AI offers a practical productivity lift as US healthcare faces pressure in 2026
The US healthcare market will stay under financial, regulatory, and workforce pressure in 2026. Rising costs, reimbursement pressure, staff shortages, and an ageing population are pushing payers, providers, and pharmacy services hard. Federal policy shifts enacted in 2025, including the One Big Beautiful Bill Act (H.R.1), are expected to alter funding flows and competition across the sector.
Amid all this, McKinsey & Company points to AI as a rare source of optimism and measurable value. "Just as the industrial revolution mechanised muscles and the internet revolution digitised information, the AI revolution is augmenting cognition itself," said Adi Kumar, McKinsey Senior Partner.
Payers: retrenchment, reset, and a productivity mandate
For payers, 2026 looks like a reset year. Expect retrenchment as organisations reweight risk portfolios in response to Medicaid, Medicare, and ACA changes. Regulatory action, demographic shifts, and rising distrust in institutions are colliding with fast-moving technology. Depending on execution, H.R.1 could weaken financials or accelerate productivity gains.
As Kumar put it, there's a real productivity imperative. The winners will translate AI into lower admin cost per member, tighter risk adjustment, and cleaner claims-with governance strong enough to keep regulators comfortable.
Providers: margin compression meets staffing strain
Provider margins remain below pre-pandemic levels. Ageing demographics and reimbursement mix shifts are squeezing revenue, while workforce shortages and burnout continue to bite. "The talent shortage is a real challenge for health systems," said Rupal Malani, McKinsey Senior Partner.
McKinsey estimates ACA and Medicaid disenrollment linked to H.R.1 could reduce margins by around 2.5 percentage points in expansion states. Health systems will need to do more with fewer hands: automate low-value work, protect clinicians' time, and defend access.
Health services and tech: AI demand and capital picking up
Health services and technology companies are set to benefit from demand for AI-enabled, end-to-end solutions. The OBBBA may create headwinds for providers but tailwinds for tech firms that can drive cost savings or revenue uplift, according to Neil Rao, McKinsey Senior Partner.
Private capital activity is expected to rebound after a tough stretch. "It's been a challenging few years… but I think we've turned a corner," said Prashanth Reddy, McKinsey Senior Partner.
Pharmacy: fewer counters, tougher competition
Pharmacy services face store closures, pricing reform, and heightened regulatory scrutiny. Adam Apfel, McKinsey Senior Partner, expects the number of US pharmacy counters to drop materially over the next 12-24 months.
That contraction will reshape access, fulfillment options, and pricing dynamics. Expect more pressure on in-store volume and continued growth in mail and home delivery.
A practical playbook for healthcare leaders
1) Focus on 3-5 AI use cases with fast ROI
- Automate prior authorization and utilization management to cut cycle times and burden.
- Deploy ambient clinical documentation to reduce note time and burnout.
- Tighten revenue cycle: coding assistance, denials prediction, claim edits, underpayment recovery.
- Improve access and capacity: demand forecasting, smart scheduling, referral management, no-show reduction.
- For payers: claims triage, fraud/waste/abuse detection, and member outreach personalization.
2) Build a lean data and model stack
- Integrate with the EHR and claims systems; standardize with FHIR where possible.
- Stand up quality pipelines, audit trails, and model monitoring (accuracy, drift, safety).
- Choose the right build/partner mix: in-house for strategic IP, vendors for speed and compliance.
3) Protect patients, staff, and the balance sheet
- Guardrails: PHI privacy, security, fairness testing, human-in-the-loop for clinical decisions.
- Validate models against clinical guidelines; track error rates and escalate exceptions.
- Run scenario tests for H.R.1 impacts: payer mix, disenrollment, contract rates, and service line exposure.
4) Rebalance the workforce
- Upskill teams to work with AI tools; redesign roles to reduce low-value clicks and handoffs.
- Use schedule optimization and virtual command centers to ease burnout and improve throughput.
- Measure the human impact: time saved per encounter, RN overtime, and turnover intent.
5) Operate by the numbers
- Track weekly: LOS, readmissions, denial rate, days in A/R, appointment lead time, no-shows, time-to-fill, Rx turnaround.
- Tie each AI use case to a value dashboard with owners, baselines, and targets.
- Stage-gate deployments: pilot, validate, expand-no big-bang rollouts without proof.
Signals to watch in 2026
- CMS and state moves tied to H.R.1 and reimbursement updates.
- Pharmacy footprint contraction and growth of home delivery and clinic-based models.
- Ambient documentation adoption at health-system scale.
- Capital flowing into AI-first service models and revenue cycle platforms.
Bottom line
Pressure isn't easing, but productivity is within reach. The systems that act now-pick clear use cases, protect patients, and measure value-will earn cost advantage and better experiences for clinicians and patients.
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