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.
Provider Data Accuracy and Network Strategy: What Health Plan Executives Need to Know for 2026
Catch the conversation with Steve Levin and Scott Westover as they share their expert insights into emerging healthcare trends, regulatory changes, and strategies for success in 2026 and beyond.
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.
“This entire industry is sort of in a pullback. They are under real pressure for profitability,” Levin said. “In many ways, the worst is behind us because we’ve sort of entered this period of restructuring, and so we have a chance now to think about the path forward.”
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.
“The five-star networks were effectively the narrowest in their market,” Levin said. “If you really want to have a high-performing network, where members feel like they’re getting the care they need and the pathways of care work, then narrow is where you want to go.”
That requires smart network design to build an efficient, effectively structured network that remains high-performing and compliant. For example, you might want to keep your network broader in areas like primary care and targeted in higher-cost specialties. But that intentional approach can pay off.
“Better networks can lead to more efficiency and more member satisfaction,” Levin said.
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.
“The data is more complicated now,” Levin said. “And it’s moving very fast.”
Levin compares the U.S. care infrastructure to an ecosystem of living organisms that is in constant flux. According to an analysis conducted by Quest Analytics, provider network composition changes 20-30% in a year, and the composition of providers at locations in network can change 35-60% in a year in any given market.
“The challenge of maintaining a high-performing network is that it’s not a single moment in time,” Levin said. “It’s something that has to be curated over time.”
Central to this ongoing curation is provider data accuracy and ghost providers. “A ghost provider is a provider who is included as part of your network offering, but there is no evidence they’re actually seeing patients,” Westover summarized. Often, this can also be situational, as provider data is contextual.
To address these challenges, healthcare organizations are turning to data-driven strategies and multipronged approaches. Prioritizing high-quality, regularly updated data is essential to minimizing the presence of ghost providers and maintaining the integrity of provider networks.
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.
“The way you reflect your health plan to your members is your health plan,” Westover said. “That’s where I think we’re headed.”
2. More Pressure on Health Plans
“What the federal government is saying is regardless of who’s responsible; health plans are accountable,” Westover said. “Whether it’s fair or not is a totally different discussion, but it does shine a very stark light on the importance of being sure that the data you’re presenting in your provider directories is reflective of the network you’re actually offering to your members — even though some of those details may not be under your control.”
That strong stance is also extending its influence down to state-level regulators. “I think states are very interested in the position taken by the federal government and are saying, ‘You’re right. At the end of the day, the member experience is the most important measure of your network,’” 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. CMS hosts quarterly “Connect A Thons” where health technology leaders can work with peers and share ideas on how to improve the data ecosystem directly with senior leadership at CMS.
“The opportunity to show how we can actually improve our data is more accessible than ever before,” Westover said.
Learn more about the latest health policy updates and trends.
What Role Does AI Play In Provider Network Strategy In 2026?
- 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.
“A network that has data integrity that you can rely on gives us a foundation upon which we can start thinking about the business challenge,” Levin said.
Both Levin and Westover identified one of the most impactful factors driving success in 2026 to be trust. Organizations that focus on trust will increase transparency and build stronger partnerships.
“Trust is the core of healthcare,” Westover said. “And when we talk about the breaks in data, the failures of the system, all of that erodes trust.”
It’s not easy work, but keeping the focus on the member experience — and remembering the humans behind the data — is key.
“The category of innovation that will build trust is aligned incentive, when you realize what we’re all working for is member experience,” Westover said. “And remembering that the member, the patient, the consumer, are all the same person. If you can keep that person in the center of your relationships, I think that’s the best chance to foster trust.”
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. Talk to one of our experts today to learn more.
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