10 Bold Healthcare Predictions for 2026: AI Doctors, Business Challenges, and Rising Drug Prices | PRIMENEWSNOW

Reflecting on 2025: A Year of Missed Predictions

In 2025, our forecasts fell short. Betting against our predictions might have been wiser. While we still believe some may eventually come true, our success rate was akin to a struggling sports team: just two out of ten.

Successes and Surprises

We accurately predicted the departure of several payor CEOs, including Andrew Witty and Lois Quam, and the resurgence of cell therapy, highlighted by Abbvie’s $2.1 billion acquisition of Capstan. However, we underestimated the persistence of AI solutions in healthcare, which continue to attract investors despite questionable business models. Only one health tech IPO, Hinge, has performed well since its debut. Contrary to our expectations, Medicare Advantage (MA) did not experience a resurgence, and the Centers for Medicare and Medicaid Services (CMS) now projects a decline of 1 million members in 2026.

Corporate Moves and Technological Delays

We were taken aback by HCSC’s costly acquisition of Cigna’s MA portfolio and Illumina’s 40% drop in 2025, despite not being acquired. Additionally, Apple did not introduce glucose monitoring with WatchOS 26, defying our prediction that Big Tech would underperform in healthcare.

Looking Ahead: Predictions for 2026

After a tumultuous year marked by tariffs, public health challenges, and funding cuts, we hope for a more stable 2026. Here are our forecasts:

1. Humana’s Bold Move Backfires

Humana’s aggressive 2026 MA plans could lead to significant membership growth, exceeding 1 million new members. However, rapid expansion may result in substantial financial losses, attracting activist investors demanding change.

2. Employers Abandon Major PBMs

Years of PBM oversight have revealed their knack for creating fees and maintaining margins. We anticipate large employers will finally seek alternatives, which have proven cost-effective and reliable, making the switch worthwhile.

3. AI Billing Codes Introduced

The Trump Administration’s enthusiasm for AI in healthcare could lead CMS to establish billing codes for AI applications. This move may spur innovation but also increase fraud. The impact of AI on healthcare costs remains uncertain, as it could either optimize or inflate expenses.

4. Resurgence of Measles

The dismantling of the CDC and relaxed vaccine regulations in some states may lead to multiple measles outbreaks. As vaccination rates decline, this highly contagious disease could make a strong comeback.

5. AI Agents: A Double-Edged Sword

AI agents, known for their rule-following nature, may lead to inefficiencies as they interact without compromise. While they could automate many tasks, the lack of shared rules among payors and providers might result in increased human intervention and longer call times.

6. Affordable Cell and Gene Therapies

Advancements in science and manufacturing are expected to significantly reduce the cost of cell and gene therapies, making them more accessible. We anticipate seeing the first signs of this progress in 2026.

7. Drug Prices Continue to Rise

Despite promises to lower drug prices, we expect costs for employers and commercially insured patients to rise in 2026. The challenge will be managing the broader eligibility of GLP-1s and encouraging lifestyle changes to sustain health improvements.

8. Political Landscape Shifts

In a surprising turn, Republicans may retain control of the House and expand their majority, driven by a strong AI-fueled economy and successful conflict resolutions in Israel and Ukraine.

9. Inflation and Interest Rates

We predict inflation will remain high in 2026, with corporations passing costs to consumers. Consequently, interest rates may stay elevated as the Fed counters the administration’s policies.

10. AI in Healthcare: A Mixed Bag

AI’s ability to deliver clinical care is impressive, but we doubt AI-native services will thrive as standalone businesses. Instead, they will enhance broader healthcare organizations, improving access and reducing costs.

Bonus Predictions

We foresee Judy Faulkner selling Epic to Microsoft, driven by antitrust concerns and her age. Additionally, we remain hopeful that Apple will successfully implement glucose monitoring, offering significant public health benefits.

We look forward to revisiting these predictions next year and wish everyone a joyful holiday season and a healthy new year.

The views expressed in this article are those of the author and do not necessarily reflect the opinions of Fortune.