As financial pressure, policy uncertainty, and technology disruption converge, IDNs are rapidly reshaping their operational, pharmacy, and care delivery strategies in 2026. HIRC's report, Integrated Delivery Networks: Market Landscape and Strategic Imperatives, provides a market overview of IDNs/systems, including recent market activity, the top trends driving IDN strategy, the status of IDN risk-bearing activities, and more. The following questions are addressed:

• What is the latest news & market activity in the IDN/health system segment?
• What is the status of merger & acquisition activity, including private equity investment in health care and trends in physician employment (independent vs. systems)?
• Which market trends are driving IDN decision-making and overall strategy?
• What are IDN decision-makers' most urgent strategic imperatives to address as they adjust to a complex and dynamic market landscape?
• What is the status of IDN/systems' risk-bearing activities, such as health system-owned health plans, direct-to-employer contracts, and participation in government and commercial value-based payment model programs?
• What is the scope of IDNs' home health, pharmacy, and alternate site infusion capabilities? What is the status of IDN/health system-owned specialty pharmacies?

Key Finding: With margin pressure intensifying, IDNs in 2026 are prioritizing cost reduction, operational efficiency, AI-enabled automation, and ambulatory expansion to preserve financial stability and improve care delivery.

IDNs Increasingly Identify Legislation & Policy, Technology/AI, and the Future of 340B as Top Disruptive Trends. Most top of mind for IDN business leaders for a second year in a row is the legislation and policy environment, particularly the Inflation Reduction Act and Medicaid cuts, as well as the policy issues that can impact reimbursement, such as site neutrality and 340B reform. IDNs also increasingly mention the growing use of technology and artificial intelligence (AI) in health care.

The full report provides the complete listing of most impactful market trends and a deep dive into the top trends identified by panelists.

Total Cost of Care Remains a Top Driver of IDN Leadership Decision-Making. IDNs’ top strategic imperatives in 2026 include reducing the total cost of care and enhancing technology capabilities/automation/AI, followed by three additional key priorities. The simultaneous pursuit of cost reduction, technology adoption, operational efficiency, and ambulatory expansion suggest a key underlying goal: do more with less as financial headwinds intensify.

The complete listing of IDNs' strategic imperatives are examined in the full report as well as results of in-depth follow-up interviews with IDN leaders on these topics.

Comprehensive View of the IDNs/Systems Market Environment. From IRA pricing reforms and 340B uncertainty to AI adoption and site-neutral payment pressure, IDNs are navigating a highly disruptive market environment. This comprehensive resource explores how health systems are responding to ongoing market, policy, and competitive pressures with a close examination of evolving health system strategy, including value-based care, specialty pharmacy expansion, direct-to-employer contracting, technology, and more.

Why does this matter to manufacturers? As IDNs navigate increasing financial and operational strain, manufacturers that align with health system priorities around efficiency, access, and total cost of care will be better positioned to build strategic partnerships.

Research Methodology and Report Availability. In December and January, HIRC surveyed 50 IDN senior leaders and pharmacy and medical directors. In-depth secondary research, online surveys, and follow-up telephone interviews were used to gather information. The full report, Integrated Delivery Networks: Market Landscape and Strategic Imperatives is part of the Organized Providers Service, and is now available to subscribers at www.hirc.com.