Pulse of the Purchaser 2026

From our partner organization the National Alliance of Healthcare Purchaser Coalitions.

Every year the National Alliance asks employers what they are doing about healthcare costs, benefits, and quality. The 2026 Pulse of the Purchaser survey gathered responses from 408 employers, fielded in May and June 2026, representing 37 coalitions and roughly 3.7 million covered lives.

This year’s headline for mental health: the foundations are in place, and accountability is next. Six in ten employers now integrate behavioral health into primary care, and the employers who can see their own claims data are the ones taking action.

Key Findings from the 2026 Pulse of the Purchaser Survey

Topic	Key Findings
Cost pressure	Employers expect an average 7.7% cost increase before plan changes; one in three expect 9% or more. Hospital and facility costs are the largest share of spending at 30.5%.
Data access drives action	Employers with complete claims-data access use 11.9 high-value strategies on average, against 7.9 without. All 26 strategies measured were more common among employers who could see their claims. About one in three still lack complete claim-level access.
Mental health foundations	79% monitor mental health parity compliance; 80% actively communicate available benefits; 74% run stigma and bias education.
Integration	61% integrate behavioral health into primary care, with another 27% considering it — 88% in total.
Vendor accountability	55% hold mental health vendors to performance metrics; 28% are considering it.
Early detection	68% use enhanced screening or early detection to manage high-cost claims; 25% more are considering it. Advanced primary care rose from 18% in 2023 to 37%.
Women’s health	59% offer mental health support specific to women, up from 43% in 2024. Menopause support nearly tripled since 2023, from 16% to 42%.
Prior authorization	85% say prior authorization is necessary; 51% say it burdens their people; 55% are considering at least one change.
Policy	Employer policy engagement rose from 42.5% to 51.3%. 87.6% support PBM reform; 84.6% support hospital price transparency.

Turning Visibility Into Value

The survey makes one point plainly: employers are not short of intent. They are short of actionable information. Where they can see the data, they act.

For Path Forward’s work with purchasers, three findings stand out:

• Collaborative Care is becoming a purchasing standard. With 88% of employers integrating behavioral health into primary care or considering it, the third payer at the table is moving the same way as Medicare and Medicaid.
• Measurement-informed care is what accountability looks like. 83% of employers have or want performance metrics for their mental health vendors. Contracts have to ask for outcomes.
• Claims transparency is the precondition. Employers cannot judge outcomes they never see. Path Forward supports every purchaser requiring clear, transparent access to claims data from mental health and substance use vendors.

The call to action is simple: make Collaborative Care a covered benefit in every plan, write measurement into every mental health contract, and give employers the same claim-level view of mental health they already have for medical care.