2026 Healthcare Trends Employers Must Prepare for Now

This blog gives you a quick look at our 2026 Healthcare Navigation Trends and Predictions report. Be sure to check out the full report for can't miss strategies.

Healthcare navigation is at a turning point. Costs continue to rise, benefits are more complex than ever, and employees expect clarity, personalization, and real help. Insights from Quantum Health’s clinical, AI and client success leaders point to six trends employers must act on now to succeed in 2026.

1. Healthcare Costs Keep Rising and Pharmacy Is the Biggest Pressure Point

Despite better utilization management, total medical and pharmacy costs are trending at 7%, with pharmacy driving half of the increase. The biggest driver isn’t price alone. Rather, it’s utilization, particularly in high-cost categories like GLP-1s, specialty, and immunology drugs. Roughly 1 in 20 members is now taking a GLP-1, with double-digit growth continuing.

What employers should know:
Plan design changes alone won’t control costs. Employers need stronger pharmacy governance, including step therapy, re-authorization, and tracking whether medications are delivering real-world results, without disrupting care.

2. Engagement Still Matters, but Outcomes Matter More

Member engagement continues to climb, with interactions per member up 20% and digital engagement more than doubling. But engagement alone no longer defines success.

Navigation support is now directly tied to outcomes:

More pharmacy approvals resolved
Better specialist coordination
Increased guidance to Centers of Excellence

What employers should know:
The equation has changed. Engagement without impact isn’t value. Employers should expect partners to clearly connect every interaction to measurable health improvements or cost savings and prove ROI.

Employees are overwhelmed by fragmented vendors, confusing pharmacy rules, and disconnected benefits. They want one accountable guide, not a maze of handoffs between carriers, PBMs, and point solutions.

What employers should know:
Navigation models that integrate advocacy, care management and pharmacy support with clinical expertise embedded at the core outperform fragmented approaches. Simplification reduces confusion, speeds resolution, and helps bend the cost curve.

4. AI Works Best When It Supports Humans

Digital self-service adoption has surged, but human support remains essential. Provider engagement stayed steady even as member engagement increased, signaling that technology is enhancing, not replacing, personal interaction.

Research shows that clinicians using AI as a decision-support tool outperform both AI-only and human-only approaches.

What employers should know:
AI should be used where it creates real value, such as predicting costs, identifying rising risk and accelerating approvals, while making human expertise smarter and more effective, not eliminating it.

5. The Rising Importance of Quality Care

As costs rise, where employees receive care is becoming one of the most powerful drivers of outcomes and spend. Yet most provider directories still emphasize network status over performance.

When employees are guided to high-performing physicians, the impact is clear:

Employers can achieve 5–10% total cost savings
Employees may experience 30–40% lower out-of-pocket costs
Quality insights informed by data from 230+ million individuals enable clinically validated, specialty-specific comparisons

What employers should know:
Quality transparency is no longer optional. Embedding quality-first provider guidance into navigation helps reduce unnecessary procedures, complications, and repeat care while improving confidence and outcomes.

6. Whole-Person Health Is Becoming the Standard

Employee needs extend far beyond traditional medical care. Behavioral health utilization continues to rise, mental health is now among the top physician claim categories, and employees are increasingly cost-conscious and benefit-savvy.

What employers should know:
The future of benefits is integrated and holistic. Employers must bring physical, behavioral, financial, and social well-being together under a unified strategy, supported by clear communication, transparent pricing, and ongoing education.