2026 Provider Network Strategy Priorities for Healthcare Leaders

Quest Analytics® Chief Executive Officer Steve Levin and Chief Network Solutions Officer Scott Westover have more than 60 years of combined experience in healthcare and technology, giving them extensive expertise in how healthcare delivery, insurance, network analytics, and provider network management continue to evolve. On The Totally Adequacy Podcast, in the episode Provider Data Accuracy and Network Strategy: What Health Plan Executives Need to Know for 2026, hosted by April Beane, VP of Marketing, Quest Analytics, Levin and Westover shared their perspectives on the latest trends and regulatory shifts — and what it means for provider data and network strategy in 2026 and beyond. Here are the key takeaways from their conversation.

What Are the Market Trends to Watch?

1. Tighter Operating Margins

An analysis by Evercore of the median operating margins for managed care organizations showed a sharp downturn in 2024 and into 2025, particularly for regionals. “This industry is under great stress right now,” Levin said. “The operating reality for health insurers is really tough.”

The continuing trend of provider consolidation has given providers more leverage on reimbursement rates, while higher member utilization rates have driven up costs.

2. Intentionally Narrow Markets

When it comes to provider networks, “bigger is not necessarily better,” Levin said. That was the finding of a recent study by KFF that analyzed the Centers for Medicare & Medicaid Services (CMS) star ratings of Medicare Advantage networks nationwide.

3. Continued Demand for Data-Driven Strategy

Delivering strong healthcare provider networks to achieve operational goals requires a data-driven approach, and there’s an industry-wide demand for better data accuracy.

What Are the Regulatory Priorities to Expect?

1. A Focus on Member-Facing Data

Federal regulators are also looking to use dynamic data to improve the member experience, Westover noted.

2. More Pressure on Health Plans

“What the federal government is saying is regardless of who’s responsible; health plans are accountable,” Westover said.

3. Joint Industry-Government Problem Solving

What’s the best way to improve member-facing data? That’s one of the most pressing questions in 2026, and CMS is inviting the industry to help answer the question through the Early Adopters initiative in the CMS Health Technology Ecosystem.

What Role Does AI Play In Provider Network Strategy In 2026?

Healthcare organizations are increasingly leaning on artificial intelligence (AI) to organize large quantities of data. There are three questions to ask when applying AI to operations, Levin said:

• Is it innovative?
• Does it change anything?
• Does it help?

What Will Differentiate a High-Performing Network In 2026?

“The best networks will present consistent, high-quality data to members and regulators alike,” Westover said. Strong data integrity can also help your team adapt to a challenging business environment.

Advancing Patient Care with Smarter Data and Connected Solutions

Position your organization for success by leveraging better provider data, smarter network analytics, and meaningful technology partnerships. We’re here to support you as trends and priorities shift. Quest Enterprise Services® (QES®) brings industry-leading solutions and services to the table, making it easier for you to adapt to changes and deliver measurable results.