What's taking center stage for payers in 2026
As 2026 approaches, whole-person care is moving to the forefront of payer strategy — while the pressure behind the scenes continues to build. Payers are navigating rising healthcare costs, intensifying competition, and a fast-evolving technology landscape, all as demand for accessible condition management and mental healthcare accelerates faster than available resources. The result is a defining moment: how payers respond now will determine who leads — and who struggles to keep pace — in the years ahead.
To help navigate this journey, we’ve gathered insights from the people living and breathing these challenges every day: Amwell’s leadership team. We asked them the heavy-hitting questions specific to their areas of expertise to help you prepare for the next year and beyond, get ahead of trends, and figure out what you need to do to set your organization and members up for success.
Here is what is top of mind for 2026, from platform consolidation to the realities of clinical inflation.
Platformization: stripping waste out of the system
Technology: rationalizing the digital stack
The consumer experience standard
Clinical & population health challenges
Platformization: stripping waste out of the system
The era of buying a new point solution for every problem is ending. For years, the industry added more apps, more portals, and more vendors, hoping that volume equaled value. Instead, it created fragmentation.
According to Ido Schoenberg, Amwell’s Chairman and CEO, payers need to shift gears entirely.
The strategy for 2026 is not about adding new bells and whistles; it is about using technology to strip waste out of the system,
Ido explains. “It involves automation replacing manual administrative tasks like prior authorization and scheduling. It involves self-service shifting member interactions to digital channels to reduce call center volume. And it involves platform consolidation to reduce the 'vendor tax.'”
This "vendor tax" isn't just financial — it's operational. Having too many vendor solutions leads to low engagement from members who are tired of remembering 10 different passwords. It also creates hidden operational friction and financial burden for payers who have to manage the procurement, integration, and utilization of these various point solutions.
When you factor in the skyrocketing costs of specialty care and GLP-1 weight loss medications, the need for efficiency becomes critical. You simply cannot afford administrative bloat when clinical costs are climbing this aggressively.
The market's response to these crises of cost, chaos, and fragmentation is a massive trend toward consolidation and platformization, which is expected to peak in 2026. However, Ido warns that it’s not as simple as just picking a vendor and moving on. It’s imperative to find a trusted, financially stable partner who will enable the platform, not just the application.
Digital chaos is the bottleneck limiting the industry today, but the tools to solve it — platforms, interoperability, and AI — are maturing rapidly. The organizations that master this convergence in 2026 will not only survive the financial storm; they will define the future of care.
Technology: rationalizing the digital stack
If platformization is the "what," then technology strategy is the "how." But right now, many health plans are dealing with misaligned legacy investments.
John Jesser, Amwell’s SVP of Strategic Partnerships and Business Development, points out that health plans have accumulated multiple digital strategy investments over time. These often aren't aligned with one another and haven't kept pace with changing care delivery models.
These investments, including digital solution vendors, will all be re-evaluated. The ability to respond to the ASO [Administrative Services Only] employer’s constant desire to employ third party engagement and care management solutions and create a tenable digital member experience is a great challenge.
Any innovation within the health plan, either on care management or digital member offerings, needs to be aware and somehow coordinated with the solutions desired and being brought to the table by the employers.
Plans have tried to manage this through manual integration efforts or revenue-sharing reseller programs, but the result is often sub-optimized investments. When programs don't talk to each other, engagement drops. And as John notes, “Lack of engagement in effective programs creates lost opportunities for cost control.”
The pressure isn't just internal. It’s coming from your clients and one thing is clear: whatever programs you do keep, they need to communicate with each other.
The consumer experience standard
Dan Zamansky, Amwell Chief Product and Technology Officer, brings the user experience into focus. He argues that members now expect their health plan experience to match the simplicity and polish of leading consumer apps like Amazon or Netflix.
“The ability to modernize core data infrastructure and rationalize the digital stack with stellar experience will be essential for any plan that wants to scale digital care effectively,” Dan says.
It’s about more than just a pretty interface. It’s about what’s happening under the hood. Dan sees Artificial Intelligence (AI) and automation as the key drivers that will fundamentally transform how care is delivered and orchestrated in 2026.
I see AI handling repetitive, labor and data-intensive tasks like prior authorization, claims triage, risk scoring, and clinical notetaking, while automation ensures these processes happen faster and with fewer errors.
The goal isn't to replace humans, but to create a symbiotic system. Technology handles operational heavy lifting, freeing humans to focus on what they do best: personalized patient interactions, high judgment, and accountability.
Of course, this comes with a caveat. Dan emphasizes that oversight and governance remain critical. Every AI recommendation must be transparent, explainable, and auditable to maintain trust and comply with regulations. Getting this balance right can fundamentally alter both the quality and cost of care.
Clinical and population health challenges
While technology evolves, the clinical landscape is becoming increasingly difficult to navigate.
Cynthia Horner, MD, FAAP and Chief Medical Officer at Amwell highlights the "triple threat" facing plans in 2026:
- Rising chronic disease burden
- Escalating medical inflation
- Tightening regulatory pressures
These are the areas where underlying data — and recent federal and state fiscal actions — show the steepest and most persistent stress.
Chronic conditions now account for roughly 90% of the nation’s $4.5 trillion in healthcare spending. Medical cost trend forecasts for 2026 project some of the highest year-over-year increases in a decade. This is driven by specialty drugs, the explosive demand for GLP-1s, workforce shortages, and hospital price growth.
These pressures intersect with a strong regulatory focus on prior authorization, health equity reporting, and AI governance. This places additional operational strain on plans that are already managing fragmented data ecosystems and uneven access to preventive care.
The behavioral health disconnect
To point out another concern, Amwell’s Director of Psychological Services, Darren Jones, PhD, identified a specific structural failure that continues to drive costs up: the separation of mind and body.
Separating medical and behavioral health services contributes to poorer outcomes and increases the cost of all healthcare, in part, because efficiencies are lost.
The solution is integration. Health plans that encourage and facilitate collaboration between medical and behavioral health providers will find that the clinical and economic outcomes are far more favorable. Treating the whole person isn't just a nice sentiment; it's a healthcare and economic imperative for 2026.
Advancing whole-person care with unified solutions
The challenges for 2026 are real: rising inflation, fragmented technology, and a sicker population. But the path forward is clear.
By moving away from fragmented point solutions and embracing a unified approach, payers can move closer to making whole-person care a reality.
Platforms such as Amwell are the cornerstone for delivering care, seamlessly connecting data, services, and stakeholders. By adopting a unified approach, payers not only improve member experience and engagement, but also achieve better clinical outcomes and control rising costs — all while making whole-person care more accessible and sustainable.
The question isn't whether you can afford to consolidate your technology and integrate your care models, it's whether you can afford not to.
Amwell is ready to help you take on these challenges in 2026 — connect with a team member today!