As we peer into the healthcare horizon of 2026, a singular theme crystallizes among industry leaders: the transition from aspirational innovation to operational necessity. The executive predictions for the coming year depict a sector at a critical inflection point, where financial survival dictates that technology must evolve from fragmented point solutions into orchestrated, interoperable ecosystems.
The narrative has shifted from the mere adoption of AI to a rigorous demand for “glass-box” transparency, measurable accuracy over speed, and the seamless integration of legacy and modern infrastructures to thwart escalating cyber threats. Amidst geopolitical supply chain shifts and the crushing weight of administrative burdens, the industry’s mandate is clear: dismantle the silos between payers, providers, and patients to prioritize equity, enforce fiscal discipline, and ensure that digital transformation finally translates into tangible, human-centric care.
Maria Ebro Andreasen, EVP & Chief Strategy Officer, FUJIFILM Biotechnologies
Continued shift from global supply chain to local
Geopolitical shifts heightened by the evolving U.S. tariff policy will be a defining force in 2026, accelerating the move to local‑for‑local biopharma supply. Innovators are reassessing global footprints to reduce exposure to supply chain interruptions, prioritizing regional manufacturing and distribution.
Building on lessons from COVID-19, outsourcing strategies are tilting toward dual sourcing and onshoring. While some innovators are expanding internal capacity, others are partnering with CDMOs, which can offer flexible footprints, rapid scale‑up, mirrored processes across sites, and shared‑risk commercial models.
Dr. Colin Banas, Chief Medical Officer at DrFirst
“Watch for platforms that connect prescribers, pharmacies, payers, and patients in one coordinated process instead of today’s disconnected handoffs and constant back and forth. Our prescription orchestration platform, for example, shows prior authorization requirements right in the EHR during prescribing and enables stakeholder alignment without phone tag. For practices dealing with value-based care pressures and Medicare reimbursement cuts, technology that eliminates non-billable administrative work means more time for patient care and fewer barriers to medication access.”
Amanda Barefoot, Head, Global Health Care & Life Sciences Strategic Advisory at SAS
Augmented intelligence unlocks the next era of rural care. AI will become the main driver of rural health access as virtual agents handle triage, care navigation and ongoing monitoring. Hybrid care teams will use AI tools that enhance human decision making by interpreting diagnostics, highlighting risks and guiding clinicians to the best next step. Value-based programs will shift toward predictive, AI-informed population management, while community resources such as transportation, food access and maternal support will be coordinated by intelligent agents that match services to patient needs at scale.
Frederik Brabant, Chief Strategy and Medical Officer at Corti
Accuracy, not speed, will become the measure of value
“In 2026, the most valuable AI will be the kind that makes clinicians more accurate, not just faster. The focus will shift from automation to augmentation: surfacing overlooked details, highlighting risks earlier, and providing structured reasoning that clinicians can trust and audit. AI will earn its place in the workflow not by being impressive, but by helping clinicians avoid the errors that are most harmful to patients.”
Peter Bridges, Chief Strategy and Growth Officer, AccessHope
“In 2026, employers can’t treat cancer benefits as a static line item. Cancer is affecting younger employees, treatments are more complex, and costs are rising faster than any other condition. The opportunity now is to move from reactive coverage to intentional benefit design that ensures every employee receives the right diagnosis, the right expertise, and the right treatment plan from day one.
“This approach reduces delays, avoids duplicative testing, and prevents the fragmented care that has become far too common and costly. Strengthening navigation, expanding access to second opinions from National Cancer Institute-designated Comprehensive Cancer Centers, updating screening strategies for today’s workforce, and supporting survivors as they return to work are no longer optional. These steps form the foundation of a cancer strategy that protects your employees and your plan.”
Robert Connely, Global Market Leader for Healthcare at Pega
Personalized Healthcare Becomes a Reality
AI that has evolved to drive marketing engagement will make personalized care more than just a buzzword in 2026. The ability to engage consumers across channels and time is needed to support healthcare consumers. Using AI to engage individuals based on a more frequent basis enables the effect of a digital care navigator that can identify a change or need and trigger other AI agents to act on the event. This is key to proactive care. The ability of AI to extend the capacity and reach payer care management teams is one of the greatest value opportunities that impact cost of care, leading to better outcomes, healthier communities, and a system that finally treats patients like individuals, not case numbers.
Anthony Cusimano, Solutions Director at Object First
Healthcare will face a high volume of cyberattacks in 2026. In both education and healthcare, one of the greatest cybersecurity vulnerabilities lies in the challenge of integrating legacy systems with modern digital infrastructure. These sectors often operate on a patchwork of technologies, such as mainframes for patient records or student information systems, SaaS platforms for scheduling or learning management, and custom-built tools for diagnostics or administrative tasks that rarely interoperate. This lack of integration creates security silos, inconsistent authentication and logging, and fragmented backup protocols, all of which increase the attack surface.
Compounding the issue, many institutions still rely on outdated tape backups or under-tested cloud appliances, leading to slow recovery times and compliance risks. As these sectors modernize, the inability to securely bridge old and new systems without introducing complexity or gaps in protection will come to a head in 2026, creating a major cybersecurity concern that bad actors will undoubtedly exploit.
David Everson, Senior Director of Solutions Marketing at Laserfiche
Federal investments will spark a wave of ECM adoption, reshaping rural healthcare operations: In 2026, rural healthcare organizations will face both pressure and opportunity to modernize as the $50 billion Rural Health Fund takes effect. With limited budgets and IT resources, these providers will increasingly adopt enterprise content management (ECM) solutions to close the long-standing technology gap with larger health systems.
By embracing ECM, these providers can automate records management, strengthen compliance, and enable secure data sharing across care networks, which are critical steps toward bridging the technology gap that has long separated rural health systems from their larger counterparts. Over the next year, expect to see a surge in ECM adoption across rural healthcare as organizations prepare to capitalize on federal funding. The result will be leaner, more digitally connected operations that improve patient information management, accelerate remote care delivery, and ensure financial stability through better billing transparency and regulatory compliance.
Mindy Fortson, Chief Operating Officer at Experian Health
“Operational efficiency isn’t just a goal for 2026, it’s a requirement for survival. Providers who leverage technology to simplify operations, streamline administrative burdens, optimize workflows, and improve patient access will drive patient-centered outcomes. This next year, providers need to focus on giving staff the technology, support, and insights they need to provide a better patient experience.”
“In the new year, regulatory pressures, like the sweeping provisions in the One Big Beautiful Bill Act, will intensify for providers. According to our new OBBBA survey, most providers aren’t ready for the changes, with nearly half saying their eligibility and billing processes will require upgrading. With an influx of self-pay patients expected, providers must prepare for delays or rejections of reimbursements and other operational headaches that impact the overall patient experience. To overcome these challenges, providers must pivot from reactive problem-solving to proactive workflow optimizations with advanced technology.”
Mark Gregory, Head of Pharmacy at Pleio
“We’re watching three powerful forces reshape pharmacy at once: DTC disruption pulling patients away from the counter, government expectations for cost reduction and preventive care elevating the need for proven clinical value, and a loneliness epidemic quietly driving non-adherence and worsening chronic disease.
Together, these forces are creating a moment where pharmacists must—and can—step into a more clearly defined clinical role. As the medication journey splinters across retail, mail order, telehealth, and digital platforms, no single entity is truly accountable for coordinating it.
Pharmacists are uniquely suited to fill that void, providing the comprehensive oversight, behavioral support, and human connection patients are increasingly struggling to find elsewhere. 2026 is the year pharmacists move from the periphery to the center of patient outcomes.”
Uwe Geuss, CTO of Retarus
“With Medicare and Medicaid cuts on the horizon, healthcare providers will need to reduce overall operational costs in the coming year to offset lost revenue – and modernizing legacy communications systems is the key.
We will see providers increasingly leaning on cloud-based solutions to create a foundation for scalable growth in a volatile market despite tighter margins. For example, by replacing outdated fax infrastructure with cloud fax, organizations are faced with less errors, downtime, and lost documents during critical communication processes, freeing their staff from administrative burdens to allow for more effort towards efficient patient care.
To continue delivering measurable results amid changing qualifications for Medicare/Medicaid, providers will make the shift to new, more efficient workflows in 2026.”
Andrea Greco, SVP of Healthcare Safety, CENTEGIX
Hospitals Will Shift from RTLS to Trust-First Safety Solutions
In 2026, I believe we’ll see brick-and-mortar healthcare organizations shift away from surveillance-style staff safety technologies, like RTLS. Driven by the need to halt staffing shortages and boost engagement, the focus will shift to employee-centric solutions that prioritize caregiver empowerment and autonomy over privacy-compromising tracking. Safety must feel like support, not surveillance, for investment effectiveness.
Sachin K. Gupta, Founder and Global CEO, IKS Health
Value-based care vs. fee-for-service
A few years ago it felt like fee-for-service medicine was waning, and that the holy grail would be value-based care with global capitation. Today people are more pragmatic and have recognized that fee-for-service and value-based care are going to coexist for the foreseeable future.
Within value-based care, one of the unexpected benefits of CMS-HCC V28 is that it places a cap on how much organizations can rely on risk-score optimization to drive premiums. While it may feel like a financial hurdle today, it will ultimately force the industry to invest in true total cost of care management infrastructure, the kind that improves patient outcomes while reducing overall cost of care.
I believe this shift will allow value-based care to finally come into its own, with physicians truly operating as the quarterbacks of care delivery, especially for patients with chronic disease. And while there is considerable skepticism about the future of value-based care, this moment of adversity is likely to spark the innovation needed for the model to reach its full potential. At the same time, fee-for-service medicine isn’t going away; these two models will continue to coexist for the foreseeable future.
Kristin Hall, Vice President, Clinical Services, Castlight Health
“If I could give employers one piece of advice for 2026, it’s this: Don’t assume your workforce fits a single social narrative. Nearly 60% of U.S. adults face at least one unmet social need, and many are navigating safety concerns or mental health challenges that directly influence whether they can even use the benefits available to them. Until we address those upstream barriers, the rest of the benefits strategy won’t matter. In 2026, lead with equity, not assumptions, and build your approach around the realities employees are living every day.”
Carley Hamann, VP Client Success, Vera Whole Health
“The market has reached a breaking point. Employers have been overwhelmed by point solution overload for years, and the collapse of the point solution era is finally here. Standalone tools that do not tie directly into primary care create noise, not results, and employers are finished paying for that. In 2026 the only solutions that will survive are those that act as one coordinated ecosystem, strengthening the member’s path into real care and connecting navigation, primary care, behavioral health and specialty access in a single unified experience.”
Cathy Hartman, Chief Healthcare Solutions Officer at Paradigm
“As we look ahead to 2026, AI has the potential to become another source of digital inequity that exacerbates health disparities. The stakes are higher than ever – for example, surgery decisions are among the most complex and costly choices members face, and low health literacy often leads to unnecessary procedures and poorer outcomes. Empowered members, who understand their options and actively participate in shared decision-making, are more likely to avoid inappropriate surgeries, follow pre- and post-op instructions, and recover faster. As payers continue to feel the regulatory and provider pressures around legacy UM tactics like prior authorization, the introduction of solutions that directly impact health literacy and drive collaboration with providers continue to gain attention.”
Frank Harvey, Chief Executive Officer at Surescripts
“Prior authorizations are notoriously challenging – especially when they impact a patient’s ability to access needed treatments. I predict that in 2026, we will see prior authorization become less of a pain point as more prescribers adopt automated prior authorization technologies, leading to faster approvals—22-seconds or less—and patients having one less barrier to accessing their prescription therapy without delay.”
Jared Kaplan, co-founder & CEO of Indigo
The True “Second Wave” of Insurtech Will Begin
“Insurtech 2.0 will be defined by actual operating leverage, not valuations fueled by cheap capital. The first wave of Insurtech, which emerged a decade ago, scaled on the back of zero-interest-rate capital and a promise — but not the reality — of superior underwriting. Growth masked underwriting flaws, and when capital tightened, many players stalled. In 2026, the increased adoption of AI will finally allow insurers and MGAs to deliver real underwriting lift—not via “tech branding,” but through measurable accuracy in pricing, faster adjudication, and continuous risk scoring, all while allowing underwriting to scale faster than ever before. This will accelerate growth in a way that’s profitable, as reinsurers will demand proof of performance, not theoretical models.”
Dr. Sean Kelly, Chief Medical Officer and SVP of Customer Strategy, Imprivata
This year, clinician burnout reached its breaking point, driven by inefficient workflows that add unnecessary friction and distract from patient care. Looking ahead, we’ll see healthcare solutions shift from a burden to an invisible care enabler. When thoughtfully designed and securely implemented, these solutions will fade into the background, empowering clinicians to focus on what matters most: caring for patients.
At the heart of this transformation are identity-centric, passwordless access models and mobile-first workflows that enhance security while simplifying the clinician experience. By tying access to each user’s digital identity through biometrics and passkeys on shared mobile devices, clinicians can seamlessly transition between systems and patients without delays while compliance and protection happen in the background. The result is a future where clinicians won’t think about technology at all—they’ll just use it, naturally and effortlessly, to connect with patients, deliver care, and save lives.
Oliver Kharraz, Founder and CEO, Zocdoc
A Financial Reckoning Is Coming for Hospitals and Health Systems
In 2026, hospitals and health systems will be forced to confront growing financial strain as Medicaid policy shifts widen the gap between reimbursement rates and the true cost of care. With uncompensated care on the rise, many systems will face mounting losses; to address this, they must move quickly to diversify their patient panels, strengthen their payor mix, and expand access. This is not just a growth strategy; it is a financial imperative to preserve care for all patients, regardless of insurance. No margin, no mission.
As financial pressure increases, systems will grapple with an internal bottleneck of their own making: the accumulation of software, decision trees, and workflow customization that promised to increase provider efficiency but has actually strangled provider access and throughput. The result? Highly paid clinical resources underutilized and operational inefficiency baked into care delivery. In 2026, hospitals will need to dismantle this throughput bottleneck and re-optimize efficient use of their most valuable asset — a provider’s time — or risk letting margins erode past the point of recovery.
Melvin Lai, Senior Venture Associate, Silicon Foundry
As we move into 2026, healthcare is poised for a major upswing in M&A activity. Valuations remain compressed, but the deeper catalyst is strategic: health companies are increasingly using acquisitions to leapfrog the slow, costly process of selling into health systems. In a sector where partnerships and integrations often take years, M&A has become the fastest path to scale, data access, and workflow integration.
Dr. James Lu, co-founder and CEO of Helix
Representation in genomic datasets will shift from an aspirational goal to an operational requirement
Traditionally, participants in genomic research have largely been of European descent, creating a problem where polygenic risk scores and variant classification algorithms trained on Eurocentric data perform poorly or produce errors in other populations. As awareness grows around these performance gaps, payers and health systems will increasingly look for evidence that genomic tools reliably serve diverse patient populations. Organizations that have invested in research across diverse populations will find themselves well-positioned, while those that have not will deal with costly catch-up efforts. The genomics leaders of 2026 will be distinguished not by the size of their datasets but by their ability to translate diverse genomic data into clinical tools that work equitably across all communities.
Scott Lundstrom, Senior Healthcare Industry Strategist, OpenText
Patients Take Control of Their Data Journey
After years of breaches and opaque practices, patients now expect transparency about how their data is used. In 2026, leading healthcare organizations will treat data visibility and consent as central to the care experience, showing who accesses their records and why. Privacy-preserving technologies like federated learning will let patients contribute to innovation without losing control. The systems that empower patients to co-own their healthcare data will set a new standard for trust and loyalty.
Michael Meucci, President & CEO at Arcadia
Payer prediction
Payers are heading into 2026 under intensifying pressure. Medical cost trend remains elevated, competition is accelerating, and both payers and providers are rapidly deploying AI across payment integrity, coding, and revenue workflows. The challenge isn’t whether AI will matter because it will. The challenge is separating what AI can fix from what it cannot. AI alone is not going to solve anyone’s trend problem. It will help, but it’s not a silver bullet. What payers truly need is transformation: better networks, aligned incentives, and a shift in strategy that connects AI to measurable performance.
As I look ahead to 2026, the real advantage will go to organizations that invest in strong data foundations, understand the operational realities of AI, and navigate payer–provider dynamics with more sophistication. Flashy tools won’t define next year’s winners. Disciplined execution will.
Provider prediction
Providers will enter 2026 at a real turning point. Competitive pressure from consumer-first entrants, shifting value-based care models, and rapid advances in AI are reshaping expectations across the industry. This next phase won’t reward passive adopters of new tools, it will reward the organizations that know how to deploy and operationalize them.
We’re clearly in a reset period. The easy gains in value-based care are behind us, and the gap between average and high-performing organizations is widening. The leaders pulling ahead are the ones that have built the ability to influence medical cost trend through better navigation and stronger prevention.
At the same time, providers are balancing operational constraints with rising competition from consumer-first healthcare models. That makes this moment both a technology challenge and an operational one. 2026 will still feel like part of the “year of AI,” but we’ll be past the early experimentation phase. The real differentiator will be embedding these tools where they can drive meaningful results.
Dr. Marla McLaughlin, Chief Medical Officer, Vera Whole Health
“Biometrics are often positioned as a silver bullet, but they’re really just the first step in a multi-step process. They’re designed to uncover hidden risks in an employee population. But if an employer uncovers that risk — whether it’s abnormal results or even normal results trending in the wrong direction — and doesn’t have a plan to intervene, all they’ve really done is gather data. Without meaningful next steps, biometrics are overhyped.”
“What is becoming essential is primary care. When employees are engaged in high quality primary care, there is a clear evidence-based cost savings. And when efforts to uncover hidden risk, such as biometrics, are paired with whole person primary care that addresses issues early and keeps people from progressing into high-risk chronic disease, the impact grows even stronger. Primary care is no longer just a nice to have. It’s becoming the foundation for an effective, affordable benefits strategy.”
Lisa Moneymaker, Chief Strategy Officer at Medidata
“In 2026, we’ll see a fundamental transformation in how clinical trials are conceived and executed, driven by the unprecedented volume of clinical, operational, and real-world data now available. This expanding data foundation is fueling a new generation of AI-enabled simulation tools that allow sponsors to model trials end to end, test assumptions, forecast bottlenecks, and refine design parameters with data-driven precision before a single patient is enrolled. This proactive approach will reduce costly amendments, accelerate timelines, and dramatically improve success rates. The ability to simulate before starting will redefine how the industry manages risk, turning clinical development into a predictive, insight-led discipline rather than a reactive process. Ultimately, this shift will allow organizations to bring therapies to market faster and with greater confidence in their outcomes.”
Dr. Joseph Nathan, co-founder, president and chief Medical Officer, ForSight Robotics
The next evolution of surgical robotics – actionable data
Similar to Waymo and Tesla’s data-collection focus and the development of advanced technology, the next evolution of surgical robotics will be shaped by data-driven intelligence. As sensors, imaging, and machine learning advance, surgical robotics will move beyond assisting surgeons to become adaptive collaborators that can react in real time. Future systems will fuse different modalities to bring together health records, adaptive procedures, advanced precision and real-time feedback and insights. Like large language models, the quality of training data will remain critical to developing these complex surgical robotics systems.
Dr. Aaron Neinstein, Chief Medical Officer at Notable
In 2026, abundance will become measurable. Systems will move from sampling five charts per provider to reviewing every chart, continuously. Instead of outreach to the top 10% of high-risk patients, outreach will become every patient, in every language, at any time of day.
Christoffer Rosenblad, CEO, XVIVO
Machine perfusion technologies continue to grow as a trusted way to preserve and transport donated organs. With this growth, there will be a greater shift toward partnership-driven models, as OPOs, transplant centers, and industry providers recognize that no one individual can meet all the necessary needs. Further collaboration among health professionals, aviation and ground transport partners, and transplant clinics, will create a more efficient, fair, and transparent system that improves organ recovery, clinical decision making, and patient outcomes.
Scott R. Schell, MD, PhD, MBA, Chief Medical Officer, Cognizant
The frontier is a learning system that unites discovery, delivery, and reimbursement into a single, continuous cycle.
Imagine a discharge workflow that compiles a summary, reconciles medications, verifies payer rules, and produces a clean claim before the patient leaves. Imagine that same data stream feeding real-world evidence studies and refining future treatment protocols.
The goal is not automation for its own sake but an auditable loop where insights travel as quickly as data itself.
Abhinav Shashank, Co-Founder and CEO at Innovaccer
Revenue cycle is going to vanish. Today, we spend roughly $1 trillion on revenue cycle management, money that’s essentially being taken away from actual patient care. The cost structure keeps growing faster than everything else in healthcare, and that has to change.
The reason the revenue cycle is so complicated is that the foundational technology doesn’t allow open communication between systems. If an internet-like infrastructure existed, where payers could seamlessly pull data from providers and providers could easily access payer systems, revenue cycle as a process wouldn’t need to exist.
So, the revenue cycle as an industry will eventually disappear.
Kristina Simmons, Founder, Managing Partner, Overwater Ventures
Women’s health will start to just be a core component of “health
Women are the majority of spenders in healthcare and consumers, yet not enough focus and research has been designed for women. Still today, studies don’t use female mice in early trials alone!
Health will shift to be consumer-centric with women designed at the center. Given the acceleration of bio, sensors, AI, we will see real opportunity for massive impact in women’s health and big companies to be built.
Mike Sitzman, partner at McDermott Will & Schulte
Drug Pricing Pressure & Uncertainty Will Cause Hatch-Waxman/BPCIA Litigation to Plummet
I also believe that in 2026 we will see a decrease in the number of Hatch-Waxman and BPCIA litigation. Since 1984, Brands and Generics have been battling each other in court over bio/pharmaceutical patents with mixed results. And while both parties have become very sophisticated in litigating such patents, there is too much uncertainty about how most cases will come out. Rather than spending millions of dollars to litigate these cases, I predict that there will be more and more pressure on settling these disputes early and often. The FTC has provided some relatively clear guidance on how to settle such cases and the IRA has placed additional pressure on drug pricing. In view of these variables, I believe that the number of Hatch-Waxman and BPCIA cases will drop and that settlements with agreed-upon launch dates will be increase.”
Sundar Subramamian, CEO of Zyter/TruCare
2026 is the Year Health Plans Move From “Black-Box AI” to “Glass-Box Decisions” and Surge Ahead of Providers
Providers jumped out early on AI with single-use-case tools such as ambient listening, medical documentation automation, and point-of-care assistants. Those were important proofs of concept, but they were primarily clinical micro-automations.
2026 is the year health plans pull ahead with population-level, system-level AI that spans claims, prior authorization, care management, risk adjustment, and quality workflows.
That acceleration will also force a major transparency shift. Members, regulators, and providers will expect ‘glass-box AI’ with clear explanations of how care decisions are made, what data informed them, and where humans intervene. Plans will increasingly need to produce explainability reports for key decisions, especially in prior auth and complex claims.
Transparent AI becomes the new compliance standard and the new competitive differentiator.
The health plans that win will be the ones that move from automation to accountability.”
Jim Szyperski, CEO, Acuity Behavioral Health
Sadly, I believe that behavioral healthcare will continue to lag further behind its healthcare peers. Despite the fact that it may well be the most significant healthcare issue of our time, there are no standards or models or ways in which to quantify improvements in care. The degree of variability that exists in clinical care from site to site will continue to inhibit progress in the industry. A great deal of discussion, particularly around AI, but very little action or consensus.
Jordan Taradash, CEO of advanced primary care provider PeopleOne Health
Value-based care will move from vision to survival strategy. With healthcare costs at a breaking point, the current fee-for-service system has become unsustainable for employers. In 2026, value-based care will become less of a “nice-to-have” and more of a critical approach for managing costs and improving outcomes.
Erik Terjesen, Managing Director, Silicon Foundry
“Big Pharma will continue to “buy, rather than build” innovation, aggressively pursuing M&A and in-licensing deals, particularly for biotechs with late-stage or near-commercial assets, to counter major upcoming patent losses.”
Owen Tripp, CEO of Included Health
The Evolution of Navigation
AI, telehealth, and integrated care will continue to reshape healthcare. Those fragmented models that patients have begrudgingly grown accustomed to will finally become obsolete. In 2026, we will see a greater adoption of highly integrated, personalized systems that combine clinical expertise, advocacy, and advanced technology to deliver truly personalized healthcare experiences. All-in-one platforms that guide patients through their entire healthcare journey, whether that’s proactively pointing them toward the care they need when they need it, explaining benefits, or supporting financial and social well-being, will take their place as the central location where care is navigated.
