The healthcare industry is under pressure from every direction—demographic, financial, operational, and technological. As we close the book on 2025 we’re noticing a pattern beneath that pressure, and it’s one of recalibration. Health plans, providers, and healthcare innovators are rethinking long-held assumptions and reorganizing themselves for a very different path forward.
As we look to the future, here are 6 predictions that we believe will define the year ahead.
1 - The Medicare market will hit a breaking point and reset
The silver tsunami is becoming more than a metaphor. With Medicare enrollment surging and many national payers exiting unprofitable markets, regional and nonprofit plans will absorb an outsized share of responsibility. Many will tap reserves to weather the storm, while others will slash benefit design and cut non-essentials just to stay afloat.
At the same time, Medicare Star Ratings, bonus payments, and incentive structures will evolve, forcing plans to reevaluate their networks with far more precision. We may even see incentive payments shift towards direct to physicians—and possibly members—rather than flowing through payers. After years of pressure, Medicare economics will eventually swing back, but only for plans that adapt early.
2 - Provider consolidation will reverse and new care hubs will emerge
After a decade of acquisitions, 2026 will mark the beginning of a reversal. Many provider groups who sold to aggregators will return to independent practice, seeking better autonomy, better economics, and more focus on patient experience.
Simultaneously, we’ll see fundamental shifts in where care happens:
- Skilled nursing facilities will evolve into primary health hubs
- There will be an explosion of primary care activities taking place at ancillary clinician groups, like the dentist office
- Nursing dynamics will become more polarized with an overabundance of specialty nurses, and an even deeper shortage of generalist nurses
- A new wave of primary care physicians will enter the market, attracted by emerging payment models that finally reward prevention over procedure
Combined, these trends point to a decentralized, rebalanced provider ecosystem.
3 - Government incentives will finally align with outcomes
After years of incremental adjustments, 2026 will usher in a meaningful shift in how government programs reward quality and outcomes. Several changes are on the horizon:
- Direct incentive payments to physicians and care teams for quality achievement
- Potential rewards or “healthy behavior” payments directly to members
- Emerging policy conversations around a national provider quality bureau
- Increased scrutiny of directory accuracy and real enforcement of penalties
Prior authorization will also shift. As analytics mature, a new wave of gold carding will allow low-risk, high-quality providers to bypass prior auth entirely. Credentialing processes will follow suit, shifting from literal verification to predictive assessment driven by data quality.
4 - The rise of the Chief Network Officer and precision contracting
As we’ve been stating all year, network strategy is no longer a back office function. It’s a growth engine. That’s why 2026 will be the year the Chief Network Officer becomes a standard leadership role.
CNOs will be charged with designing purpose-built, outcome-based networks, segmenting providers and negotiating with surgical precision, operationalizing value-based care strategies, integrating non-medical providers (like social workers and care coordinators) into contracting models, and picking the right innovation partners amid mounting point-solution fatigue.
This is also the year many health plans will acknowledge that they can’t do everything on their own. Precision matters and platform-powered network operations will become non-negotiable.
5 - Data will become the most valuable asset and the biggest organizational gap
Health plans have talked about data governance for years, and in 2026, they will finally be forced to treat data as a strategic asset. This is because everything depends on it:
- Feeding AI strategies with clean, complete, and properly governed data
- Supporting network design, contracting, credentialing, and Stars performance in real-time
- Broadening data orchestration to improve member experience
- Meeting increasingly aggressive regulatory requirements
CAQH may even move toward privatization, raising fundamental questions about provider-attested data and whether attestation is still necessary if external data quality surpasses self-reporting. All said, plans that modernize their data infrastructure will move faster, while those that don’t will struggle to keep up.
6 - Hyper-tailored networks will redefine the commercial and specialty landscape
The commercial market will become a proving ground for hyper-targeted network design. Individual Coverage Health Reimbursement Arrangement (ICHRA) plans will surge as employers seek narrow, highly customized networks. At the same time, rental networks will reemerge in a more modern form, offering affordable, limited-purpose coverage for travel or out-of-area needs.
Specialty networks will also gain momentum, especially for high-cost, high-burden conditions like cardiac care and oncology, where targeted design can meaningfully shift outcomes and cost. If a new insurer launched tomorrow, their first product wouldn’t be broad coverage, it would be a purpose-built specialty network. This shift will also shape end-of-life and home-based care as more older adults age at home and plans rely on specialized networks to support them.
2026 is the year the old playbook stops working
Whether it’s Medicare, provider behavior, government incentives, network strategy, data governance, or market design, the next era of healthcare will reward precision, adaptability, and bold leadership.
The organizations that pull ahead won’t wait for the market to stabilize. They’ll recalibrate and build the future now before everyone else sees the opportunity.
