Major transformation may be ahead with regulations, AI and financial pressures driving impact on the industry
COSTA MESA, Calif.: Experian Health today unveiled its predictions for the healthcare industry, a year that will be significantly shaped by new regulations, mounting financial pressures, and the shift from AI awareness to adoption. As the revenue cycle grows increasingly complex, healthcare organizations must look to harness technology to enhance human expertise in 2026.
The following are five predictions that will define the next phase of healthcare in the near term and beyond:
- Challenge of Claim Denials: Claim denials will remain one of the most persistent and costly challenges for healthcare providers in 2026. According to Experian Health’s recent State of Claims survey, more than one-third of providers say that 10 percent or more of claims are denied. That problem won’t go away in the coming year. While AI offers proven results to streamline claims management, adoption remains low, with just 14 percent of respondents using AI to help with claim denials. For large-scale adoption, organizations need confidence in the technology and vendors must ensure transparency and auditability of these technologies without introducing new complexities.
- Regulation Impacts on Patient Experience: Providers will see a significant rise in self-pay patients, creating revenue impacts as changes from the One Big Beautiful Bill Act (OBBBA) begin in 2026 and more broadly go into effect in 2027. The Congressional Budget Office projects the number of uninsured Americans will increase by 10 million by 2034. With regulatory changes in patient coverage, financial operations and administrative processes, providers must focus on optimizing their systems and workflows. Experian Health’s OBBBA survey found many providers aren’t prepared for the new law, with providers saying eligibility (43%) and billing (42%) are the primary areas requiring improvement.
- Evolution of AI: In the next six months, we will see providers rapidly adopt AI to solve their top pain points with the most immediate impact on data accuracy and patient engagement. Experian Health’s new AI survey among providers found the top use cases of AI are:
- 52% for insurance eligibility and benefits verification
- 45% for patient scheduling
- 44% for patient registration
Use cases will focus on specific projects as teams get trained and build up their in-house expertise. Broader scopes and robust implementation of AI may take a few years but there is optimism to leverage the technology at scale as the survey showed that 53% of respondents feel AI will be adopted widely but require oversight, while more than a third say AI will become essential for operational efficiency.
- Industry Shift in Prior Authorizations: A silver lining of 2026, the Interoperability and Prior Authorization Final Rule, taking effect in January, is expected to give providers a seamless, modern and transparent experience. The new rule is expected to transform administrative workflows for providers and payers in scope (e.g., Medicare Advantage organizations, Medicaid & CHIP FFS and managed care, Qualified Health Plans on federally facilitated exchanges). By streamlining prior authorizations, providers expect to reduce administrative burden, speed up access to care for patients and allow them more time for patient care.
- Rural Hospitals at Risk: A recent report shows that up to 700 rural hospitals, along with clinics and nursing homes, could shut down in the coming years. These facilities face mounting financial strain driven by declining patient volumes, rising operational costs, workforce shortages, and shifts toward outpatient and telehealth models. To cope, many may resort to layoffs, reduced investments in quality initiatives, fewer available services, and ultimately, closures. To stay financially solvent in 2026, rural hospitals will need to diversify revenue streams, embrace telehealth and value-based care models, and strengthen partnerships with larger health systems.
“Healthcare enters a pivotal year of regulatory change and accelerated adoption of new technology similar to the digital transformation during the pandemic,” said Jason Considine, President at Experian Health. “AI is proving its value in addressing long-standing issues like claim denials and administrative burdens, but adoption must be built on trust, transparency and accountability. Providers are bracing for the financial and operational effects of new legislation, making it critical to modernize systems thoughtfully to simplify healthcare for all.”
For more information on Experian Health, visit www.experian.com/healthcare.
About Experian Health
At Experian Health, we serve more than 60 percent of U.S. hospitals and more than 7,500 medical practices, labs, pharmacies and other healthcare providers with data-driven platforms and insights that help our clients make smarter business decisions, deliver a better bottom line and establish strong patient relationships.
Experian invests in talented people and new advanced technologies to unlock the power of data and innovate. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 25,100 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.
For more information about Experian Health, visit http://www.experianhealth.com. Learn more about Experian at www.experianplc.com or visit our global content hub at our global news blog for the latest news and insights from the Group.
Fonte: Business Wire