Shouldn't it still work out in the aggregate? Assuming people move both in and out of the provider?
Sure, but the decisions get made at the scale of a single company, not the industry as a whole.
For the mentioned new gene therapy treatments, people have been asking congress to come up with a new model for how to pay for treatment. Here's a recent opinion piece by a Louisiana Senator where he lists off the proposals he's heard: https://www.statnews.com/2019/06/12/paying-for-coming-genera...
Unfortunately, they probably won't want to. People frequently change insurance, so the most likely outcome is they'll have to pay for an expensive treatment, but never see the savings.
This is currently playing out for some new expensive new gene therapies.