales capacity, particularly in support roles such as ancillary specialists, SDRs and customer success. At the same time, sales executives are increasingly pulled into defending renewals and driving expansion within existing accounts. Despite this added coverage, seller productivity hasn’t improved. The growing mix of roles brings more complexity and unclear ownership across the coverage model, creating friction rather than enabling more effective selling. The constraint has less to do with resources and more to do with how capacity is deployed.

3. Elevating the seller requires translating investment into behavior change

As competition intensifies, organizations are asking more of their sellers—not just in terms of productivity, but in how they engage and win. What were once routine reorders are now becoming increasingly competitive rebids, requiring sellers to lead with clear value articulation, ROI and a differentiated employer benefits story. While many payers are investing in tools, insights and enablement to support this shift, these investments are not consistently translating into behavior change at the front line. Simultaneously, turnover (while normalizing) remains costly. Projected 2026 sales attrition sits at 12.7% (down from a 15.8% peak), with nearly 60% voluntary. And each departure costing an estimated 155% of target compensation when factoring in backfill and disruption. Because of this, we’re seeing a continuous drain on effective capacity. Therefore, elevating the seller is not just a capability imperative. It requires ensuring investments drive tangible changes in how sellers spend time and engage buyers, or risk losing as much capacity as is being added.

4. AI expands seller bandwidth, but only with disciplined execution

Alexander Group’s 2026 AI and Go-to-Market Job Evolution research found that AI “power users” deliver 18% more customer calls, cover 19% more accounts and close deals that are 23% larger. 68% of organizations expect core seller roles to change dramatically by 2028. The disconnect between spending and results is the central RevOps challenge for the remainder of 2026 and into 2027.

How Health Insurers Should Respond to Revenue Growth Pressures

To close the gap between investment and impact, companies must take deliberate, practical actions across strategy, structure and management by focusing on where to drive performance, how to deploy capacity and how to enforce accountability.

Strategy: Reposition the broker channel as a performance system

• Shift broker programs from static commissions to tiered, performance-based incentives that reward growth, retention and profitable product mix
• Align incentives to growth with new member credits and threshold-based payouts
• Reinforce profitability by rewarding high-margin products and tying retention to tier eligibility
• Introduce clear broker tiering so sales teams can actively use the program as a performance management tool, not just a payout mechanism

Structure: Reallocate capacity before adding it

• Audit how current sales capacity is deployed before approving additional headcount
• Use sales time studies to ensure roles (sales executives, account executives, specialists) are focused on highest-value activities
• Split roles where needed (e.g. fully insured vs. ASO) to better match buyer complexity
• Where AI expands capacity, deliberately redirect that time toward account development, deeper portfolio selling and increased customer touchpoints- instead of allowing it to become unmanaged overload

Management: Professionalize sales compensation and manager enablement

• Modernize compensation design to better align pay with productivity and strategic outcomes. 78% of surveyed payers are driving more pay-for-performance into 2026 plans.
  • Migrate from target rate to target pay to better differentiate performance expectations
  • Tie SPIFs and accelerators to profitable growth, not just volume
• Strengthen first-line manager enablement as the primary driver of AI adoption, behavior change, and quota credibility. Top-performing firms in our 2026 Sales Compensation Trends research were twelve points more likely to hold standing meetings with sales leadership on plan performance.
• Establish consistent operating rhythms (e.g., regular leadership reviews of plan performance) to improve accountability and outcomes
• Invest in compensation governance and operations to close the discipline gap between investment and measurable impact. Roughly 51% of firms told us they need to improve sales compensation governance and operations. That is the discipline gap between investment and impact.

The Forward View

Leaders who will succeed in the next two quarters are those who treat execution as a system rather than just a series of point fixes. Channel approach, sales deployment, compensation and AI adoption are not separate workstreams. They are the same growth play, viewed through different lenses. Firms that take a holistic approach across strategy, structure and management are the ones that turn midyear pressure into year-end momentum.