Healthcare Trends 2026: Key Challenges and Opportunities Shaping the Future
Each year, leading industry analysts help clarify where the healthcare landscape is headed. McKinsey’s 2026 outlook offers one of the clearest views yet into the pressures and opportunities shaping the next chapter of U.S. healthcare. Their analysis shows that “industry EBITDA as a percentage of national health expenditures fell from 11.2 percent in 2019 to 8.9 percent in 2024,” underscoring the financial strain many organizations continue to face.
Building on McKinsey’s findings — and combining them with our own perspective on emerging market dynamics — we’ve identified the trends that will matter most for healthcare leaders preparing for 2026 and beyond.
1. Financial Pressure Deepens Across the Ecosystem
McKinsey highlights a sobering near‑term outlook: payers and providers continue to absorb the bulk of financial pressure, driven by rising utilization, higher pharmacy costs, and shifting enrollment patterns. Medicaid and ACA disenrollment, in particular, are reshaping risk pools and compressing margins.
Yet the report also points to a turning point. After 2027, organizations that take decisive action on pricing, cost management, and portfolio strategy are positioned for stronger performance. We see this as a critical moment for leaders to reassess operating models and invest in long‑term resilience.
2. Payers Face Diverging Paths — With Group Insurance Leading Growth
Payer EBITDA dropped sharply in 2024, falling from $61 billion to $29 billion. Much of this decline stems from higher claims costs and coverage losses following the expiration of pandemic‑era protections.
But McKinsey identifies a major bright spot: group commercial insurance is expected to become the largest payer segment by 2029, growing from $9 billion to $27 billion in EBITDA. As the report notes, “about six million” of the nine million people expected to disenroll from Medicaid are already employed — creating a significant opportunity for employer‑sponsored coverage.
Our view: organizations that strengthen employer partnerships and streamline enrollment pathways will be best positioned to capture this shift.
Other payer dynamics to watch:
- Medicare Advantage margins begin recovering in 2026
- ACA plans stabilize after subsidy expirations
- Medicaid faces the steepest decline, with EBITDA potentially reaching –$7B by 2028
3. Providers Navigate an Uneven Recovery
Providers are experiencing a mix of volume recovery and financial strain. While utilization has rebounded, uncompensated care is rising as more individuals lose Medicaid and ACA coverage. McKinsey notes that “EBITDA margins remain below prepandemic levels,” and margins may dip again in 2027.
Acute Care
Hospitals face headwinds from tariffs, subsidy expirations, and potential site‑neutrality policies. Long‑term recovery is expected, but unevenly distributed across markets.
Pre‑Acute Care
Ambulatory surgery centers (ASCs), urgent care, and outpatient services continue to grow as site‑of‑care shifts accelerate. ASCs benefit from newly approved orthopedic and cardiovascular procedures, though margins may tighten slightly.
Post‑Acute Care
Home health and hospice remain among the strongest performers, driven by aging demographics and patient preference for home‑based care. Skilled nursing facilities, however, face stagnant growth and rising labor costs.
Our perspective: organizations that expand home‑based care capabilities and strengthen referral pathways will be better positioned for the next wave of demand.
4. Health Services & Technology (HST) Emerges as the Fastest Growing Segment
HST stands out as the most dynamic part of the healthcare ecosystem. According to McKinsey, “HST is expected to continue as the fastest growing segment in healthcare,” with EBITDA projected to exceed $110 billion by 2029.
Growth is driven by:
- Rapid adoption of generative AI
- Increased outsourcing by payers and providers
- A shift from services to software platforms
- Strong venture capital investment (over $11B annually in 2023–2025)
One of the most striking insights: 85% of healthcare organizations are pursuing gen‑AI initiatives, with ambient medical scribing already adopted by 10% or more of U.S. physicians.
Our take: the organizations that win will be those that integrate AI into core workflows — not just pilot programs — and build governance structures that ensure safe, scalable adoption.
5. Pharmacy Services Undergo Rapid Transformation
Pharmacy services are being reshaped by specialty drugs, GLP‑1 therapies, and new pricing models. Drug spending rose 11% from 2023 to 2024 and is projected to reach $990 billion by 2029.
Key shifts include:
- Growth in ambulatory infusion and hospital specialty pharmacy
- Expansion of cost‑plus and direct‑to‑consumer models
- Heightened competition across the value chain, including 340B dynamics
- Regulatory changes affecting margins and supply chain costs
Our perspective: pharmacy strategy is becoming a core differentiator for payers and providers alike — not a back‑office function.
Conclusion: A Challenging Landscape with Clear Opportunities
McKinsey’s research makes one thing clear: the next few years will require healthcare organizations to rethink traditional models, embrace technology, and strengthen financial discipline. As the report states, “Healthcare leaders must rethink traditional models, improve performance, and embrace technology to remain competitive.”
By combining these insights with our own experience across the healthcare ecosystem, we see 2026 as a pivotal year — one where bold action, strategic investment, and operational innovation will separate the organizations that thrive from those that struggle to keep pace.
Source: McKinsey & Company, What to Expect in US Healthcare in 2026 and Beyond, January 2026.
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