2026 Healthcare Trends and Predictions

2025 has been another whirlwind year for healthcare. Between the new Administration upending the apple care, the explosion of AI, and the continued march of GLP-1s, the landscape has shifted under our feet.

Will things settle down in 2026 or become even more volatile? Hosts David E. Williams and John Driscoll join CareTalk to share their predictions for 2026, discussing how AI will evolve, why affordability will dominate the conversation, what may change in drug pricing and value-based care, and how policy decisions could ripple across the healthcare system.w

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CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (Chairman, UConn Health) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy. 

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Transcript

David : 0:00

2025 has been yet another whirlwind year in healthcare. In between the new administration upending the apple cart, the explosion of AI and the continued march of GLP ones, the landscape has shifted under our feet. So will things settle down in 2026 or will they become even more volatile? Welcome to Care Talk, America's home for incisive debate about healthcare, business and policy. I'm David Williams, president of Health Business Group.

John: 0:32

And I'm John Driscoll, the chairman of Yukon Health.

David : 0:36

So John, we're reaching the end of yet another year of Care Talk. And I have to say, uh, with the whirlwind and all, it's been as rewarding as ever. I wanna personally thank everyone in our audience for devoting. Portion of your week to us for all the comments that you've shared. And, uh, I'll say, you know, keep it coming. Keep those comments coming.

John: 0:55

It's, it's sort of wild. We almost hit 500,000 streams this year. Maybe we will before the end of the year, but north of 475,000 streams, a, a growing audience across all demographics. We really appreciate you and so we will continue to deliver for you and thanks for listening.

David : 1:11

Great. So I hope everyone has a great holiday season, uh, and has a chance to catch their breath because we're gonna have some exciting episodes in 2026. And I think, John, these predictions are also a way of setting out a little bit the roadmap, uh, for what we're going to be discussing next year. So this is our predictions issue for 2026 and let's dive into it. Yeah, let's drum roll please, or Thank you. So David.

John: 1:37

What's gonna happen with AI and healthcare in 2026?

David : 1:43

So I guess you could say it's like the good, the bad, and the dangerous. There's some pretty cool stuff that's gonna happen. So I think you're gonna see health systems getting their act together and having some concrete efficiency gains from coding, documentation, triage, kind of administrative stuff. But I also think that you could have some kind of an event hard to predict exactly what. That actually leads to some action. You know, some people are denied care by ai. That shouldn't have been. Uh, so the, some of the anger I think may shift from, from prior authorization, um, over there. And, uh, yeah, some real workforce disruption, I think too.

John: 2:17

I, I think sort of three things. I think the good AI is more efficient, the bad. We don't always know what AI is doing, so you could also have see someone getting care they don't need or care that actually could hurt them. Um, and I don't think we've really delved built enough of an AI safety regime, but there's no question that AI is being used by everyone. So you could also see insurance companies and providers kind of fighting over bills to a, uh, to, to, to the middle. It could likely be the, the World War I equivalent of trench warfare as. Payers and providers are, are deploying bot against bot. But, but Dave, the, the, the, the big, the big key word today, um, across the economy and the politics of the moment is affordability. And nothing is, is more central, certainly to the political dialogue, is the affordability of healthcare, particularly the extension of the Obama and Biden care. Subsidies. What's, what do you think is gonna happen to affordability of healthcare in 2026?

David : 3:20

Well, John, I think that's exactly right. You know, ai, number one, that's the number one thing people are talking about, but affordability is really central. And when you talk about affordability, it really is healthcare. I mean, how many eggs can you eat? You know, the cost of eggs, even if it went way up, it is not gonna rival what happens here. You're not

John: 3:35

watching enough tick of TikTok, weightlifting videos. There's you actually, you can, you can eat a lot of eggs, but let's stay focused on healthcare.

David : 3:42

So I think that you know where it's gonna start, uh, toward the end of 2025 and into 2026 is about these subsidies that are expiring and a lot of anger being expressed at health plans. Hey, I can't afford my health insurance, but John, to really tackle affordability and I'd like to predict that this will happen, it's actually gonna be much more encompassing than just what are people on the Obamacare exchanges paying in terms of subsidies or not. It's gotta be hospitals, it's gotta be drugs. Doctors, utilization, lifestyle administration, the whole, the whole ball of wax, John.

John: 4:17

Whole kahuna. No, I, I think that's right. I think if the, the affordability conversation in for healthcare in 2026 will rapidly expand beyond the conversation about subsidies in Congress, because what we're seeing in healthcare trends are increased costs for hospitals than docs. You know, a, a worst case mix, uh, index, which say people are showing up into the hospital later and sicker. And you're also gonna see those higher costs translated into higher premiums for everyone. And the Republicans really have to get their arms around a solution here because the, the, I think the net result of the government shutdown about healthcare articulated by the Democrats has got Republicans carrying the blame for healthcare costs. And while they're currently just talking about the subsidies, I think that's gonna flame out and be an issue for all of us because when you look at the predictions on employer. Healthcare costs, they're going up, which means the average covered consumer in a, in a, with a family of four, their premiums are going up and they're gonna be up going up to a level that, that, that no one's ever seen before. And so I think affordability is gonna go from, from a government issue to kind of an, you know, a total country issue. And I, I don't actually know. How we're gonna solve that in the context of no actual movement towards bipartisan reform. And it's certainly not really, you know, gonna be helped much by a few drugs here and an HSA contribution there. So, David, while we're thinking about drugs,

David : 5:55

can we, can we go back for a sec,

John: 5:56

John? Sure.

David : 5:57

Because I wanna, I actually think maybe what we can do. Uh, maybe this is something we can really try our best on care talk to, bring out some of the other areas. So let me, let me focus on a couple of areas of cost Sure. That are underdressed and, and maybe partly the solution. So. There's a lot of anger right now at health insurers, and that's from both Democrats and Republicans. Right. And I think it's a little disingenuous, uh, for the Republicans to be, you know, yelling at the health insurers for what they're doing. So, I mean, we have a system in this country, including with Medicare Advantage, by the way, which is, includes private insurers. That was part of Obamacare, really, because Republicans wanted it. We don't have a public option. We don't have your universal care. We don't have government. Paid care. So we gotta figure out actually how to work with the health plans and not just use them as a scapegoat. The other one is if you look at the provider system, and in some cases, you know, like the insurers are trying to hold the line on costs, but there's a lot of expectation of higher. Of higher rates from the providers. And so some of the focus also needs to be on maybe some of the large hospitals and health systems that are also expensive. We're not just gonna solve this by pointing at one thing and certainly not from a partisan standpoint. So, John, if we can try, I predict that we are going to do a good job of explaining how the whole system works and maybe encouraging people to work together, uh, to have affordability. That's the only way it's gonna happen.

John: 7:22

I, I predict we can come up with the solutions and it won't happen except perhaps at a state level given the dysfunction in Congress is what I predict

David : 7:31

in 26. So, let's talk about drugs. John, I know you wanna talk about, I know you wanna talk about number three about drugs. Well, I,

John: 7:35

I, I, I think, I think that drugs are an area which is a bipartisan, there's bipartisan anger and support for doing something about it. I mean, to be, to give is due the most favored nation. Uh, pricing where he is, you know, reducing the cost of things like GLP ones to what Europeans are paying. He's, he is making progress and they are, when you listen to the specific administrator and, uh, the leaders of Medicare and Medicaid, they're proud and they want to extend, not just the voluntary. Intention to reduce costs, but turn that into more deals. Like the deals they, they've cut with Pfizer and Novo and others to get access to branded drugs at a lower price, um, direct and, and, and, and for those covered under government benefits. So I actually think that you're gonna see some relief at the margin, um, on drug costs. What do you think?

David : 8:36

Well, I do think that the idea of negotiating drug prices is a good one, and that one of the mechanisms for doing that is, uh, what may be, it was called the Inflation Reduction Act. Maybe it should be rebranded as the Affordability Act that was signed by President Biden and, uh, ridiculed and not voted on, uh, by not, not favored by any Republicans. And that's, that is one of the tools that Trump is using too, to negotiate, uh, drug prices. So I think we're gonna see an impact of that. And maybe there's a nice bipartisan element, uh, to build on that now on GLP ones. I think what we're gonna see is something interesting, which is you've got, um, these drugs have actually. Caused health plans to say, Hey, I'm losing money 'cause I'm paying for all these expensive drugs. So there's a lot of restricted coverage, but at the same time they are, they work efficacious. Yeah, they work. And so it seems ridiculous, efficacious.

John: 9:22

Can you use like normal human words?

David : 9:25

They work. I could effortlessly use them, John. And so I think it's an opportunity though to have some outcomes based contracts, coordination of care, holistic approach that brings all the pieces together and actually, uh, deliver on some of the promises that the drugs. Actually have. So I think you're gonna see a lot, uh, a lot of that happening.

John: 9:45

You, you're, it's gonna be really interesting to see what happens in the drug channel to the PBM legislation. There has been a not lot of bipartisan movement to somehow restrict or reregulate reregulate in a meaningful way. The pharmacy benefit managers, I don't know whether that's gonna happen in. 2026. But if you're looking to blame groups, yeah. The groups that are more likely to attract blame are the ones with the worst public profile now to be insurance companies and PBMs. PBMs have historically done a really nice job at bringing down cost trend in many, many areas, but just the black box way in which they've operated, you know, draws a lot of concern. And obviously they've been the the target. Of large pharma. And the other thing I think that's gonna be interesting, and I think we'll expand in 2026, is a direct relationship between large pharmaceutical companies and consumers. You're seeing that with the GLP ones. I suspect that more and more of pharma's desire to, to go direct to consumers, we'll continue and expand and logically that should disintermediate and lower the cost of getting access to drugs for folks who need them.

David : 10:54

It's weird, John, that, uh, telehealth seems to evolved a a lot into basically, you know, tell a drug telepharmacy call and get your prescription for this, that, or the other. I'm not sure that's something that we foresaw and I don't know whether it is foresaw too big of a word, John, that we, that we saw in the past and pointed out. Um, I don't, you can use

John: 11:11

that.

David : 11:12

I don't know, um, whether I should foreswear my use of big words, but. It's weird how the telehealth has evolved in that direction. Do you see some sort of a, of a change in that and becoming broader and less drug focused?

John: 11:25

No, I think you're, I think I, I predict you're gonna see more, uh, telepharmacy and telehealth. I mean, Dave, there, the telehealth solved a, a, a critical moment in time of no access, but it also showed that convenience and access really matter. And then of course, there's na naturally reversion back to. The system post the, the COVID crisis. But the reality is people still need convenient access to care and you can have a direct relationship and an absent. I mean there, there are obviously some abuses around pill mills on the internet and people who are pushing a DD drugs or other kinds of drugs, and you're still seeing that a lot through social media. But you, the country built a muscle on how to connect directly to consumers who needed access. And I actually think. Rural transformation grants. A lot of the, uh, which is the federal government's attempt, we should probably do an episode on that to wire, uh, the rural areas. I mean, it's gonna be $50 billion invested in rural areas. A lot of that is gonna be spent towards wiring and connecting, you know, the, you, you've gotta use the rails that already exist and, and telehealth is one of the most important ones. So I, I, I'd watch that and I would expect it to expand. The biggest problem still with drugs is, is, is, is, is access and pricing and tele telepharmacy obviously solves the access problem. David, speaking of access problems, access to healthcare, jobs, what do you predict is going to happen in immigration in 2026? I mean, historically, um, before the, don't send us your huddled masses approach of the current administration immigration. Was one of the greatest sources of bringing in medical talent, doctors, nurses, allied health professionals, to alleviate the fact that we're not producing as many doctors as nurses as we need. What happens in 2026 as the burden of docs and nurses retiring starts to hit in a major way? The lack of access, which is helping drive up costs turns into a burning issue. Do you see any changes in immigration in 2026?

David : 13:33

Well, John, so this is for our prediction number four, and I say immigration is a healthcare issue, but my prediction is it's gonna be seen as a healthcare issue and felt as a healthcare issue in 2026. Now, what do I mean about that? So one is that you've got people that are being thrown out of coverage and that's gonna strain the safety net. You know, we just did a conversation, we just had a, an episode with Scott Seidman from NUM Rx. They serve the federally qualified health centers. A lot of those patients are actually gonna be thrown off. Medicaid for immigration related reasons, they're legal immigrants, but there's, they're tightening the ability for them, uh, to be there. And so I think for some of these health centers and, and particularly actually in urban areas, immigration's gonna be their top unfunded mandate. They've gotta take care of people who are immigrants, but that are no longer covered and therefore no longer paid for when you take away coverage from that patient. Where the actual effect shows up is in the providers that have to treat them anyway. So that's gonna be a big one. And then another, uh, source John, is not just not letting people in the country, but actually taking people's immigration status away. So another example there is you have some communities that have protected status, uh, hate Haitians being a good example. Many Haitians working here, you know, in Boston, uh, who are legal immigrants under temporary protective status. And they work, uh, as nurses. It's AIDS a lot in home healthcare and they're losing that status and there's no easy way. Uh, to, to replace them. And this is gonna, basically, you're gonna have healthcare affordability is gonna run headlong into the immigration's tightening and the, uh, and the ice arrest. So I think immigration, big deal. So, so it's really, it's, it's really a

John: 15:08

problem on both sides. We're restricting access of talent and we're reducing care of people who need to be covered. I mean, that's just gonna put more pressure on the system. So immigration is the healthcare issue perhaps, that people aren't really thinking about. For 2026. So da David, what about value-based care? Is it dead? Is it going anywhere? Is it still a thing? It's been value-based care, uh, care where insurance companies and the feds and states are actually asking people to manage chronic care in a budget has had a rough couple of years.

David : 15:39

Yeah. Well, it hasn't been deported though. Uh, so that's a, that's a positive. So it's done better, you know, on a relative basis. But I think, John, that the, the signs are pointing in the direction of value-based care, actually making a comeback or an, or maybe, you know, value-based care, 2.0, 3.0, whatever happening. And the clearest sign of that is a CMS. Access program, which to my understanding is likely to be the most consequential model of value-based care since the accountable care organizations. And that's because they're supposed to be, uh, simpler, more predictable payments, which is gonna make it possible for, so do

John: 16:16

you wanna, do you wanna just step back just unannounced recently, but just Yeah. De describe if you, if you will, exactly what that means, or if you're stuck, I can help you.

David : 16:27

Well, I, you know, I like to give an, an opportunity sometimes for someone to feel good. I don't know that much about it. Uh, my understanding, I mean, I like the name of it. Um, I don't know what the, what the acronym is you average, but yeah, ID like to hear your

John: 16:38

voter. I like the name of it, that it's probably good 'cause doing it. No, the average, I like to consider

David : 16:43

myself, I like to consider myself a, a above average, but go ahead.

John: 16:47

So, so the, um, well remains to be seen, um, the. The ACCESS program is a newly announced program by the federal government. The federal government pays for 51 cents out of every healthcare dollar. It's Medicare and Medicaid, and it's the first time they have put out a performance based payment program, the details of which are still coming out, where if you do a better job leveraging data and intervening with people who suffer from chronic disease, things like. Heart disease and diabetes, and you can show it through the data that you're actually doing a better job, you will get paid more. And so what the, the federal government and this administration, I think is really investing in the best of managed care, where they wouldn't call it that way value-based care to create value by actually making sure that docs, nurses and allied professionals intervene with folks who got long-term chronic or sometimes poly chronic disease in a way that. Changes the arc of their illness so they don't stay sick and get sicker. But based on metrics actually are doing better than the average or better than they, than than would be expected. And the federal government's gonna pay for that. Uh, we, we can go into those details in other issue, but it's a very exciting program 'cause it's the first time that this kind of pay for performance has been, has been part of the. Fee for service, not the traditional managed care or bundled programs that are typically run by the private sector. This is one where the federal government will actually create incentives for doctors, nurses, and those who are managing folks with really complex diseases to get paid if they do a better job. I think it's terrific.

David : 18:28

John, there's a second part of the value-based care story for 2026, which I think may compliment what's happening from CMS, and that's looking at digital and AI based models may gain some momentum. I've been reading some interesting thoughts on this topic. So a lot of what we do in medicine is, is very, very reactive. Usually, you know, wait for a patient to have. Pain or concern that they bring themself into the office and then, you know, maybe they get a referral, uh, somewhere and that's still gonna happen. But with AI and more engagement through digital models, maybe possible to kind of get upstream of that a bit. And goose. Mm-hmm. Things that are more preventive or. Prevention of, uh, things from going downhill and having, for example, providers who are specialists, getting the right patients in their office as opposed to those that are sort of lower acuity or in the wrong place. So I see some opportunity here and I think the two could go hand in hand and dare I say it, maybe for 20, 27 even become synergistic.

John: 19:24

Well, we will see. But those are our predictions for 2026, David. It's, it's been a terrific year.

David : 19:31

It really has John, despite, uh, everything, uh, it's been, it's been fun and I'm looking forward to seeing you, uh, in early 2026 at the JP Morgan Healthcare Conference. And I hope we'll be able to do some stuff, uh, together, uh, remotely, but also in person, uh, in the coming year. We will, we're gonna see,

John: 19:47

we'll, that, that, that is, that is the, that's our prediction for 2026 and again, we, we, we tha thank our audience and we look forward to any comments and thoughts on our predictions as we navigate. Another really interesting year. Year in 2026. Happy holidays, everybody. Well,

David : 20:04

happy holidays. I'm David Williams, health Business Group President.

John: 20:09

And I'm John Driscoll, the chairman of Yukon Health. If you liked what you heard or you didn't, we'd love you to subscribe on your favorite service.