Healthcare leaders tout confidence, admit uncertainty for 2026

Many of the executives leading hospitals and health plans are expressing seemingly contradictory sentiments about their prospects for 2026.

A Deloitte survey of 120 C-suite executives captures mixed emotions about the outlook for the year ahead.

On one side, most executives say they feel good about the prospects of their organizations in the coming year. More than two-thirds of those surveyed said they are confident their organizations will perform better than their competitors in the coming year.

But the survey also reveals persistent uncertainty about the healthcare industry, driven by changes in regulations and federal policies.

In this year’s survey, 43% of respondents said they are uncertain or neutral about the industry’s prospects. That’s a sharp increase from a year ago, when only 28% expressed uncertainty.

Alicia Janisch, vice chair and U.S. health care sector leader at Deloitte, tells Chief Healthcare Executive® that healthcare leaders are bracing for a year of unpredictability.

“The health plans and providers may feel like they're playing a game where the goalposts keep moving, the field might shift, and even the rules change mid-game,” Janisch says. “So it's not an easy environment to be in.”

Four out of five healthcare leaders (80%) said the regulatory and policy changes in the coming year represent their top strategic priority.

(See part of our conversation with Alicia Janisch in this video. The story continues below.)

‘A lot of uncertainty’

Healthcare leaders have been grappling with the pending expiration of tax credits for the Affordable Care Act, which help Americans buy coverage. The credits are slated to expire at the end of the month, and legislative remedies to preserve them have fallen short. Analysts expect millions of Americans to drop coverage because they can’t afford higher premiums, which are projected to more than double.

In addition, hospitals and other providers are anxious about federal approval for telehealth programs. Medicare waivers for telehealth programs are slated to expire Jan. 30, when a short-term government funding bill expires. Health systems have been pushing for permanent reforms, or at least multi-year extensions, and those calls grew louder after the government shutdown disrupted telehealth programs.

“Are those going to become permanent? Are those going to roll back? And what's it going to look like for other providers? So a lot of a lot of uncertainty that organizations are dealing with,” Janisch says.

The federal government is also weighing possible changes in Medicare reimbursements for outpatient procedures, which could be costly to hospitals. The government has been proposing to pay the same rate for outpatient services, whether they are delivered in a hospital or an ambulatory surgery center or some other outpatient facility.

“Reimbursement models are changing quickly,” Janisch says, adding to complexity in strategic planning.

Skepticism with AI

Many health systems and health plans are investing in AI capabilities to streamline operations, but some are being more tentative, the Deloitte survey found.

About half (49%) of respondents say they are experimenting with generative AI and agentic AI, but 18% say that they haven’t adopted those tools yet. And only one-third of the survey’s participants said they were operating AI at scale.

“I think in any new technology, especially, there's always people that are a little skeptical about what could be, versus what is,” Janisch says.

But she says AI-powered documentation tools are helping to reduce some of that skepticism. Ambient listening tools are gaining popularity with health systems, as they quickly summarize patient encounters and reduce documentation time for physicians.

Health systems and health plans should adopt an “AI mindset,” whether it's providing a better experience for patients or members, Janisch says.

Health systems that are weighing AI solutions need to get input from doctors and nurses about the use of those tools and how they fit into workflows, she suggests.

“One thing we really stress is that clinicians are part of those decisions,” she says.

She recalls visiting a health system and talking with a chief information officer about AI. The CIO brings visitors to a nearby hall with hospital beds and challenges those bringing AI solutions to prove that they work at the bedside, help patients and improve the clinician experience.

“I think that's a very important viewpoint to not lose sight of going forward,” she says.

More chief financial officers are also saying they want to apply more AI technology to revenue cycle management, Janisch says.

Health systems that can utilize AI to help improve efficiency, perhaps by reducing administrative work on staff, may find themselves better equipped to deal with the uncertainty in the year ahead, she says.

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Forge partnerships

Health systems and health plans should look at building new partnerships to bolster their organizations, particularly in an uncertain environment.

Janisch says they should look at finding partnerships with entities outside the world of health care.

Health plans could be working with grocers to address nutrition programs to help people stay healthy, she suggests. Hospitals and health plans could work with ride share organizations to make sure people can get to appointments.

Janisch also sees value in working with community organizations to help people get better access to care.

“I think bringing together organizations from outside health care will really spark innovation and lead to critical and creative solutions that really are going to bring a healthier future,” she says.

Healthcare leaders are placing a premium on developing strategies to plan for the future, with some looking ahead to the next five years.

But leaders are also trying to navigate ever-changing shifts in federal policy as well.

“We are hearing more long-term planning, but again, it's done under this umbrella of uncertainty … because of the regulatory uncertainty going on,” she says.