Reflections from 2025 and the Future of Benefits for 2026

As we close out the year, it’s clear that 2025 was a definitive turning point in benefits. We stood at a stark intersection: on one side, a “renewal reckoning” driven by historically high costs that pushed budgets to their breaking point, and on the other, the rapid maturation of AI. 

Against the backdrop of financial strain, we watched as AI moved into the benefits space—not as a cold, impersonal technology, but as a force to make healthcare and technology at large more “human.”

At HealthJoy, we’ve always believed that technology should connect people and simplify the complex. That’s why I’m calling 2025 “The Year of Connection.” It was the year the Benefits Operating System (OS) finally came to life—connecting data, systems, and member context. We moved beyond simple navigation to build a central hub that ingests (not just links to) the core data that shapes a member’s experience. 

In 2025, we closed the gap between members and their care through the evolution of JOY, our virtual benefits assistant, and with strategic partnerships. In 2026, we will scale this foundation to address the top industry trends, empowering employers and partners to master the chaotic landscape of rising costs, demand for GLP-1s, deferred care, widespread patient discontent, the benefit “black box” of cost, and the ongoing AI revolution.

From 2025 Learnings to 2026 Innovations: Trends Defining the Healthcare Landscape

The AI Revolution 2.0: JOY Brings the Conversation to Members

2025 was about AI adoption; 2026 will be about utility. We're witnessing a fundamental shift from “Reactive AI”, simply just answering questions, to  “Agentic AI”, which proactively performs sophisticated tasks like scheduling appointments, filing simple claims disputes, and even executing complex benefit comparisons seamlessly.

In anticipation of this shift, we took a giant leap forward this year. When we first introduced JOY, it was about providing immediate answers. We’ve upgraded JOY to go beyond rigid scripts, leveraging Generative AI to truly understand intent, context, and history, but we aren’t stopping at conversation.

We’re building JOY to be an active agent in your healthcare journey.

• From Search to Schedule: We’re moving toward an experience where JOY helps manage the logistics, assisting with scheduling, availability, and closing the gap between “finding care” and “getting care”.

• Anticipatory Guidance: Instead of waiting for a member to type “back pain”, the new, smarter way will analyze claims data and utilization patterns, so our AI can proactively surface relevant benefits, before a member thinks to ask. 

The enhanced JOY experience retains context across the healthcare journey. It understands context, nuance and your specific plan details better than ever before. For HealthJoy members, this means the experience feels less like a search engine and more like a dedicated benefits professional who knows their history and anticipates their needs—and it’s available 24/7/365. 

This capability is paramount. When people are seeking care, they’re often stressed and overwhelmed. They don’t need a search bar, they need a partner. This year, we delivered that personalized guidance at scale, helping thousands of people access answers about their benefits instantly.

The Omnichannel Standard

“Digital health” can no longer be synonymous with “mobile-only”. While the smartphone remains the center of our lives, user behavior consistently shows us that when people are dealing with complex healthcare tasks, they often prefer the real estate and focus of a desktop environment. True engagement requires meeting members where they are, on the device they prefer.

Recognizing this shift, we made a major accessibility expansion with the launch of the HealthJoy web experience. We have effectively broken down the “app store barrier”. Now, members can access their benefits wallet and 24/7 healthcare concierge support directly from their browser—whether they’re at their office desk, at home, or simply prefer not to to download another app. 

By offering a fully synced, web-based experience, we’ve opened the door for higher adoption across diverse demographics and work styles. We’re ensuring that help is always just one click away, regardless of screen size. 

The GLP-1 “New Normal”

In 2026, the “hype” around GLP-1s will settle into an operational reality. The companies that win next year will successfully implement a managed GLP-1 strategy—utilizing clinically rigorous frameworks, rather than resorting to an open checkbook approach or a total ban of these life-changing prescriptions. 

There is a middle ground, and the companies that achieve it, will thrive in the “new normal.”

Every broker has had conversations about the skyrocketing demand for GLP-1s, particularly for weight loss. The challenge is clear: while HR teams know there is demand within their populations, organizations cannot afford to simply deny these drugs, nor can they sustain the financial drain of uncapped coverage. 

In response, we shifted our strategy from reaction to sustainable action. In 2025, we introduced our partnership with CareValidate and their CareGLP product. This collaboration offers a dual approach to managing this high-cost category:

• Clinical Rigor: Members utilize a clinical process to confirm medical necessity and adherence to protocols, ensuring the medications are routed to the members who need them most. 
• Sourcing Smarter: We source prescriptions for up to 50% less than retail cost through competitive and ethical supply chains. By enabling access to discounted prices, health plans can avoid expensive claims for off-label weight loss use while still supporting employees’ health goals.

The outcome is powerful: We help members get the prescriptions they need without breaking the plan’s bank.

The Deferred Care Wave 

One of the quietest but most dangerous cost drivers for 2026 is deferred care. When members put off care until it becomes an emergency, the result is a wave of avoidable and expensive high-cost claims. 

As the cost of care continues to climb, the temptation for members to “wait it out” will only increase. Early intervention and steering members to preventive programs is the only way to defuse high-cost claims before they explode. 

To that end, we expanded our Virtual MSK Therapy program this year to include Movement Health and Injury Prevention. We wanted to focus on MSK because these issues are often the first thing members ignore, but are the most costly to fix later.

Our program takes a proactive approach that helps reduce healthcare spend and improves employee wellbeing by offering on-demand virtual programs that address a wide range of preventive needs, including general movement, job-specific injury prevention, bone density, fall prevention, and more. 

Given that 50% of pain and injuries can be prevented, this is an area of healthcare spend that cannot be ignored. By catching these issues early, we aren’t just improving wellbeing, we’re protecting the plan. 

Discontent & The Push for Transparency

It’s no longer just about pharmacy. From rising premiums to opaque hospital facility fees, patients are reaching a breaking point. The cost of being healthy has become unaffordable for many. 

In 2026, transparency must go beyond Pharmacy Benefit Managers (PBMs) to include the entire care ecosystem. Employers will desperately need tools that expose cost variances for common procedures, imaging, labs and specialist visits. The employers who can offer affordable access to high-quality care—not just coverage on paper—will unequivocally win the talent retention war.

This year, we aligned with industry disruptors to validate this, most notably hosting a strategic dialogue with entrepreneur and healthcare advocate Mark Cuban.

Cuban’s candor on PBMs and the layers of “middlemen” driving up costs was a powerful validation of what we and our clients have known for years. As he noted:

“Transparency isn't a luxury; it's the only way forward.”

We’re taking that challenge seriously. The insights gained have reinforced our 2026 commitment to exposing the opacity of pricing models, pharmacy being just one of those areas. We’re moving toward a future where we don’t just navigate care, but actively shine a light on where costs are hiding. 

To further meet the need for transparency, we enhanced our Data Insights Dashboard. The latest updates give our partners a dynamic and on-demand view of performance metrics and actionable insights to supercharge benefits strategies and drive impactful improvements in population health. Additionally, brokers can now unlock comprehensive, real-time aggregate performance metrics across their entire HealthJoy client portfolio with the Book of Business view. The 2025 enhancements give our partners and their clients deeper insights into program savings, steerage breakdowns and ROI calculations. 

The Renewal Crisis & Strategic Intelligence 

Every benefits consultant I’ve spoken to this year is facing the same problem; the rising cost of healthcare is completely unsustainable. This renewal season has been arguably one of the worst in history. And, the hard truth is that 2026 isn’t looking much better—not without major strategic shifts. 

For too long, CEOs and CFOs have tolerated a “black box” level of opacity in healthcare spend that they’d never accept in any other part of the business. Now, as costs escalate by 10-15% or more, that tolerance is beginning to evaporate. Many executives feel forced to pull the only lever they know: cutting benefits programs. This is a short-term fix with long-term consequences for talent retention. To avoid slashing benefits, companies need to stop guessing and start strategizing.

For brokers, this is a critical moment in time. Steep renewals are a recipe for a client retention crisis. Brokers need tools and insights to navigate budget meetings and strategy sessions with confidence and data. That’s why we launched our Benefits Intelligence Brief. 

We’re moving brokers and their clients from “looking back” at historical claims data to “looking forward” at strategy. This is a distinct advantage of the Benefits OS. Because we ingest and centralize plan data, we can use AI to analyze client benefit guides, generating prescriptive, actionable intelligence that identifies exactly where a strategy is working and where there’s room for optimization.

Resources like this give HR teams the ammunition they need to defend budget decisions and pinpoint the areas where employees are struggling, ensuring every dollar spent delivers maximum value.

A Final Word 

2025 has been an exciting year. Technology has finally caught up to our mission. We now have the AI architecture to execute what we set out to do when HealthJoy was founded. 

To help our clients and broker partners navigate these shifting sands—from the operationalization of AI to the affordability crisis—we aren’t just observing the market, we’re evolving with it. 

2026 is about activating those tools at scale to build a clearer, fairer, and ultimately more affordable healthcare future for our members. I look forward to continuing this journey with you.