2026 is a reset year. Employers are facing cost pressures and utilization patterns that make business as usual impossible. Incremental adjustments won’t stabilize budgets or improve performance anymore.

At Corporate Synergies, we’re tracking four shifts that will materially change how employers manage their benefit plans in the year ahead. These realignments are already shaping where organizations direct their attention and resources in response to clear cost and utilization trends.

1. Care navigation moves from system-level thinking to provider-level performance

The first major shift ahead is a clear pivot: the move away from relying on hospital or health system affiliations as a shorthand for quality. Instead, employers are zeroing in on the measurable performance of individual clinicians, who most directly influence outcomes and total cost of care.

This shift is driven by access to more granular datasets that show:

• Complication and readmission rates by clinician
• Adherence to evidence-based treatment pathways
• A wide cost variation for the same procedure across providers
• Differences in prescribing patterns for chronic conditions

As care guidance tools become more sophisticated, employees will be matched with clinicians whose performance lowers unnecessary costs, not just hospital preferences. Employers gain a precise way to reduce avoidable utilization by guiding members to proven clinicians.

“The focus is shifting away from hospitals and systems, as individual provider and provider group track records are proving more influential in better health outcomes and lower costs,” said John Crable, senior vice president at Corporate Synergies.

2. GLP-1 medications become a more complex coverage decision

GLP-1 medications remain the top cost driver in employer plans. As the market changes, with lower prices and new discount models, employers must reassess their coverage strategy.

Many employers are reconsidering whether GLP-1 coverage still delivers value. With pricing and utilization continuing to move unpredictably, some organizations are slowing down or stepping back altogether.

Employers that commit to covering GLP-1s should consider the following guardrails:

• Clinically grounded eligibility that is tied to diagnosis and comorbidities
• Metabolic or nutritional counseling paired with prescriptions
• A clear separation of diabetes use from weight management use
• Utilization controls to prevent non-evidence-based or off-label prescribing

In addition to these coverage strategies, organizations should consider looking beyond traditional pharmacy coverage to support employees without absorbing unpredictable costs. HSAs give employees a way to allocate pretax dollars toward GLP-1 expenses when medically necessary.

HRAs can also help by offering employers a controlled way to reimburse eligible costs without increasing claims spend. In some cases, lifestyle accounts may be an option to fund weight management or metabolic health programs entirely outside pharmacy benefits. These approaches offer flexibility at a time when the GLP-1 market is moving faster than many plan designs can keep up with.

3. Benefits will become more intentional and outcome-focused

In 2026, employers will move beyond broad benefits menus, instead designing plans focused on measurable outcomes. Rising renewals and high-cost therapies prompt deeper evaluation of which programs provide actual value.

“Employers can no longer afford to treat benefits as a passive expense; instead, they must invest in solutions to improve employee health, reduce waste and deliver measurable value,” said Harrison Newman, vice president at Corporate Synergies.

This targeted approach also extends to support programs that materially affect productivity and claims. Caregiving support, for example, is increasingly tied to measurable workforce outcomes, such as lower absenteeism, reduced turnover and fewer eldercare-related disruptions.

4. Employers accelerate creative self-funded strategies to regain control from traditional carriers

Employers are looking for more flexibility in how their plans are managed and structured. As a result, many are exploring models outside of traditional fully insured arrangements with major national carriers. In 2026, creative self-funded strategies will continue to grow as a natural extension of this desire for more visibility and control.

“Over the coming year, we can expect a wave of creative self-funded strategies—from reference-based pricing and high-performance networks to more innovative plan designs,” said Newman. The shift is less about replacing carriers altogether and more about reclaiming control of cost, quality and experience. It enables employers to tailor networks, scrutinize pharmacy spend and integrate vendors around measurable outcomes.

Precision is favored over broad strategy in 2026

Employers are shifting from broad plan structures to targeted, data-driven, outcome-oriented decision-making. The common thread is that employers are taking back control of the variables that meaningfully drive cost and care quality. Measurable outcomes, not legacy structures, will create plans that are more predictable, sustainable and aligned with actual employee needs.