Hi friend,

In healthcare, it is payers who decide where most money gets spent. Their decisions can shape an entire market, determining which solutions get adopted and which don’t.

Over the last two months, I’ve been speaking to several payers to get their take on the US market, what trends they’re seeing, what their priorities are, and what’s driving their decisions as we move through 2026.

In this week’s edition of The Hemingway Report, we discuss the seven major trends I heard from these conversations.

Note: This report was written in partnership with the One Mind Accelerator and the One Mind Accelerator Payer Council. Many thanks to everyone who spoke to me as part of the research for this article.

Behavioral health costs have been rising rapidly, growing more than 10% YoY for many health plans. With member utilisation still strong, this trend is expected to continue. At payers, the people responsible for behavioral health costs are concerned about this rising cost trend. It’s also now getting attention at the executive level, with several CEOs citing increases in behavioral health costs as a major contributor to overall higher medical spend.

What’s driving this increase? Overall, it’s greater utilisation, but specifically in outpatient spend and in autism care. While payers recognise that this is driven by increased demand for services from their members, their main concern is that these costs are climbing without clear visibility into quality, return and uncertainty around how these costs will change in the future.

However, while BH costs are rising quickly, they are still a small part of total medical spend for payers — usually less than 10%. Cancer, MSK, other chronic diseases and GLP‑1s cost them more and thus command more of their attention - a recent report highlighted that 96% of employers expressed concern about the long-term cost implications of GLP-1s. 

This puts behavioral health providers in a tricky spot. Payers are concerned about the rate at which BH spend is growing. But the burning platform is in other disease areas. That’s where payers are focusing most of their strategic attention and where they are incentivised to adopt innovative solutions. This can make it difficult for BH companies to get attention, especially at the payer executive level.

As a reaction to increasing costs, payers are increasingly looking for ways to ensure members get the “right care” — the right modality, the right amount of care, the right provider for their needs, etc. They are also pushing for more distinct “episodes of care” in an attempt to avoid long-term, continuous usage of services where it may not be needed — especially in areas like outpatient psychotherapy.

Payers are seeing high levels of utilisation and are very interested in better triage and navigation in order to steer patients toward care that better fits their clinical profile, which may mean moving sub-clinical clients out of high-cost treatment. Supporting better triage and delivering lower-cost sub-clinical interventions is a major opportunity for AI and digital players looking to gain traction with payers.