Tendo’s top 5 healthcare predictions for 2026: what’s to come for hospitals, health plans, and patients.

The future of healthcare in 2026 isn’t a slow, steady evolution—it’s a site-of-care, AI-fueled revolution against inefficiency. For health systems, payers, and patients, the old rules are dissolving, replaced by a new blueprint focused on the trinity of value: Cost, Quality, and Convenience. Let’s dive in.

1. The Hospital System Becomes the Ambulatory System

The hospital is no longer the center of the universe—it’s now the high-acuity backup plan. Fueled by CMS’s phase-out of the inpatient-only list starting in 2026 (making complex procedures billable in outpatient settings), major systems are turning their defensive strategies into an aggressive offense plan going forward.

• The Big Shift: Large health systems (such as Tenet, HCA, and Optum) are diversifying their footprint by pouring capital into Ambulatory Surgery Centers (ASCs), imaging centers, rehab, and mobile-to-the-home-based services. The recent acquisition moves—like Ascension buying Amsurg, SCA consolidating with US Digestive, HSS & Legend’s new ASC platform, and ASC newcomers Atlas Health Partners and Compass Surgical Partners growing their system JVs—are just the beginning.
• The Edge: If you’re still banking on high-margin hospital stays for standard surgeries, your revenue model is already dissolving. Posterior arthrodesis spine fusion? Get it at the ASC. Chemotherapy Infusion? The oncology nurse is making a home visit. Efficiency and access are the new profit drivers.

2. Healthcare’s Newest Workforce

AI Agents: Not Using Them May be Considered Malpractice Soon

In 2026, technology portfolio reviews aren’t about adding another app; they’re about maximizing AI leverage. To ignore this shift isn’t just a business mistake—it could soon be considered clinical liability.

• Physician Empowerment: As a patient, you should expect your doctor to be AI-enabled. This means AI is constantly reviewing a patient’s full history, making info overload into actionable gold for physicians. Each diagnosis comes baked-in with scanning for the latest clinical trial matches, and providing a powerful “alternative point of view” 2nd opinion safety net for complex diagnoses.
• The Clinician’s Agent: Every provider, from the MD to the nurse to the medical director, will get their own personal, tunable AI wingman. This isn’t just about ambient note generation (which will hit 90%+ adoption by the end of 2026)—it’s about automating discharge planning, personalizing patient follow-ups, and delivering real-time diagnostics in the ED. The radiologists did it first; now it’s coming for every service line.
• Friction reducer: Clear payment reimbursement for AI is coming. The AMA’s Clinically Meaningful Algorithmic Analyses (CMAA) framework and CMS New Technology Add-on Payments (NTAP) will solidify and go active in 2026. We may even see reliable pay-for-data models emerge for provider systems as a self-reinforcing improvement and trust mechanism.

3. Information Asymmetry Crumbles: Welcome to Healthcare Commerce with Natural Market Dynamics

The age of secret pricing and opaque quality rankings is over. The price transparency rules for providers and health plans, enforced by the CAA and other laws, are finally bearing fruit, transforming the healthcare market from a confusing labyrinth into a competitive marketplace.

• Leveling the Field: Negotiated prices, costs, and quality options will be used as foundational insights for contracting and navigation. Quality will be measured as procedure-level proficiency and complexity-adjusted outcomes. This is what enables the trinity of value (cost, quality, convenience) to drive new plan designs.
• The AI Navigator: Human navigators can’t keep up, so AI navigation agents will be fed this firehose of cost and quality data to guide members to the best possible care options. Every health plan & ACO will roll out a conversational AI for healthcare discovery & access, turning the engagement into a shoppable consumer experience.

4. Novel Government Programs Lead the Way to Payment for Outcomes

CMS is getting genuinely innovative with its new Health Tech Ecosystem, being more collaborative than ever with the entrepreneurial community. The launch of the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model in 2026 is a massive, tech-forward statement: CMS is going to pay for results, not activity.

• Outcomes, Not Micromanagement: ACCESS introduces a system that pays for measurable results—like a specific reduction in A1C, blood pressure, weight, or pain from a patient’s baseline—offering consistent, predictable payments that reward improvement. Clinicians get the flexibility to use technology-supported care to achieve the result. PCPs get paid a co-management fee for informed referrals and reviews.
• The Ecosystem: The model forces a cleanup of the data landscape, requiring interoperability and a clean national provider directory. It’s the clearest government signal yet: Focus is on the costly, complex care. Tech is the business plan.

• My kids take: The new CMS agenda is Bussin’, they ate, slayed it.

5. Self-Insured Employers Take the Wheel in 2026

Free from the inertia of legacy models, self-insured employers are pioneering the healthcare plan architecture that just makes sense. They hold the purse strings and are financially responsible, and 2026 is when they finally realize how much power they have with this new blueprint.

• Primary care as a membership: this is a high-incentive, membership model centered on robust “quarterback” navigation to manage total cost of care from a trusted “ask me anything” PCP who is empowered to answer with a whole new toolset.
• Specialty care managed as a predictable episode: All the cost and complexity of healthcare is actually in specialty care. Simplified models, such as direct contracts and episode bundles—aligning incentives for efficiency, will be leveraged at scale.
• Unified Rails: Transparent TPAs and PBMs are merging to create one clean claims rail across medical and pharmacy. This clean, transparent, direct model is the blueprint for future health plans as a simplified model of commerce without traditional insurance.

The Takeaway:

There you have it—2026’s healthcare: ambulatory empires, clinician copilots, transparent commerce, outcome obsessions, and employer uprisings. Get smart, get efficient, or get left behind. At Tendo, we’re building some of the tech to make this real and scalable with our Clinical Quality Insights & Healthcare Marketplace.