Health Plan Operations in 2026: Navigating Regulatory Pressure & Workforce Constraints
As health plans move into 2026, increasing regulatory pressure, workforce shortages, Medicaid uncertainty, and operational complexity are reshaping the managed care landscape. Health plan leaders must maintain compliance, operational stability, and member satisfaction—while adapting to constant change.
This webinar explores practical strategies for strengthening health plan operations, improving regulatory compliance readiness and implementing flexible staffing models to support long-term resilience.
Key Operational Challenges Facing Health Plans
During this session, Trillium and Toney Healthcare addressed critical operational priorities, including:
Platform transitions and system implementations
Prior authorization regulatory updates and workflow impact
Behavioral health integration requirements
Medicaid policy shifts and funding uncertainty
Workforce shortages and staffing flexibility strategies
Maintaining CMS and state regulatory compliance
Attendees gained actionable insights into how health plans can proactively manage operational risk while improving efficiency and performance.
Strategies for Resilient Managed Care Operations
To succeed in today’s healthcare environment, health plans must:
Implement flexible, scalable staffing models
Strengthen cross-functional operational planning
Build strategic partnerships to support surge capacity
Ensure regulatory readiness and audit preparedness
Align behavioral health integration with compliance frameworks
Operational resilience requires more than short-term fixes—it demands forward-looking strategy and execution.
SPEAKERS
Michael Smith, MD, Chief Medical Officer, Trillium Health Resources
Christie Edwards, COO, Trillium Health Resources
Erin Montgomery, President, Toney Healthcare
How Toney Healthcare Supports Health Plan Success
Toney Healthcare partners with Medicare Advantage, Medicaid, and managed care organizations to provide:
Interim leadership and operational staffing support
Compliance and regulatory readiness consulting
Prior authorization process optimization
Support during platform transitions and system implementations
Behavioral health integration operational guidance
Medicaid operational strategy and execution support
Our team brings deep expertise in health plan operations, managed care compliance and regulatory strategy, helping organizations stay compliant, efficient and adaptable in a rapidly evolving environment.
Connect With Us
If your organization is navigating regulatory change, staffing challenges, Medicaid uncertainty, or operational transformation, we’re ready to help.
Let’s discuss how Toney Healthcare can support your health plan operations strategy in 2026 and beyond.
Toney Healthcare’s team of experts is ready to help you address your utilization, care and behavioral health resource needs with plug-and-play health management services and expertise so you get the help you need, fast—and without HR headaches.