The invisible cost system: Why health plans keep missing millions in print and mail savings

In an industry obsessed with cost containment, health plans continue to overlook one of their most controllable expense categories: member communications. Not the obvious line items — printing and postage — but the entire operating environment that surrounds them.

Over three decades of working with health plans nationwide, I've observed a consistent pattern: organizations invest heavily in digital transformation while the physical communications infrastructure quietly consumes millions without strategic oversight. The irony is striking. We'll spend months optimizing a claims processing system to save basis points, yet allow our print and mail operations to run on autopilot, absorbing 3% to 5% annual cost increases as if they're inevitable.

They're not.

The hidden cost architecture

The real expense of member communications extends far beyond the vendor invoice. It's an entire cost system that most health plans have never mapped.

Consider materials decisions made years ago — envelope types, paper stocks, card materials — that now drive costs through manufacturing labor, postal qualification, inventory management, and waste. A dozen different envelope formats might seem like a trivial detail until you calculate the impact on presort density, setup labor and inventory obsolescence.

Or translation and accessibility, treated as transactional purchases rather than enterprise assets. Most plans pay to translate similar regulatory language repeatedly because there's no memory system, no reuse architecture. The same words, purchased again and again.

Return mail is typically managed reactively rather than as a data correction engine. But undeliverable mail isn't just a postage problem — it's a signal that your master data is deteriorating, your member outreach is failing, and you're about to reprint at rush rates.

Inventory models that seemed prudent when established now drive storage costs, obsolescence, emergency orders and compliance exposure. Marketing materials ordered in bulk sit in warehouses, going stale with every regulatory update.

And then there's clinical and regulatory mail, which is often your highest volume. It is engineered for compliance but not for cost. Files generated "as is" from core systems, with limited address correction, minimal presort optimization, and conservative class selection that leaves postal discounts uncaptured.

Why this persists

The persistence of these cost drivers isn't about capability. It's structural.

Print and mail operations typically report through different parts of the organization — compliance, operations, member services, marketing — each optimizing for their own objectives. No one has enterprise visibility. No one is accountable for the total cost system.

Vendor relationships compound the problem. When print, mail, fulfillment, translation, and inventory are managed separately, optimization becomes nearly impossible. Each vendor handles their piece efficiently while system-level waste proliferates in the handoffs.

And unlike clinical or claims operations, communications infrastructure doesn't generate the data that triggers strategic review. There's no real-time dashboard showing that your envelope proliferation is destroying presort performance or that your lack of translation memory is costing you six figures annually.

What changes

The health plans that have tackled this systematically see a fundamentally different cost trajectory. Envelope standardization that simultaneously impacts materials, labor, postal qualification and inventory. Return mail transformed from overhead into a data correction engine. Translation spend that declines year-over-year as reusable assets accumulate. ID card programs redesigned around on-demand fulfillment rather than inventory. Clinical mail volumes where postal engineering captures discounts that were previously left on
the table.

These aren't revolutionary initiatives. They're operational fundamentals that most health plans simply haven't applied to communications infrastructure. The plans that do typically find 20% to 30% in savings opportunities once they see the system clearly.

The assessment imperative

The challenge for health plan leadership isn't whether these opportunities exist—they do, in virtually every organization we've assessed. The challenge is gaining visibility into your actual cost system.

Most plans can't answer basic questions: How many envelope types are we using? What's our effective presort qualification rate? What percentage of our translation spend is new versus repeated content? What's driving our reprint volumes?

Without that baseline, optimization is impossible. You're managing vendor invoices rather than system performance.

The path forward begins with structured assessment—mapping the full cost architecture, quantifying waste, identifying which improvements are immediate and which are structural, and determining where to pilot first. The health plans that treat this seriously typically find 20-30% savings opportunities once they see the system clearly.

A different conversation

The broader question is why this remains relegated to operational obscurity rather than strategic focus. We've accepted that member communications are expensive and growing, as if that's an immutable fact of the business.

It's not. Print and mail operations are actually more controllable than most cost categories because they're fully within your operational jurisdiction. No provider negotiations. No benefit design trade-offs. No regulatory uncertainty. Just engineering and discipline.

The irony is that while health plans invest aggressively in member experience, care management, and digital engagement, the communications infrastructure supporting all of it continues to operate as a cost center rather than a strategic capability.

Perhaps it's time to change that conversation. Not because print and mail is the largest expense in your P&L, but because it's one of the most controllable — and most neglected.

In an industry where every margin point matters, leaving millions on the table through inattention seems like an increasingly expensive oversight.

Gary Bolnick is CEO of Command Direct, a healthcare communications partner serving health plans nationwide from its headquarters in Long Island, New York. With 30 years in the industry, he has worked with health plans to modernize their communications infrastructure and reduce costs while maintaining regulatory compliance.