Buckle Up for the Year Ahead

The Case Manager

In 2026, proactive, educated, and informed Case Managers will be the Gamechangers for Employers and Employees. 

2025 ended with the US House and Senate leaving Washington, D.C., without addressing the challenges the country is facing, including the costs of healthcare for all of us. 

As a result, employers will face pressure to approach health benefits differently. According to UnitedHealthcare, 7 trends are shaping employer benefits strategies in 2026.

High operating costs are forcing workforce restructuring across industries. Artificial intelligence (AI) accelerates faster than many anticipated, transforming both business operations and benefits. At the same time, medical and pharmacy costs continue climbing, while behavioral health utilization places new demands on employer health strategies. Case Managers and Occupational Health Nurses will be needed more than ever to educate employers and employees on navigating the complex healthcare system more effectively.  Let’s look at how these trends will impact the workers' compensation industry. 

1. Doing more with less as workforce restructuring continues

High operating costs are driving employers toward a leaner workforce, with efficiency taking priority over expansion. A recent survey found that 62% of managers reported higher workloads in 2025 due to freezes or staff reductions. Organizations are consolidating roles, cross-training employees, and prioritizing upskilling over new hiring. As teams shrink, benefits teams face higher question volume and greater employee dissatisfaction due to fewer resources, intensifying the need for clearer communication and simpler member navigation. Employers and employees seek easy-to-access information and materials to help field member questions, and members seek easy-to-understand coverage. Nurse case managers are available to explain policies and help employees access the services they need to return to work after an injury or illness.

2. Return-to-office mandates tighten, but employees negotiate new terms

Employers are regaining leverage in enforcing return-to-office policies as the labor market shifts in their favor. Yet employees continue finding ways to maintain flexibility. According to recent data, 43% of hybrid workers engage in “coffee badging” — the idea of showing up briefly to meet attendance requirements before working remotely.  This dynamic reflects broader tensions around workplace flexibility.

These shifting attendance patterns also influence how employers think about on-site services, wellness initiatives, and communication timing. For benefits teams, understanding these patterns can help shape strategies around on-site health services and benefits that support both in-office and remote work arrangements. It’s important to note that successful return-to-office mandates require employers to balance realism and flexibility — allowing some adaptability while ensuring policy compliance and creating an office environment compelling enough to prevent the “coffee badging” trend. Many nurse case managers have been able to work from home and use technology to perform their work. Going back to an office is not popular – but might be necessary. We will see how this plays out for the case management industry. Flexibility will be key for managers and employers going forward. 

3. AI adoption accelerates across operations and vendor ecosystems

AI is moving from pilot projects to operational reality. Data shows that 92% of companies plan to increase their AI investments over the next 3 years.  Employers are exploring AI to improve internal efficiencies and employee productivity, enhance communication, service, and support to customers, and support employees. Interestingly, employees are 3 times more likely to be using generative AI today than their leaders expect a gap that suggests employers may need to accelerate both AI strategy and employee training to stay competitive. Employers may want to identify employees at risk of AI disruption and focus on expanding their skill sets to ensure future readiness. Nurse Case Managers should take advantage of educational webinars on how AI is impacting all aspects of healthcare. Those who do will be ahead of the game. 

4. Employer health benefit affordability reaches a tipping point

Cost pressures are intensifying across employer health plans. Employers project a median 9% increase in health care costs for 2026.  Even with planned design changes, that projection only falls to 7.6%. These increases are pushing many employers beyond incremental adjustments toward more significant shifts in benefit strategy. These pressures are accelerating interest in alternative plan models that emphasize value, navigation, and more predictable cost patterns. This area directly relates to the rules, function, and value case managers bring to the industry. As I have said before, if we do not demonstrate our value, we will be replaced by lower-level employees who will handle the functional work related to employee health. Missing will be creativity, industry understanding, ability to communicate with all team members, and the holistic perspective that nurse case managers bring to the setting. 

5. Momentum slows for GLP-1 coverage for obesity

Employer enthusiasm for covering GLP-1 drugs for weight loss is being tempered by financial realities. Among large employers with 5,000 or more workers, 66% reported that covering GLP-1s for weight loss had a significant impact on prescription drug spending.⁵  Focus groups and interviews reveal that virtually every employer cited high drug costs as the primary reason for reevaluating or restricting coverage.⁶  Some organizations that initially offered broad coverage are now implementing stricter criteria or eliminating obesity coverage entirely while maintaining diabetes indications. Nurse case managers and occupational health nurses support employers and employees in wellness programs, helping them discontinue medications and adopt healthier behaviors that replace the behaviors that contributed to obesity. 

6. Cancer and specialty drug costs continue rising

Specialty oncology spending remains a significant cost driver for employer health plans. Research shows that, in 2023, launch prices exceeded $100,000 per year for 95% of new anticancer therapies.  These costs are creating pressure at a time when employers are trying to stabilize overall spending. Many employers are reassessing cancer Centers of Excellence (COEs) and specialty pharmacy benefit managers to balance innovation with financial sustainability and seeking programs to better manage and support complex care needs. The collision between breakthrough treatments and cost-containment strategies is forcing difficult conversations about formulary management and how to ensure access to innovation within finite budget constraints. Having a Nurse Case Manager available to work with an employee or a family diagnosed with cancer can be instrumental in ensuring people get the right care, in the right setting, for the most cost-effective price when working with employees with complex medical conditions like cancer. 

7. Global mental health costs increase as employers push for value

Mental health has appeared — for the first time — among the top conditions driving employer health care costs.  This shift reflects both increased utilization and the growing recognition of mental health needs across workforces. More than 1 in 8 people globally live with a mental illness, and depression remains a leading driver of time away from work.⁸  Those numbers become more concerning when looking at the U.S.: More than 1 in 5 U.S. adults experience mental illness.  Employers are responding by moving beyond simple access expansion toward strategies that emphasize quality, appropriateness, and measurable outcomes, such as when lower-severity support may be the most appropriate choice. And vendors are facing greater pressure to demonstrate measurable outcomes rather than relying on access or utilization metrics. Having a nurse case manager with behavioral health experience or a psychologist as part of the medical team is important for those with mental health conditions. Exploring the setting with a multidisciplinary team when mental health diagnoses arise will ensure patients and caregivers understand the condition, the treatment, and how they can support each other. 

I hope this information provides insight into the trends we will face as a country in 2026, so you can understand your role in helping the employers you work with implementing policies for their employees. 

To learn more and get the references used to develop this article, visit https://www.uhc.com/employer/news-strategies/health-care-trends-impacting-employers 

All the best for a Happy and Healthy 2026. 

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