Our 2026 managed care trends and predictions report identified six forces we believed would shape healthcare in 2026. Six months later, it’s a good time to ask two simple questions.
- What did we get right?
- What are we watching now?
What did we get right?
1. Healthcare affordability became the organizing issue.
Healthcare affordability became the lens through which policymakers, employers, payors, providers, and consumers viewed nearly every healthcare debate. That’s exactly where the conversation sits today.
CMS’s proposed OPPS rule for 2027 uses affordability to justify site-neutral payment policies, transparency initiatives, and reimbursement reductions. The debate is increasingly centered on who absorbs rising healthcare costs, and providers have become the default answer. They are consistently portrayed as the primary driver of healthcare costs while absorbing rising labor costs, supply costs, technology investments, declining reimbursement, and growing administrative burden. Meanwhile, payors continue reporting billions of dollars in annual profit with comparatively little public scrutiny.
Providers that fail to explain and drive advocacy for the cost of maintaining emergency departments, trauma centers, transplant programs, teaching programs, behavioral health services, and rural access will discover that someone else is happy to explain those costs for them.
2. AI in healthcare split into two conversations.
Artificial intelligence evolved largely as we expected. Provider organizations continue deploying AI to reduce documentation burden, improve coding accuracy, streamline revenue cycle operations, and return time to clinicians. Research conducted this year by UI Health Care showed that physicians can earn trust when they’re transparent about how they use AI and reassure patients that their clinical judgment still drives care decisions. The highest-performing message was simple, “Your doctor reviews and approves all AI recommendations.”
However, states like California and others aren’t waiting for comprehensive federal oversight. They’re establishing rules for transparency, human oversight, and accountability for AI-assisted healthcare decisions while federal policymakers continue examining how payors use AI in utilization management and coverage determinations. Healthcare is defining acceptable use of AI through accountability, not capability. It’s interesting that the largest payors are buying ads in local business publications stating they are not using AI for clinical decisions — yet denials continue to increase.
3. Medicare Advantage continued losing credibility
We predicted Medicare Advantage (MA) would spend 2026 defending its credibility rather than celebrating its growth. That’s exactly what’s happening.
Federal investigators continue finding evidence that beneficiaries are being denied medically necessary care only to receive approval after appeal. A recent HHS Office of Inspector General report found that MA plans overturned 95% of appealed denials for skilled nursing facility admissions. Denials issued by contractors were even more concerning. NaviHealth denied care at a higher rate than other reviewers, yet MA plans later overturned 97% of those denials when beneficiaries appealed. HHS concluded these findings raise serious questions about contractor oversight and the denials that are never appealed.
Consumers bought MA for lower premiums and additional benefits. They’re increasingly judging it by whether they can receive the care their physician recommends without unnecessary administrative barriers. Credibility becomes difficult to sustain when the system repeatedly concludes its own denials should never have happened in the first place. More providers have also stopped lending their brand to MA products where they continue to lose more money than traditional Medicare. That is, they have strategized, re-negotiated based on data, and terminated many of the MA products.
4. Contract disputes are in both the newsroom and the courtroom.
We predicted that provider-payor disputes would continue moving into public view. That trend has increased as more health systems explain contract disputes directly to patients, employers, and their communities instead of negotiating behind closed doors.
More provider-payor disputes are reaching the courtroom. Health systems are increasingly challenging payor behavior through litigation, reflecting a broader willingness to contest unilateral payment policies, administrative barriers, and contract interpretations that threaten access to care or financial sustainability.
These disputes reflect more than disagreements over the price of care. They’re battles for long-term viability that are playing out in boardrooms, courtrooms, and the court of public opinion. If you don’t have a communication plan tied to these disputes and lawsuits, your patients won’t understand.
What we’re watching now
Congress continues to cede ground to the states
We predicted regulators would begin responding to vertical integration. That response is emerging, but not where we expected. Congress has yet to enact bipartisan proposals addressing the conflicts created by vertically integrated healthcare organizations, leaving states to chart their own course.
Tennessee’s FAIR Rx Act directly challenges common ownership of pharmacy benefit managers, insurers, and pharmacies. Indiana has expanded oversight of pharmacy benefit managers while studying the impact of vertical integration and recommending additional legislative and regulatory action. Other states continue advancing legislation focused on ownership, transparency, and market concentration.
Whether that momentum ultimately produces a national framework or a patchwork of state-by-state regulation remains one of the biggest questions facing managed care.
The next challenge
Six months into 2026, we don’t need to change the central thesis of the report. The forces shaping managed care in January continue shaping it today. If anything, they’ve accelerated. Affordability continues driving policy and overall perception. AI is increasingly being judged by accountability but not fast enough. Medicare Advantage is struggling to keep trust of its beneficiaries. Provider-payor disputes are becoming battles over long-term viability, not simply reimbursement.
Those trends point to a larger challenge. Healthcare organizations can’t control every payment policy, legislative proposal, or managed care contract. They can control how they prepare for them, how they communicate them, and how they help patients navigate them.
Health literacy and financial literacy are no longer separate conversations. A patient who skips a colonoscopy, for whatever reason, making a healthcare decision that could become physically, emotionally, and financially devastating later. Helping people understand both their healthcare choices and their financial choices may become one of the most important responsibilities healthcare organizations assume in the years ahead.
The future will belong to organizations that help shape policy and set trends — through better strategy, stronger communication, and a willingness to advocate for the patients and communities they serve. We’ll continue supporting our physician, hospital, and provider clients while watching these trends closely and return early next year with our 2027 Managed Care Trends and Predictions report to see where they’re headed next.
