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The year 2026 will be a year of tumult in American healthcare. <\/p>\n
Getty Images<\/p>\n
As December kicks off, the cloudy mist surrounding my crystal ball is beginning to clear. The year 2026 is near on the horizon, and turbulence and fear is foretold for the U.S. healthcare industry. <\/p>\n
This momentous year will be nothing, if not, dramatic. <\/p>\n
There will be winners and losers. Loud villains, quiet heroes and villains masquerading as heroes.<\/p>\n
And underlying it all, a spirit of revolution and change.<\/p>\n
Growing public discontent with rising costs and poor patient experience will fuel legislative activity \u2014 most of which won\u2019t result in much change.<\/p>\n
Clinicians \u2014 frustrated by commoditization \u2014 will strike back with intentionality.<\/p>\n
Artificial intelligence will boom, but it will also bust.<\/p>\n
Would-be healthcare change makers will be frustrated by the intransigence of an industry that must change, but persistently refuses to do so.<\/p>\n
In that regard, 2026 will be a year like any other in U.S. healthcare. But in other key respects it will be profoundly different. <\/p>\n
Here\u2019s how:<\/p>\n
1. Healthcare\u2019s AI Revolution Will Hit Speed Bumps<\/p>\n
U.S. healthcare outpaces nearly every other industry sector in the rate of AI adoption, according to a recent study<\/a> by Menlo Ventures. For good reason, U.S. healthcare is under unprecedented cost pressures, and AI is the latest cure-all being adopted by healthcare executive teams and boards. While AI has shown considerable promise for relatively straightforward uses like ambient dictation, its application in other domains will be more challenged and problematic. Rewards will be slower to materialize than expected. Agentic AI holds significant promise, but legacy operators and processes will be slow to change deeply ingrained process, values and attitudes. AI snake-oil salespeople (fueled by venture capitalists chasing outsized returns) have flooded the zone, a phenomenon that is sure to fuel false starts and threaten the pace and depth of true organizational change in the short-run.<\/p>\n 2. MAHA Goes Mainstream: Alternatives to Traditional Care Will Grow<\/p>\n U.S. Secretary of Health Robert F. Kennedy Jr.\u2019s Make American Health Again movement has refocused U.S. interest in prevention and wellness. The longevity medicine and lifestyle medicine movements will continue to gain traction as Americans keep expressing discontent with a traditional healthcare system that treats ailments rather than prevents them. Companies like Function Health<\/a> that advertise direct-to-consumer laboratory testing and Prenuvo<\/a> that advertise direct-to-consumer radiologic screening studies will grow in prominence. Social media influencers and wanna-be influencers have popularized biohacking and the quantified self combined with meaningful lifestyle modification. These notions will become more mainstream, especially as patients struggle with accessing high-quality traditional primary care and are regressing (evolving?) toward do-it-yourself healthcare. The caution for the American public is the insidious movement to pit traditional American medicine against lifestyle and longevity-oriented approaches rather than seeing them as complements that have their own role and place in the U.S. healthcare ecosystem. <\/p>\n The MAHA movement is tapping into something fundamental in the American psyche \u2014 deep distrust of the U.S. healthcare industry.<\/p>\n Getty Images3. The GLP1 Revolution Will Continue\u2026 With Some Detours<\/p>\n Real world data on GLP1s will fuel even more interest in the class of drugs. It\u2019s hard to think of a modern pharmaceutical analog to these weight-loss medications. There\u2019s not been a drug that has simultaneously had massive clinical impact on patients \u2014 while also gaining outsized visibility on account of celebrity culture. It\u2019s not an exaggeration to say that Eli Lilly and Novo Nordisk have changed the course of human history. Now, with a few years of widespread GLP1 use in play, there will now be an increasing number of real-world studies \u2014 studies and data analyses of patients on these drugs outside of a clinical trial setting \u2014 that will further shape our perspective on these drugs. The risk of these real world studies is that they will identify safety signals that crest more caution around these drugs. The opportunity is the same: real world studies may identify novel clinical indications and sub-populations where there are additional benefits of these drugs not previously contemplated or popularized. And did I mention that anyone can buy these drugs direct through telemedicine companies or pharmaceutical manufacturers? And that the cash price has been falling? And that next-generation GLP1s that are purported to be even more effective are on their way? If it wasn\u2019t interesting enough already \u2014 it\u2019s about to get more so. <\/p>\n 4. Medicare Advantage Will Remain Popular Despite Its Haters<\/p>\n Medicare Advantage is American healthcare\u2019s favorite current punching bag (I know \u2014 I have led Medicare Advantage plans for the last decade). And, yet, the program grows year after year (with the exception of a small expected decline this year). Why? No one wants to say it (especially out-of-touch policy elites) but the alternative \u2014 traditional Medicare \u2014 has become a program that is exclusively feasible for rich seniors. For everyone else, Medicare Advantage, with lower out-of-pocket costs and more generous coverage is the only option. Does Medicare Advantage have its flaws? You bet. But the alternative \u2014 traditional Medicare with a Part D plan and supplement \u2014 is priced far outside of what is reasonable (roughly $1000\/month or $12,000\/year) for most senior couples living with an average annual income in the low $50,000s. If Congress is ever able to fix traditional Medicare by making coverage more generous and covering a broader array of services, would I take my ball and go home? You bet I would. Until then, Medicare Advantage is an important part of the U.S. social safety net that should be improved in its own right. <\/p>\n U.S. Rep. Ro Khanna is among U.S. lawmakers who are critical of Medicare Advantage. <\/p>\n Getty Images5. Patient And Clinician Discontent Will Boil Over <\/p>\n Patient discontent will boil over (more than it already has). Medical debt and bankruptcy. Surprise billing. Insurance denials with Byzantine appeal processes. Soaring medical premiums and drug costs. Patients have never felt more (justifiably) abused by U.S. healthcare, and they just aren\u2019t going to take it anymore. And, yet, patients aren\u2019t alone. Healthcare professionals are inflamed by flattening wages, corporatization and its downstream effects, and the insidious effects of labor arbitrage (remember when giving part of your job away to someone else felt like a good idea? What about your whole job!). The work of leading in healthcare will be managing patient discontent and leading a disenchanted workforce through change and transformation. Rebuilding trust with patients and reinvigorating a tired healthcare workforce isn\u2019t for the faint of heart. The challenge for healthcare leaders who are used to leading incrementally will be in making big bets that will feel more like evolution and revolution. Look for a few bold leaders to take some big swings. And others to sit on the sidelines perpetually blaming the \u201cbroken system\u201d (hint: if you\u2019re not busy fixing it or reflecting on your own part in the dysfunction, you\u2019re part of the problem). <\/p>\n 6. The Small Guys Will Continue To Lose<\/p>\n National and regional plans \u2014 including state-based Blue Cross Blue Shield plans \u2014 have faced massive losses on account of mispricing, changes to reimbursement and higher than anticipated medical utilization. Reserves of these plans are declining significantly and several health plans have been sold or consolidated as a result. Earlier this year, Massachusetts\u2019 Commonwealth Care Alliance became part of CareSource. Minnesota\u2019s UCARE, for years a proud Medicaid and Medicare health plans, was shut down and became part of Medica. Independent Health recently joined forces with MVP Health. There were will be more such transactions in 2026 among both health plans and hospitals as scale becomes increasingly critical to survival. In the David vs. Goliath battle for the soul of American healthcare, Goliath is winning as David limps along trying to find a way forward.<\/p>\n Minnesota\u2019s UCare, once a proud not-for-profit health plan, is no longer.<\/p>\n UCG\/Universal Images Group via Getty Images7. Digital Health IPOs Will Continue Apace \u2014 And Transaction Volume Will Ramp<\/p>\n The year 2025 was the return of the digital health IPO with Hinge Health and Omada Health making their debut in the public markets (disclosure: I have been on the board of Omada Health since 2024). The year 2026 will bring more such transactions as venture capital investors seek liquidity and the public markets have shown a reasonable appetite for them. Alongside these IPOs will be other transactions as startups attempt to avoid the growing digital health graveyard. Companies that have run their course will find themselves in face-saving merger activity with great proclamations of success despite insider knowledge to the contrary. It\u2019s a jungle out there, and not everyone will survive.<\/p>\n 8. Pharma Pricing and PBMs Will Remain In The Cross-Hairs<\/p>\n Every few years, pharmaceutical prices raise public ire before fading into the background, only to return again (Epipen anyone?). The year 2026 will be a year of peak antagonism toward the pharmaceutical industry. Mistrust for COVID-19 vaccinations, a change in public health messaging and Mark Cuban\u2019s anti-pharma, anti-PBM messaging has elevated antagonism toward all things pharma \u2014 not to mention the rise of the president\u2019s new drug negotiation platform, TrumpRX. The pharmaceutical industry and adjacent industries like PBMs will need to think long and hard about how they show up in this time of public scrutiny and ire. Those who closely follow the industry know it is producing innovations that have meaningfully bent the arc of human health. As always, the question is \u2014 at what price? And how will that price be paid?<\/p>\n A board displays prescription drug price discounts to be available at TrumpRx.gov.<\/p>\n Getty Images9. Lots Of Legislative Activity, But Little Action<\/p>\n There are countless healthcare bills circulating around Congress today along with the perpetual presidential promise of a new healthcare solution. Lots of good intentions abound, but I think we forget sometimes how hard it was to pass the Affordable Care Act (it was only 40 years in the making) and how contentious and divisive even the most simple and common-sense policy fixes are. Look for 2026 to be a year of many proposals, lots of legislative bark and very little bite. Not even the surging health insurance premiums on the exchanges will change that. Most changes in health care will come from attempts at regulatory fixes from CMS Administrator Dr. Mehmet Oz and others in the executive branch \u2014 though we could see a few modest, milquetoast bills make it through the halls of Congress. Any change to health care is politically radioactive for even the most seasoned politicians \u2014 and as such it\u2019s always a good bet that little will happen despite lots of desire for bigger change.<\/p>\n 10. Health Equity Makes A Modest Comeback<\/p>\n Last year, I made the prediction that health equity would be erased from the public imagination. And I was right. Chief health equity officers disappeared overnight. Health equity initiatives vanished. The lingo and the parlance pivoted completely. And, yet, the problems represented by health equity did not vanish. They persist. And so I believe that efforts to address the needs of specific, high-needs population will make a comeback. Not just because it\u2019s the right thing to do, but because in the right settings, it\u2019s actually good business. We may use different words, but health equity and work to address inequity will make a resurgence. And where it doesn\u2019t? Shame on those corporate leaders for whom it was just a momentarily hustle. Values were rented, not bought. We see you. <\/p>\n Doctors like New York\u2019s Dr. Ramon Tallaj, founder and chairman of SOMOS Community Care, are focused on health equity and care for low-income populations \u2014 even if the words have been stripped from public dialogue.<\/p>\n Copyright 2022 The Associated Press. All rights reserved.A Closing Note From The Fortune Teller\/Author<\/p>\n This last October, I met a board-certified oracle at a Halloween party who told me that I had a strong sense of clairvoyance. <\/p>\n It was not the first time such a claim has been made. <\/p>\n