Key Considerations for Planning Your 2026 Strategy

2026 presents healthcare leaders with a landscape shaped by payment volatility, technology disruption, regulatory deadlines, and urgent clinical needs. This brief covers key considerations and distills the top strategic imperatives and actionable recommendations for executive teams. The focus is on resilience, compliance, and measurable impact. The underlying theme is the speed of change that the industry is facing. I believe this pace will continue to fuel industry consolidation, causing small to mid-sized providers to fall further behind. If our goal is to stay independent, we must take thoughtful action to avoid this fate.

Key Strategic Imperatives for 2026

1. Dramatic Revenue Shifts

Many changes are occurring that will need to be sorted to limit, to the extent possible, lost revenue.

• Medicaid cuts, redeterminations, loss of enhanced ACA subsidies, and ACA premium increases will dramatically increase uninsured populations.

• Increasing prior authorization rules will affect collection rates.

• Medicare ACO REACH and MSSP updates demand rigorous coding, care coordination, and risk management, potentially reducing revenue opportunities.

  
  

2. Self-Pay Becomes Self-Funding

Providers must prepare to respond to a change in how individuals without insurance or those who are underinsured view their situation. These consumers are better informed than in the past and are becoming skilled negotiators. Many health technology innovators are capitalizing on this opportunity, including providing individual self-insurance products, direct-to-consumer networks, or pricing services. This can be an opportunity for providers that see this population as a chance for revenue replacement or growth.

3. Technology & Interoperability

AI is moving from experimentation into mission-critical operations across both payer and provider environments. Changes are coming at such a fast pace that many will struggle to keep up and take advantage of the opportunities to reduce administrative costs and provide better care. Further, while regulations covering health technology, interoperability, and AI may be behind in many ways, new regulations will impact these efforts.

• HTI-1/TEFCA interoperability and HIPAA Security Rule updates.

• FDA AI/ML guidance and the related PCCP framework enable safe, pre-authorized AI model updates.

• HHS Cybersecurity Performance Goals adoption as the standard. Remember, cybersecurity is patient safety!

  
  

4. Clinical & Operational Priorities

We must prioritize execution capacity over new pilots. Scale ambient AI scribes and inbox automation to reduce burnout and reinvest savings in behavioral health staffing. ED boarding times for youth remain high; invest in step-down stabilization, telepsychiatry, and school-based partnerships. Track outcomes by completed care, not just ED visits. Continue efforts to reduce variation in care and disparities between populations.

5. Rural Health Access

Every state has received $200 million, on average, to work on improving rural health access in 2026. We must understand our state’s program, as every state has its own improvement plan, and find a path to get involved. Efforts will likely include care-close-to-home strategies, mobile clinics, telehealth hubs, school partnerships, pharmacist-led care, and data integration.

6. Consumer Experience

Providers have spent enormous resources on improving the consumer experience. Many have used customer engagement as the key metric for measuring success. However, these efforts only track the experience of patients seen in the office. We should consider redefining engagement as closed care gaps, completed visits, and converted referrals.

7. Weather

Extreme weather disruptions are wreaking havoc in many parts of the country. We must ensure our organization is ready with facility resilience plans, toolkits, and HeatRisk protocols for vulnerable populations.

8. Margin Compression Drives Strategic Transformation

Cost pressures continue to intensify as healthcare expenses rise faster than inflation and wages. Leaders face challenges including labor inflation, delayed payer reimbursements, and increasing costs for supplies and operations. Simultaneously, payer organizations report that escalating use of services, demands for higher reimbursement rates, and regulatory demands are placing significant stress on margins. There are no easy fixes; we must do the work to find opportunities.

9. Workforce Sustainability Requires Productivity Redesign

Despite some stabilization, workforce burnout and disengagement persist. Labor remains the largest expense for hospitals, and turnover continues to threaten care continuity. Organizations are increasingly turning to AI-enabled workflows—such as ambient documentation and inbox automation—to reduce clinician burden and improve productivity without compromising care quality. However, it is not clear that reliance on agentic AI will reduce disengagement, so we should continue to look for ways to keep the team mission-focused.

10. Behavioral Health Capacity—Especially Pediatric—Is a Strategic Imperative

Pediatric behavioral health demand continues to outpace supply, causing persistently high emergency department boarding times. Leaders must invest in step-down programs, telepsychiatry, and school-based partnerships to meet growing community needs.

Conclusion

As we navigate the complexities of 2026, we must remain vigilant and proactive. By focusing on these strategic imperatives, we can enhance our resilience and ensure sustainable growth. Together, we can improve patient outcomes and thrive in this evolving landscape.

For more insights on navigating the changing healthcare landscape, visit Wilkerson Strategies.