Health care plan. Photo: Adobe Stock
Controlling spiraling costs and navigating an increasingly complex policy environment are top of mind for health plan executives as they look ahead to 2026. More than 8 in 10 say regulatory pressures are affecting their costs and margins, according to new research from HealthEdge.
“The cost of health care is outpacing both inflation and wage growth, and this existential challenge is straining every corner of the industry ecosystem,” said Alan Stein, chief solutions officer for the health care technology company. “Health plan leaders are in the untenable position of trying to control costs, maintain pace with regulatory change and meet the rising expectations of both members and providers.”
The latest survey of 550 executives revealed a shift in concerns. Since the One Big Beautiful Bill Act was enacted last summer, regulatory and compliance pressures have outranked challenges such as member satisfaction and workforce shortages, which executives identified as more significant last year.
Executives overwhelmingly are turning to technology and services as their primary strategy to combat rising costs and address regulatory challenges. Six in 10 respondents are automating manual processes with artificial intelligence, machine learning or advanced analytics. They plan to increase their use of digital tools to over the next 12 months to reduce spend. Additionally, more than half of payers are applying AI or machine learning to avoid penalties associated with interoperability mandates and prior authorization requirements by automating more approvals.
The survey also revealed a disconnect between payer executives and their members on the perceived role of a health plan. Although three-quarters of executives said their members see them as a partner in the care journey, only half of consumers expressed the same opinion in an earlier poll. Payers are accelerating investments in digital tools to address this discrepancy and bring themselves closer to their members. More than half said their organizations already offer online scheduling systems (59%); personalized health and wellness recommendations (57%); and a mobile app (53%) to their member populations.
With mounting pressure on margins and increased consumer volatility, health plan leaders are rapidly expanding deployment of automation and next-generation solutions to deliver a seamless experience and strengthen member relationships. Although only one-third of payer organizations currently offer chatbots, half of executives said they are committed to implementing them within the next year
“There are difficult decisions on the horizon in the coming year, but it is clear payers are embracing modern, connected and scalable technology and services to support collaborative, data-sharing partnerships,” Stein said. “AI has rapidly emerged as the primary strategy to help combat rising costs and meet regulatory requirements, and investments around technology modernization, interoperability and automation reflect that.”
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