The 2026 healthcare navigation report
What employers must prepare for now
Healthcare and benefits are evolving faster than ever, and employers are under pressure to keep up. Rising pharmacy costs, growing complexity and the demand for integrated, outcome-driven solutions are reshaping the landscape.
To help employers tackle these challenges, we spoke to a team of Quantum Health leaders with decades of expertise on all things healthcare and benefits.
Read on to discover the critical trends and actionable insights you need to navigate 2026 with confidence.
Panel of Experts
What’s inside
Top 6 employer trends for 2026
From skyrocketing pharmacy costs to the rise of whole-person health, learn what’s driving change and how to respond effectively.
The employer mandate for 2026
Six strategic imperatives every organization must act on to control costs, improve outcomes, and simplify the benefits experience.
Expert perspectives
Hear from industry leaders on AI adoption, clinically embedded navigation, and whole-person health strategies — including practical action items for employers.
Healthcare costs keep rising, and pharmacy is the biggest pressure point
Healthcare costs aren’t coming down, even with better utilization management. Our 2025 data shows total medical and pharmacy costs trending at 7%, with pharmacy driving fully half of that increase. Medical trends continue to be driven primarily by unit price growth, fueled by provider consolidation and rising labor costs1, rather than increased service volume.
Pharmacy, by contrast, is rising because utilization is accelerating, especially in high‑cost therapeutic areas. GLP‑1 use alone grew from 3.8% to 4.4% of members in a single year, meaning roughly one in 20 members is now taking one of these medications, and similar double‑digit utilization growth is happening in categories like anti‑obesity and immunology.
What this means for employers
Plan design changes alone won’t be enough. To control costs without compromising care, employers will need stronger pharmacy governance, including step therapy, re-authorization and tracking whether drugs are actually delivering real-world results.
Looking to fight these costs?
Quantum Health’s new suite of solutions is built to help you identify and take on your most pressing medical and pharmacy challenges.
Engagement still matters, but outcomes matter more
Member engagement is at an all-time high, but what’s changing is why people are engaging. In 2025, interactions per member grew by 20%, and digital engagement more than doubled. Members aren’t just reaching out more, they’re using support in more intentional, problem-solving ways. That’s reflected in the results. Pharmacy approval issues were resolved 32% more often, specialist coordination increased 22%, and guidance toward Centers of Excellence rose 17%.
These interactions directly remove barriers to care and reduce friction in the system. In fact, recent research from Aon showed that Employees understanding the value of the benefits offered rose 7 spots this year to become the second most important concern for health system employers.2
Pharmacy approval issues
Occur when a medication requires prior authorization or clarification before it can be filled; resolving them removes delays and helps members start treatment sooner.
Specialist coordination
Helps members connect with the right in‑network specialist, ensure records are shared, and remove administrative friction that slows care.
Centers of Excellence (COEs)
These are high‑quality, high‑value providers with proven outcomes for specific procedures or conditions, often at lower total cost.
What this means for employers
The old idea that “engagement equals value” is fading. What matters now is impact. Employers should expect partners to connect every interaction to a clear health or cost outcome and prove ROI, not just activity.
Integrated, clinically led navigation is now expected
Healthcare complexity continues to be one of the biggest pain points for employees. Quantum Health data shows that confusion between carriers, PBMs and providers still plagues members. Employees want one accountable guide, not a maze of disconnected vendors.
As pharmacy rules and restrictions increase, members have more questions about prior authorizations, network access and coverage. Members are looking for better answers that cut across all their benefits.
What this means for employers
Solutions that integrate navigation, care management and pharmacy support into a single, clinically led model will outperform fragmented approaches. Simplification reduces confusion, speeds resolution and ultimately helps bend the cost curve.
AI works best when it supports humans
Members are clearly shifting toward digital, self-service experiences. Digital engagement more than doubled overall, and among highly digital members it nearly doubled again. Employees want fast access to information, transparency and real-time answers.
At the same time, human support hasn’t gone away. Provider engagement stayed steady even as member engagement grew. This signals that technology is enhancing, rather than replacing, personal interaction.
The importance of humans and AI working in harmony is evidenced by a 2025 Harvard study. This research found that while AI models alone outperformed physicians in diagnostic accuracy (90% vs. 74%), physicians using AI as a “second opinion” tool achieved the highest accuracy of all.3
What this means for employers
AI should be applied where it creates real value: predicting costs, identifying members who need outreach and speeding up approvals. The most effective strategies use AI to make human support smarter and more efficient, not to eliminate it.
The rising importance of quality care
As healthcare costs continue to rise, where employees receive care is becoming one of the most powerful drivers of both outcomes and spend. Not all clinicians deliver care with the same level of effectiveness or appropriateness, yet employees are often asked to make provider choices with little visibility into quality. In 2026, quality transparency is no longer optional.
What's changing:
Traditional provider directories focus on network status, not performance. But data shows that when employees are guided to high-performing physicians, the impact is significant:
- Employers can realize 5–10% total cost savings4
- Employees may see 30–40% lower out-of-pocket costs4
- Provider quality insights can be informed by data sets spanning 230+ million4 individuals, allowing for clinically validated, specialty-specific performance comparisons
Because provider choice influences the vast majority of healthcare spend, enabling employees to choose the right provider upfront reduces unnecessary procedures, complications and repeat care.
What employers should do:
Traditional provider directories focus on network status, not performance. But data shows that when employees are guided to high-performing physicians, the impact is significant:
- Make quality-first provider guidance a core part of healthcare navigation, not a separate tool
- Use clinically validated performance data that measures appropriateness and effectiveness, not proxies like volume or affiliation
- Embed quality insights at the point of decision-making so high-value care becomes the default choice
As the industry shifts from volume to value, employers that
prioritize quality transparency
will drive better health
outcomes, lower avoidable
costs and a more confident,
informed employee population.
Whole-person health is becoming the standard
Employee needs now extend well beyond traditional medical care. Use of behavioral health services continues to rise, and employees are increasingly turning to employee assistance programs for help with mental health, finances, legal issues and childcare. Mental health is now one of the top categories of physician claims.
Employees are also far more cost aware. We’ve seen a sharp increase in questions about pricing, coverage and network access, especially around GLP-1 medications and benefit changes.
What this means for employers
The future of benefits is integrated and holistic. Employers should bring physical, behavioral, financial, and social well-being together under a single Total Rewards strategy. Clear communication, transparent pricing, and ongoing education will be essential to improving employee experience while managing costs.
The employer mandate for 2026
Quantum Health data is clear that cost, complexity and consumerism are converging. To succeed in 2026, employers must:
Contain costs
through smarter pharmacy management and alternative plan models.
Redefine value
by measuring outcomes rather than engagement volume.
Simplify and integrate
navigation to eliminate friction for employees.
Use AI responsibly
to enable transparency, prediction and personalization.
Elevate care quality
by guiding employees to high-performing providers using transparent, clinically validated insights.
Invest in whole-person well-being
to drive retention, resilience and workforce performance.
Employers that successfully act on these six themes will position themselves for measurable cost control, better health outcomes and a benefits experience that feels both simple and strategic.
Chief AI Officer
Shannon Skaggs
About Shannon
Shannon has spent more than two decades leading and shaping Quantum Health’s navigation and care coordination strategy, driven by a clear vision for growth and improving the healthcare experience for clients and their members. Shannon has led Quantum Health’s adoption of AI across our solutions and internal technology, unlocking unprecedented insights and capabilities.
Valuable expertise
-
AI Must Deliver Tangible Outcomes, Not Experiments
Employers are done with pilots that sound impressive but fail to change results. They now expect AI to show a measurable return in cost control, clinical efficiency and member experience. -
Change Management and Trust Determine Success
The biggest barrier to adoption isn’t the technology but organizational readiness. Employers must build trust in AI systems through transparent communication, employee training and responsible governance. -
Institutional Knowledge Gives AI Context and Power
AI in healthcare can’t operate in a vacuum. Success depends on deep understanding of care delivery, benefits structure and human navigation. That means AI must be developed and guided by teams that truly understand the healthcare ecosystem.
What employers can do
-
Demand Proof of Impact from Vendors and Partners
Require evidence that AI tools actually reduce costs, improve access, or drive engagement quality. Focus on measurable ROI tied to specific use cases. -
Invest in Change Management and Transparency
Prepare teams and members for AI integration by communicating clearly how it works, what it does, and how it improves their experience. Build confidence before expanding automation. -
Choose Partners with Deep Domain Expertise
Select AI solutions developed by organizations that understand healthcare navigation, claims, and clinical operations. Context and credibility are essential for both compliance and effectiveness.
What he has to say
The biggest shift is moving from proof of concept to proof of impact. We all love these fancy, magical tools, but now it’s, ‘Okay, show me what they actually do.’
Numbers to know
93%
of employers want technological solutions that include human support.
Chief Medical Officer
Dr. Stanley Crittenden
About Dr. Crittenden
Dr. Stanley Crittenden has an unwavering focus on clinical excellence and is deeply passionate about doing his part in improving the healthcare system for all. As Chief Medical Officer for Quantum Health, Dr. Crittenden is responsible for Quantum Health’s Clinical Strategy including Utilization Management, Pharmacy and Clinical Programs, enhancing Quantum Health’s existing clinical operations and strategy along with growing its value-based care programs and clinical focus.
Three Main Themes for Employers
-
Cost Driver Strategy is Rising
It's not enough to be satisfied with broad cost-containment strategies. Employers need clear visibility into the specific conditions, population segments and treatments that drive their trend. Understanding why costs are rising is the new baseline for action. -
Clinically Embedded Navigation Is the Future
The navigation model of the future must have clinical expertise at its core. When navigation, utilization management and care management are unified, every interaction becomes an opportunity for clinical intervention and cost reduction. -
Outcomes Are the New Currency of Value
Employers expect proof that navigation and care management actually change results. Engagement and satisfaction are no longer enough. Measurable improvements in health outcomes, avoided costs and total spend are what define value in 2026.
Three Action Items for Employers
-
Seek Granular Insight into Cost Drivers
Ask vendors and partners to show which clinical areas, conditions, and utilization patterns are driving your organization’s trend. Use this intelligence to target interventions and benefit design decisions more precisely. -
Partner With Clinically Led Navigation Solutions
Choose vendors whose models embed medical professionals within navigation and advocacy teams. This ensures that every member interaction has the potential to prevent complications, improve adherence, and reduce avoidable costs. -
Tie Every Vendor Relationship to Measurable Outcomes
Require that all programs, from navigation to point solutions, demonstrate clear ROI. Look for partners who can show a direct link between their services and total population health and financial performance.
What he has to say
The outcomes of clinically embedded navigation will define the next generation of employer healthcare.
Numbers to know
Managing GLP-1 costs is now the #1 pharmacy priority for
77%
of large employers5
VP, Clinical Programs
Shelley Grant
About Shelley
Shelley Grant leads the development and execution of enterprise clinical strategies designed to improve health outcomes, address disparities, and advance value-based care. A registered nurse and Certified Case Manager with 30+ years of experience, her work has been instrumental in creating accountable, high-performing clinical programs that support members across the continuum of care.
Three Main Themes for Employers
-
Whole-Person Health Is Now a Core Cost and Risk Management Strategy
Employee populations are facing increasing clinical complexity. Chronic conditions rarely exist in isolation, and behavioral health, family stressors, caregiving responsibilities and social factors frequently overlap with physical illness. Separating medical, behavioral and social programs is no longer effective. Whole-person integration is now required to manage both health outcomes and total cost of care. -
The Bar Is Rising for Measurement and ROI
Employers are no longer satisfied with programs that demonstrate engagement or utilization alone. They now expect clear, measurable outcomes tied to both clinical improvement and financial performance. This includes visibility into how interventions reduce utilization, prevent escalation, and improve condition management across populations. -
Rising Specialty and Pharmacy Costs Demand Earlier, More Targeted
Intervention
Specialty medications, gene and cellular therapies, and expanding GLP-1 utilization continue to place upward pressure on employer costs. Delayed care, access challenges and lack of early intervention often lead to higher downstream spend.
Three Action Items for Employers
-
Prioritize Integrated Solutions That Address Physical, Behavioral,
and Social Health Together
Employers should evaluate partners based on their ability to deliver connected, whole-person insights and outcomes rather than siloed programs. Integration across domains is essential to reducing complexity and improving ROI. -
Look for Outcome-Based Reporting, Not Just Engagement Metrics
When assessing vendors, employers should ask how programs demonstrably reduce cost, improve access, or prevent escalation. Solutions should clearly articulate success measures and provide transparent reporting tied to employer priorities. -
Invest in Early Identification and Proactive Clinical Engagement
Employers should look for navigation and care models that surface rising risk early, reduce access barriers, and guide members to appropriate care before conditions become more severe and costly.
What she has to say
You never saw a behavioral health diagnosis in the top five ten years ago. Now you always do.
Numbers to know
38%
of employees are satisfied with their benefits as a whole6
Client success team
Chris Reed
VP, Client Success
Abdulrahman Basith
Sr. Strategic Healthcare Advisor
Melissa Reilly
Senior Strategic Healthcare Advisor
Our Client Success team with Quantum Health clients to ensure they achieve their goals, all while tailoring the experience to the precise needs of their members. Over 25+ years, this team has developed an unmatched understanding of what clients need and how organizations can maximize the value of healthcare navigation.
Numbers to know
49%
of employers say controlling benefits costs is their top issue7
What they’re saying
We’re seeing a significant increase in adoption of digital self-service tools. Engagements per member have more than doubled.
Three main themes for employers
Pharmacy cost pressure will shape employer strategy in 2026
GLP-1 utilization is rising, unit cost improvements are modest and pharmacy now drives half of trend. Employers must respond with strong plan governance, particularly around GLP-1s, specialty drugs, and prior authorization workflows.
Members are becoming more consumer-minded and digitally active
Engagement with healthcare navigation solutions like Quantum Health is up 20% year over year, and digital interactions more than doubled among members with claims. Employees are acting more like healthcare consumers, actively checking costs, networks and benefit details before care.
Complexity in the healthcare ecosystem is increasing member friction
Members are struggling with tightening pharmacy policies, directory errors, benefit changes and pre-service confusion around costs. This rising friction places pressure on employers to ensure accurate navigation, integrated communication and simplified access points.
Three action items for employers
Strengthen GLP-1 and specialty drug governance
Employers should implement and maintain clear indication criteria, step therapy rules, re-authorization timelines and active engagement support to avoid runaway pharmacy costs.
Invest in digital-first tools backed by human navigation
Members increasingly expect self-service capabilities for simple tasks, but still rely on human help for complex needs.
Employers should ensure they offer a dual-track experience: Digital for convenience, human expertise for high-stakes decisions and problem resolution.
- Digital for convenience
- Human expertise for high-stakes decisions and problem resolution
Improve pre-service cost clarity and benefits education
Employers must:
- Provide clearer coverage explanations
- Improve transparency around preventive vs. diagnostic coding
- Help members understand where to go and what they will pay
This reduces avoidable spend and improves the employee experience.
Turn these findings into results
Quantum Health is built to help your organization take on these trends. Learn how we can lower costs, improve outcomes and deliver a better experience for your employees.
Appendix
1 https://www.bbrown.com/us/insight/2025-healthcare-cost-outlook-drivers-trend-insights/
2 https://www.aon.com/en/insights/reports/benefits-survey-of-hospitals
4 https://emboldhealth.com/what-we-do/embold-edge
6 https://quantum-health.com/reports/beyond-the-bottom-line-ebn
7 https://quantum-health.com/reports/improving-engagement-with-a-human-in-the-loop