What managed care is facing as we head into 2026 isn’t a sudden disruption, but the long-term consequences of decisions made years ago — about payment models, network design, consolidation, and cost control. Patients are struggling with affordability. Providers are absorbing pressure they can no longer offset. Payors are tightening controls as they’re crushed by the weight of quarterly profit reporting. Everyone agrees costs are a problem. No one agrees on how to make them manageable without shifting the burden to someone else.
As Brandon Edwards and Kevin Thilborger note in “What to Expect in 2026: Managed Care Trends & Predictions,” this isn’t a story of simple escalation. Some of last year’s signals accelerated. Others stalled. A few revealed limits the industry was reluctant to admit. The result is a system behaving differently under stress — sometimes strategically, sometimes defensively, often at the expense of trust and access.
Affordability sits at the center of this moment, but the consequences extend far beyond price. Network design, ownership structure, administrative burden, and physician autonomy are no longer background issues. They’re shaping the patient experience in real time and reputations will suffer if they’re not addressed.
The 2026 report examines five forces driving these shifts and what they reveal about where health care is headed next. Not predictions for prediction’s sake, but signals worth paying attention to before today’s pressure becomes tomorrow’s constraint.
