Healthcare Predictions 2026: Market Shifts That Will Define the Industry
For 2026, we predict four significant developments in healthcare: provider data regulations will require new compliance standards, health plans will make consumer experience a top strategic priority to win new members, AI investments will need to demonstrate clear return on investment, and digital health companies will see accelerated growth driven by enterprise adoption.
Together, these shifts will reward organizations that can deliver measurable improvements in outcomes, member satisfaction, and operational efficiency.
Regulators Raise the Bar on Provider Data
New regulations are significantly tightening requirements for provider data accuracy and management. CMS rules effective July 2025 are raising the bar on accuracy, update frequency, and required data elements for health plan directories. At the same time, global privacy and data-access laws are raising expectations on how healthcare data is governed, shared, and kept interoperable.
"Regulators are taking provider data seriously and pushing the industry to collaborate to solve this long-running problem. We’re seeing this with the work that CMS is doing on a national provider directory and their push for incorporating accuracy standards when evaluating network adequacy and quality."
CMS’s development of a global provider directory and its push for enhanced data adequacy standards represent a major shift in regulatory focus. Health plans and large health systems will need to invest in enterprise-wide provider data management systems with real-time accuracy and comprehensive data to meet these compliance requirements.
The regulatory environment is making provider data governance a critical compliance requirement. Organizations that establish robust provider data systems now will avoid the scramble to meet new compliance standards while competitors face potential penalties and compliance risks. Health plans with superior provider data accuracy will also have operational advantages in network quality and adequacy, member satisfaction, and regulatory compliance that directly enable them to enter new markets. Clean provider data will also become a prerequisite for safe AI deployment, powering accurate routing, referral management, and network steering models.
Health Plans Prioritize Consumer Preferences
Health plans will make consumer experience a top strategic priority in 2026 to win new members in an increasingly competitive market. As consumers become more demanding and willing to switch plans based on digital experience and service quality, member preferences will become the primary battleground for plan growth.
The stakes are high. 45% of members report the inability to self-serve as one of the biggest hurdles to satisfaction. At the same time, 65% of consumers express a preference for health plans that use AI to create more personalized experiences. Health plans that fail to meet these expectations will lose ground to competitors who can deliver on consumer expectations.
Health plans will respond by investing in member-facing digital capabilities that mirror consumer expectations set by retail and technology companies. Leading payers will prioritize self-service portals, mobile apps with transparent cost and coverage information, and simplified member journeys from plan selection through care access. AI-powered tools that direct members to high-quality, in-network providers, identify gaps in care, and deliver personalized health recommendations will move from pilot to production, with early adopters seeing significant improvements in member satisfaction.
The competitive advantage is clear. Health plans that deliver superior digital experiences will differentiate themselves during open enrollment periods and employer contract renewals. Better member experience translates directly to stronger word-of-mouth referrals, higher broker recommendations, and improved Net Promoter Scores that influence plan selection. Health plans with consumer-grade digital capabilities will also achieve lower acquisition costs, reduced administrative overhead from fewer customer service calls, and improved Star Ratings that drive Medicare Advantage enrollment. In 2026, the ability to attract and retain members through a superior consumer experience will set growing health plans apart from those losing market share.
AI Meets Return-on-Investment Reality
Healthcare organizations are transitioning from AI experimentation to demanding measurable business results. Health systems and health plans that deployed AI solutions throughout 2025 are now requiring concrete evidence of operational and financial impact.
This shift is already underway. Healthcare organizations are asking vendors to prove specific outcomes rather than sell on potential capabilities. Health systems want documented reductions in documentation time, improved coding accuracy, and measurable gains in staff productivity. Health plans are demanding faster prior authorization processing, more accurate risk adjustment, and reduced administrative costs.
"Companies that have been piloting and trying out AI are going to start demanding hard ROI and demonstrated value both for patients and for the bottom line. They’re going to start to treat AI as any other kind of technology and ask: Does it help me achieve my mission? Does it save my organization money? Does it unlock new revenue streams?"
Healthcare organizations positioned to succeed in 2026 are those treating AI as standard business technology, with defined success metrics, clear timelines, and measurable return-on-investment requirements.
Digital Health Growth Hits New Heights
Digital health companies are positioned for a breakthrough year in 2026, driven by widespread AI adoption among enterprise customers. Health systems, health plans, and employers are actively deploying and scaling AI in their operations, documentation, and care navigation – creating strong demand for digital health solutions that can integrate with and enhance these AI strategies.
Enterprise buyers now have dedicated budget lines and strategic plans for AI-enabled tools, moving beyond one-off pilots. Digital health funding has stabilized and is ticking back up, with AI-enabled companies capturing the majority of investment dollars. The types of solutions getting funded – workflow automation, virtual care navigation, remote monitoring, data infrastructure, and more – align directly with what enterprises are prioritizing.
“Digital health is going to have a boom year because of AI adoption by enterprises like hospital systems, employers, and health plans,” says Maslak. “Digital health companies that focus on delivering outcomes are going to be able to sell faster. There will also be a reckoning for those not delivering value as the market chooses the winners that drive outcomes.” Digital health platforms that embed AI capabilities and can demonstrate measurable improvements in cost, quality, or experience within months, not years, will see accelerated sales cycles and expanded enterprise budgets. Procurement teams are increasingly weighing real‑world evidence – impact on readmissions, time to appointment, no‑show rates, or total cost of care – over feature lists, which creates a clear advantage for outcome‑proven vendors.
Stay ahead of these market shifts with H1’s provider data platform. Request a demo today.
